Application Value Of C-arm Computed Tomography Parenchymal Blood Volume(C-arm CT-PBV) Perfusion Imaging In The Evaluation Of Transarterial Chemoembolization Of Hepatocellular Carcinoma

Purpose:Using Gd-EOB-DTPA-enhanced MRI as the standard,the ability of C-arm CT-PBV perfusion imaging and digital subtraction angiography images to detect lesions before embolization of liver cancer and the ability to recognize residual lesions after embolization was compared;at the same time,it was explored before and after embolization.The predictive value of changes in PBV perfusion to the early prognosis of TACE treatment.Materials and methods:A total of 25 cases of HCC patients treated with TACE in our department from July 2019 to March 2020 were selected,and all of them met the clinical or pathological diagnosis of HCC in the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer(2019 Edition)of China.There were 19 males and 6 females.The age range ranged from 36 to 81 years,with an average age of 58.12±12.43 years.According to BCLC classification,4 cases were grade A,9 cases were grade B,and 12 cases were grade C.All patients underwent serological examination(liver function,renal function,ion,tumor marker,blood routine,coagulation routine,etc.),imaging examination(liver MRI plain scan enhancement,chest CT plain scan)before TACE,Exclude patients who do not meet the entry criteria.Before and after TACE,the catheter was placed in the same position as the common hepatic artery for control angiography,And then post-processing the raw data collected at Syngo XWP(Siemens Medical Workstation),And rebuild automatically,Get PBV image.Then compare the PBV image and DSA image before and after embolization,For missing unembolic lesions or unfinished The target lesion of total embolism was supplemented with embolism.The patients were followed up one month after TACE treatment and enhanced liver MRI plain scan,and the m RECIST efficacy was evaluated according to the MRI images before and after treatment.Results:A total of 25 patients were collected,and the success rate of TACE technique was 100%.18 patients developed fever,nausea,vomiting,epigastric pain and other embolic syndrome after surgery.One case had adverse reaction of contrast agent,and all of them improved after symptomatic treatment.No serious complications occurred in any of the patients.According to preoperative MRI images,a total of 43 lesions were included,2 of which were lesions of ectopic origin supplying blood.Among the patients with multiple lesions in the liver,the largest lesion was selected as the research object.Gd-EOB-DTPA-enhanced MRI images before TACE were used as the standard to evaluate the lesion detection ability of DSA and PBV images before embolization.The detection rate of PBV image was 95.34%,and that of DSA image was74.42%.PBV image was significantly better than DSA image(P < 0.05).There was a good consistency between the size of the lesion measured by PBV images and MRI images(rs=0.996,P < 0.001).After embolization,DSA images and PBV images showed a sensitivity of 90% and specificity of 83.87% in the detection of incomplete embolization or residual lesions.The sensitivity and specificity of DSA images were 64.29% and 96.27%respectively.There was also a statistical difference between the two(χ2=15.21,P < 0.05).At postoperative follow-up,patients were grouped according to the Mrecist solid tumor evaluation criteria,and the treatment response was 3/25(12%)for CR patients,7/25(28%)for PR patients,6/25(24%)for SD patients,and 9/25(36%)for PD patients.The distribution of PBV perfusion difference between different treatment response groups was not identical.Pairwise comparison showed that the difference between PD group and SD group(adjusted P=0.029)was statistically significant,while the difference between other groups was not statistically significant.Conclusion:PBV images have the potential to evaluate the location and range of HCC tumors before TACE,and are superior to DSA images in focus recognition.At the same time,it still has advantages in detecting residual tumor lesions after TACE treatment,which is a promising technique for evaluating the intraoperative embolization effect of TACE.However,in predicting the prognosis of TACE treatment,the difference of PBV perfusion value is not enough to explain the relationship between PBV perfusion value and the prognosis of TACE treatment,which still needs further study.