Background: Factors affecting morphological changes in the liver following selective internal radiation therapy (SIRT) are unclear, and the available literature focuses on non-anatomical volumetric assessment techniques in a lobar treatment setting. This study aimed to investigate quantitative changes in the liver post-SIRT using an anatomical volumetric approach in hepatocellular carcinoma (HCC) patients with different levels of treatment selectivity and evaluate the parameters affecting those changes. This retrospective, single-institution, IRB-approved study included 88 HCC patients. Whole liver, liver segments, tumor burden, and spleen volumes were quantified on MRI at baseline and 3/6/12 months post-SIRT using a segmentation-based 3D software relying on liver vascular anatomy. Treatment characteristics, longitudinal clinical/laboratory, and imaging data were analyzed. The Student’st-test and Wilcoxon test evaluated volumetric parameters evolution. Spearman correlation was used to assess the association between variables. Uni/multivariate analyses investigated factors influencing untreated liver volume (uLV) increase.Results: Most patients were cirrhotic (92%) men (86%) with Child–Pugh A (84%). Absolute and relative uLV kept increasing at 3/6/12 months post-SIRT vs. baseline (all,p≤ 0.005) and was maximal during the first 6 months. Absolute uLV increase was greater in Child–Pugh A5/A6 vs. ≥B7 at 3 months (A5,p= 0.004; A6,p= 0.007) and 6 months (A5,p= 0.072; A6,p= 0.031) vs. baseline. When the Child–Pugh class worsened at 3 or 6 months post-SIRT, uLV did not change significantly, whereas it increased at 3/6/12 months vs. baseline (allp≤ 0.015) when liver function remained stable. The Child–Pugh score was inversely correlated with absolute and relative uLV increase at 3 months (rho = −0.21,p= 0.047; rho = −0.229,p= 0.048). In multivariate analysis, uLV increase was influenced at 3 months by younger age (p= 0.013), administered90Y activity (p= 0.003), and baseline spleen volume (p= 0.023). At 6 months, uLV increase was impacted by younger age (p= 0.006), whereas treatment with glass microspheres (vs. resin) demonstrated a clear trend towards better hypertrophy (f = 3.833,p= 0.058). The amount (percentage) of treated liver strongly impacted the relative uLV increase at 3/6/12 months (all f ≥ 8.407,p≤ 0.01).Conclusion: Liver function (preserved baseline and stable post-SIRT) favored uLV hypertrophy. Younger patients, smaller baseline spleen volume, higher administered90Y activity, and a larger amount of treated liver were associated with a higher degree of untreated liver hypertrophy. These factors should be considered in surgical candidates undergoing neoadjuvant SIRT.
背景：选择性内放射治疗（SIRT）后影响肝脏形态变化的因素尚不明确，现有文献主要关注于肝叶治疗背景下的非解剖性体积评估技术。本研究旨在采用基于解剖的体积测量方法，探究不同治疗选择性水平的肝细胞癌（HCC）患者SIRT术后肝脏的定量变化，并评估影响这些变化的参数。这项经机构审查委员会批准的单中心回顾性研究纳入了88例HCC患者。使用基于肝脏血管解剖的分割式三维软件，在基线及SIRT术后3/6/12个月通过MRI量化全肝、肝段、肿瘤负荷及脾脏体积。分析治疗特征、纵向临床/实验室及影像学数据。采用Student's t检验和Wilcoxon检验评估体积参数的演变，Spearman相关性分析评估变量间关联，单/多变量分析探究影响未治疗肝体积（uLV）增长的因素。 结果：大多数患者为肝硬化（92%）、男性（86%）、Child-Pugh A级（84%）。与基线相比，SIRT术后3/6/12个月的绝对和相对uLV持续增加（所有p≤0.005），并在前6个月达到最大增幅。Child-Pugh A5/A6级患者在术后3个月（A5级p=0.004；A6级p=0.007）和6个月（A5级p=0.072；A6级p=0.031）的绝对uLV增幅大于≥B7级患者。当Child-Pugh分级在术后3或6个月恶化时，uLV无显著变化；而当肝功能保持稳定时，uLV在术后3/6/12个月较基线均显著增加（所有p≤0.015）。Child-Pugh评分与术后3个月绝对及相对uLV增幅呈负相关（rho=-0.21，p=0.047；rho=-0.229，p=0.048）。多变量分析显示，术后3个月uLV增长受年龄较轻（p=0.013）、¹⁰⁰Y给药活度（p=0.003）和基线脾脏体积（p=0.023）影响；6个月时受年龄较轻影响（p=0.006），而使用玻璃微球（对比树脂微球）治疗显示出更优增生潜力的明显趋势（f=3.833，p=0.058）。治疗肝脏范围（百分比）对术后3/6/12个月的相对uLV增幅有显著影响（所有f≥8.407，p≤0.01）。 结论：肝功能（基线保留良好且SIRT术后稳定）有利于uLV增生。年龄较轻、基线脾脏体积较小、¹⁰⁰Y给药活度较高以及治疗肝脏范围较大与未治疗肝增生程度更高相关。这些因素应在接受新辅助SIRT的手术候选者中予以考虑。
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