目的：探讨磁共振磷谱成像（³¹P magnetic resonance spectroscopic imaging， ³¹P MRSI）在肝细胞癌（hepatocellular carcinoma， HCC）患者首次肝动脉灌注化疗（hepatic arterial infusion chemotherapy， HAIC）疗效评估中的价值。方法：前瞻性连续收集2023年11月至2024年8月间上海交通大学医学院附属瑞金医院收治的计划接受HAIC的HCC（巴塞罗那临床分期C期）患者13例，均为男性，平均年龄（54±14）岁。所有患者在接受第1次HAIC前[平均（1±1） d]和后[平均（24±6） d]，接受³¹P MRSI检查。在患者接受第6次HAIC[距首次HAIC中位151 d（四分位间距为123~179 d）后或在患者接受转化手术[距首次HAIC中位94 d（四分位间距为66~106 d）]后，根据修订后的实体瘤疗效评价标准（modified response evaluation criteria in solid tumor， mRECIST）或病理评估标准，将患者分为应答组（n=6）与无应答组（n=7）。分析HCC患者磷酸单酯（phosphomonoester， PME）/磷酸二酯（phosphodiester， PDE）比值及磷酸乙醇胺（phosphoethanolamine， PE）/PDE比值在首次HAIC后的变化及变化幅度（ΔPME/PDE和ΔPE/PDE），比较上述指标在首次HAIC前后改变的组间差异，采用受试者工作特征（receiver operating characteristic，ROC）曲线下面积评估上述指标预测HAIC疗效的价值。结果：应答组HAIC治疗前后PME/PDE比值、PE/PDE比值没有变化，无应答组显著升高。治疗前，无应答组PME/PDE比值（0.97比1.91，P=0.027）和PE/PDE比值（0.55比1.23，P=0.014）低于应答组。在无应答组中，治疗后的平均PME/PDE比值（3.04比0.97，P=0.006）和平均PE/PDE比值（2.03比0.55，P=0.014）均较治疗前显著升高；首次HAIC前后，ΔPME/PDE和ΔPE/PDE（1.69比0.40，P=0.029；1.80比0.47，P=0.032）显著大于应答组。HAIC前，PME/PDE比值<0.91、PE/PDE比值<0.74以及HAIC前后相应的ΔPME/PDE≥0.4、ΔPE/PDE≥2.2预测无应答的ROC曲线下面积分别为0.83、0.91、0.86和0.83。结论：对HAIC无应答的HCC患者，在首次HAIC后PME/PDE比值和PE/PDE比值升高。基线及首次HAIC后的PME/PDE比值和PE/PDE比值有望用于预测HAIC的疗效。

Objective This study aims to investigate the value of ³¹P magnetic resonance spectroscopy imaging (³¹P MRSI) in evaluating the therapeutic efficacy of the first cycle of hepatic arterial infusion chemotherapy (HAIC) for patients with hepatocellular carcinoma (HCC). Methods A total of 13 male patients (mean age: 54±14 years) with Barcelona Clinic Liver Cancer-C stage HCC intended to receive HAIC at Ruijin Hospital were prospectively and consecutively enrolled from November 2023 to August 2024. Each patient underwent ³¹P MRSI before the first cycle [mean (1±1) d] and after the first HAIC cycle [mean (24±6) d]. After the 6th HAIC [median 151 d since the first HAIC (interquartile range, 123-179 d)] or after conversion surgery [median 94 d since the first HAIC (interquartile range, 66-106 d)], patients were divided into response group (n=6) and nonresponse group (n=7) according to modified response evaluation criteria in solid tumor (mRECIST) or pathological assessment criteria. The phosphomonoester (PME)/phosphodiester (PDE) and phosphoethanolamine (PE)/PDE ratios in patients with HCC, as well as their changes and change amplitude (ΔPME/PDE and ΔPE/PDE), were analyzed. Differences in these indicators before and after the first cycle of HAIC were compared between the response and nonresponse groups. The area under the receiver operating characteristic (ROC) curve was used to evaluate the value of these indicators derived from ³¹P MRSI in predicting HAIC efficacy. Results In the response group, the PME/PDE and PE/PDE ratios showed no change before and after HAIC, whereas it significantly increased in the nonresponse group. Before the first cycle of HAIC, the ratios of PME/PDE (0.97 vs. 1.91, P=0.027) and PE/PDE (0.55 vs. 1.23, P=0.014) in the nonresponse group were lower than those in the response group. In the nonresponse group, the mean ratios of PME/PDE (3.04 vs. 0.97, P=0.006) and PE/PDE (2.03 vs. 0.55, P=0.014) increased significantly after HAIC compared with those before treatment. After the first cycle of HAIC, ΔPME/PDE and ΔPE/PDE (1.69 vs. 0.40, P=0.029; 1.80 vs. 0.47, P=0.032) were significantly greater in the nonresponse group than in the response group. The area under the curve (AUC) values for predicting nonresponders were 0.83, 0.91, 0.86, and 0.83, for the PME/PDE ratio <0.91, and PE/PDE ratio <0.74 before the HAIC, ΔPME/PDE≥0.4 and ΔPE/PDE≥2.2, respectively. Conclusions In patients who do not respond to HAIC, the PME/PDE and PE/PDE ratios increase after the first cycle of HAIC. Baseline PME/PDE and PE/PDE ratios or after the first cycle of HAIC may be useful for predicting the efficacy of HAIC.