Clinical significance of the changes in contrast-enhanced CT texture parameters before and after DEB-TACE for hepatitis B virus-related hepatocellular carcinoma
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摘要:
目的 研究乙肝相关肝细胞癌患者经载药微球-经导管动脉化疗栓塞（DEB-TACE）治疗前后增强CT纹理参数变化，并探讨其临床意义。 方法 选择我院2018年6月~2021年6月收治的117例乙肝相关肝细胞癌患者作为研究对象，均采用DEBTACE治疗，分别于患者治疗前、治疗后6周行增强CT扫描，获得纹理参数，分析增强CT纹理参数在评估DEB-TACE治疗疗效中的价值。 结果 DEB-TACE治疗后，HCC患者增强CT纹理参数偏度、熵值、平均值及峰度均较治疗前降低，能量较治疗前上升，差异有统计学意义（P < 0.05）。经DEB-TACE治疗后，共86例患者预后良好，31例预后不良。不同预后患者经治疗后，偏度、熵值、平均值及峰度均较其治疗前降低，能量均较其治疗前上升，差异有统计学意义（P < 0.05）。预后良好组患者治疗前后偏度、熵值、平均值及峰度均低于预后不良组，治疗前后能量均高于预后不良组，差异有统计学意义（P < 0.05）。DEB-TACE治疗前纹理参数在预测HCC患者预后中的效能均较高(AUC>0.75)，各参数联合应用的预测价值最高（AUC=0.920，95% CI：0.870~0.970）。DEB-TACE治疗后纹理参数在预测HCC患者预后中均具有一定的效能（AUC>0.70），各参数联合应用的预测价值最高（AUC=0.810，95% CI：0.731~0.888）。 结论 增强CT纹理参数在评估HCC患者DEB-TACE治疗预后中具有一定的价值，可为临床HCC的治疗提供参考。 Abstract:Objective To explore the changes in the contrast-enhanced CT texture parameters such as skewness, energy and entropy before and after drug-eluting beads transarterial chemoembolization (DEB-TACE) for hepatitis B virus-related hepatocellular carcinoma (HBV-related HCC), and discuss their clinical significance. Methods A total of 117 patients with HBV-related HCC in our hospital from June 2018 to June 2021 were enrolled. All patients received DEB-TACE treatment. Contrast-enhanced CT scans were performed before and 6 weeks after treatment, and the textural parameters were recorded. The value of contrast-enhanced CT texture parameters in evaluating the efficacy of DEB-TACE treatment was analyzed. Results Compared with data before treatment, the skewness, entropy, mean and kurtosis of enhanced CT texture parameters in HCC patients were decreased, and energy was increased in patients after DEB-TACE treatment, with statistical difference (P < 0.05). Of 117 patients, 86 patients had good prognosis and 31 had poor prognosis after treatment. The skewness, entropy, mean and kurtosis were decreased in patients with different prognosis status, and the energy was increased in patients after DEB-TACE treatment (P < 0.05). The skewness, entropy, mean and kurtosis of good prognosis group were lower, and energy was higher than those of poor prognosis group before and after treatment (P < 0.05). The textural parameters before DEB-TACE treatment were all highly effective in predicting the prognosis of HCC patients (AUC>0.75), and the predictive value of combined detection of all parameters was the highest (AUC=0.920, 95%CI: 0.870-0.970). The textural parameters after DEBTACE treatment were also all highly effective in predicting the prognosis of HCC patients (AUC>0.70). The predictive value of combined detection of all parameters was the highest (AUC=0.810, 95% CI: 0.731-0.888). Conclusion Contrast-enhanced CT texture parameters are valuable in assessing the prognosis of HCC patients underwent DEB-TACE treatment, which can provide a reference for clinical HCC treatment. -
图 1 肝癌患者治疗前后增强CT图
A: 某肝癌患者术前动脉期增强扫描结果, 提示病灶呈明显的快进快出特征; B: 术前CT平扫结果示SVI段病灶呈稍低密度, 直径约3.3 cm: C: 治疗后6周动脉期扫描图像，提示该病灶已无强化特征; D: 治疗6周后CT平扫图, 病灶密度较治疗前降低.
Figure 1. Enhanced CT image of liver cancer patient before and after treatment.
图 2 DEB-TACE治疗前纹理参数在预测HCC患者预后中的ROC曲线
Figure 2. ROC curve of DEB-TACE pre-treatment texture parameters in predicting prognosis of HCC patients.
图 3 DEB-TACE治疗后纹理参数在预测HCC患者预后中的ROC曲线
Figure 3. ROC curve of texture parameters in predicting prognosis of HCC patients after DEB-TACE treatment.
表 1 DEB-TACE治疗前后肝细胞癌患者增强CT纹理参数水平比较
Table 1. Comparison of the levels of enhanced CT texture parameters in patients with hepatocellular carcinoma before and after DEB-TACE treatment (n=117, Mean±SD)
时间 偏度 能量(×106) 熵值 平均值 峰度 治疗前 0.83±0.21 4.49±1.43 2.03±0.36 77.69±13.25 5.06±0.78 治疗后 0.49±0.13 5.11±1.49 1.61±0.27 61.15±14.07 4.15±0.65 t 21.633 -4.593 14.422 13.097 13.767 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 不同预后患者治疗前后增强CT纹理参数水平比较
Table 2. Comparison of the levels of enhanced CT texture parameters before and after treatment in patients with different prognosis (Mean±SD)
预后及治疗前后 偏度 能量(×106) 熵值 平均值 峰度 预后良好(n=86) 治疗前 0.69±0.17 5.63±1.13 1.76±0.32 66.03±12.33 4.43±1.16 治疗后 0.34±0.08 6.26±1.21 1.45±0.37 53.15±10.48 3.45±0.85 t 25.966 -4.993 8.333 10.473 9.043 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 预后不良(n=31) 治疗前 1.02±0.21 2.96±0.51 2.39±0.43 93.31±13.15 5.91±1.09 治疗后 0.69±0.14 3.57±0.62 1.83±0.51 71.87±11.78 5.09±1.45 t 10.499 -6.011 6.634 9.577 3.595 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 t两组治疗前 8.689 12.672 8.543 10.377 6.185 P两组治疗前 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 t两组治疗后 16.840 11.809 4.412 8.248 7.524 P两组治疗后 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 DEB-TACE治疗前纹理参数在预测HCC患者预后的价值分析
Table 3. Analysis of the value of DEB-TACE pre-treatment texture parameters in predicting the prognosis of HCC patients
指标 截断值 AUC 95% CI P 敏感度（%） 特异性（%） 偏度 0.87 0.781 0.696~0.867 < 0.001 62.0 86.6 能量 4.03 0.775 0.686~0.864 < 0.001 70.0 83.6 熵值 2.11 0.759 0.669~0.848 < 0.001 56.0 86.6 平均值 79.73 0.776 0.691~0.862 < 0.001 76.0 76.1 峰度 5.51 0.753 0.663~0.884 < 0.001 56.0 82.1 联合 - 0.920 0.870~0.970 < 0.001 94.0 79.1
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表 4 DEB-TACE治疗后纹理参数在预测HCC患者预后的价值分析
Table 4. Analysis of the value of textural parameters in predicting the prognosis of HCC patients after DEB-TACE treatment
指标 截断值 AUC 95% CI P 敏感度(%) 特异性(%) 偏度 0.49 0.704 0.606~0.803 < 0.001 60.0 79.1 能量 3.91 0.700 0.604~0.796 < 0.001 76.0 59.7 熵值 1.74 0.707 0.613~0.800 < 0.001 68.0 56.7 平均值 59.9 0.713 0.619~0.807 < 0.001 74.0 64.2 峰度 4.33 0.714 0.621~0.808 < 0.001 58.0 80.6 联合 - 0.810 0.731~0.888 < 0.001 88.0 64.2
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