Chen Yan, Shi Kexin, Li Zhen, Wang Huixia, Liu Nana, Zhan Pengchao, Liu Xing, Shang Bo, Hou Ping, Gao Jianbo, Lyu Peijie
Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Clinical Medicine, Henan Medical School of Zhengzhou University, Zhengzhou, Henan, China.
Front Oncol. 2023 Jul 19;13:1199426. doi: 10.3389/fonc.2023.1199426. eCollection 2023.
This study aimed to investigate the value of quantified extracellular volume fraction (fECV) derived from dual-energy CT (DECT) for predicting the survival outcomes of patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).
A total of 63 patients with HCC who underwent DECT before treatment were retrospectively included. Virtual monochromatic images (VMI) (70 keV) and iodine density images (IDI) during the equilibrium phase (EP) were generated. The tumor VMI-fECV and IDI-fECV were measured and calculated on the whole tumor (Whole) and maximum enhancement of the tumor (Maximum), respectively. Univariate and multivariate Cox models were used to evaluate the effects of clinical and imaging predictors on overall survival (OS) and progression-free survival (PFS).
The correlation between tumor VMI-fECV and IDI-fECV was strong (both < 0.001). The Bland-Altman plot between VMI-fECV and IDI-fECV showed a bias of 5.16% for the Whole and 6.89% for the Maximum modalities, respectively. Increasing tumor VMI-fECV and IDI-fECV were positively related to the effects on OS and PFS (both < 0.05). The tumor IDI-fECV-Maximum was the only congruent independent predictor in patients with HCC after TACE in the multivariate analysis on OS ( = 0.000) and PFS ( = 0.028). Patients with higher IDI-fECV-Maximum values had better survival rates above the optimal cutoff values, which were 35.42% for OS and 29.37% for PFS.
The quantified fECV determined by the equilibrium-phase contrast-enhanced DECT can potentially predict the survival outcomes of patients with HCC following TACE treatment.
本研究旨在探讨双能CT（DECT）得出的定量细胞外容积分数（fECV）对预测肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）后生存结局的价值。
回顾性纳入63例治疗前接受DECT检查的HCC患者。生成平衡期（EP）的虚拟单色图像（VMI）（70 keV）和碘密度图像（IDI）。分别在整个肿瘤（Whole）和肿瘤最大强化区域（Maximum）测量并计算肿瘤VMI-fECV和IDI-fECV。采用单因素和多因素Cox模型评估临床和影像预测因素对总生存期（OS）和无进展生存期（PFS）的影响。
肿瘤VMI-fECV与IDI-fECV之间相关性较强（均<0.001）。VMI-fECV与IDI-fECV之间的Bland-Altman图显示，Whole模式下偏差为5.16%，Maximum模式下偏差为6.89%。肿瘤VMI-fECV和IDI-fECV升高与对OS和PFS的影响呈正相关（均<0.05）。在TACE术后HCC患者的多因素分析中，肿瘤IDI-fECV-Maximum是OS（=0.000）和PFS（=0.028）唯一一致的独立预测因素。IDI-fECV-Maximum值较高的患者在高于最佳临界值时生存率更高，OS的最佳临界值为35.42%，PFS的最佳临界值为29.37%。
平衡期对比增强DECT测定的定量fECV有可能预测TACE治疗后HCC患者的生存结局。
