The clinical value of contrast-enhanced MRI texture analysis in predicting the curative effect and prognosis of patients with intrahepatic cholangiocarcinoma after hepatic arterial infusion chemotherapy

Objective: To investigate the clinical value of contrast-enhanced MRI texture analysis in predictingthe curative effect and prognosis of patients with intrahepatic cholangiocarcinoma after hepatic arterial infusion (HAI) chemotherapy. Methods: The clinical data of 77 patients with unresectable cholangiocarcinoma, who were admitted to authors' hospital during the period from May 2014 to May 2019, were retrospectively analyzed. All patients received three cycles of HAI chemotherapy of gemcitabine combined with oxaliplatin. Before treatment, the texture features of intrahepatic assessmentable lesions demonstrated on the enhanced MRI images of arterial phase and portal phase were analyzed, from which the texture feature parameters, including mean value, kurtosis, skewness and entropy, were extracted. According to RECIST 1.1 standards, the patients were divided into control group and progression group. The texture feature parameters were compared between the two groups, and the predictive value of texture analysis for short-term efficacy was evaluated. The patients were followed up to record their survival time. Cox regression analysis was used to evaluate the factors affecting prognosis. Results: The patients were divided into control group (n = 39) and progression group (n = 38). No statistically significant differences in mean value, kurtosis, skewness and entropy of lesions in arterial phase existed between the two groups (P > 0.05). There were no statistically significant differences in mean value, kurtosis and skewness of lesions in portal phase between the two groups (P > 0.05). The entropy in the progression group was (1.592 ± 0.137) which was significantly larger than (1.465 ± 0.066) in the control group, the difference was statistically significant between the two groups (P < 0.05). The ROC curve was drawn and the area under curve (AUC) was 0.817, the sensitivity was 79.5%, specificity was 76.3%, the Youden index was 0.558, and the corresponding entropy value was 1.503. Kaplan-Meier survival curve was drawn, the median survival was 13 months and 8 months respectively, the difference was statistically significant between the two groups (P = 0.006). Based on the entropy value, the patients were divided into high-entropy group and low-entropy group. Kaplan-Meier survival curve was drawn, the median survival was11 months and 13 months respectively, the difference between the two groups was not statistically significant (P = 0.116). Multivariate analysis indicated that preoperative T stage of intrahepatic cholangiocarcinoma was the independent factor affecting prognosis. Conclusion: Contrast-enhanced MRI texture analysis of unresectable intrahepatic cholangiocarcinoma has certain clinical value in predicting the short-term curative effect for patients with unresectable intrahepatic cholangiocarcinoma receiving HAI chemotherapy. (authors)