Journal of Diagnostics Concepts & Practice >

2026 , Vol. 25 >Issue 03: 337 - 345

DOI: https://doi.org/10.16150/j.1671-2870.2026.03.010

Original articles

Prospective study on value of 31P magnetic resonance spectroscopic imaging in evaluating efficacy of hepatic arterial infusion chemotherapy for advanced-stage hepatocellular carcinoma

  • LI Jingzhe ,
  • LIN Huimin ,
  • WU Xinyu ,
  • DENG Rong ,
  • LIU Peng ,
  • YANG Yuchen ,
  • YAN Fuhua
Expand
  • 1a Department of Radiology, b. Department of Hepatological Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2 College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2026-03-30

  Revised date: 2026-05-12

  Accepted date: 2026-05-12

  Online published: 2026-06-27

Fold

Abstract

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.

Key words： Hepatocellular carcinoma; 31P magnetic resonance spectroscopic imaging; Hepatic arterial infusion chemotherapy; Therapeutic response evaluation

Cite this article

LI Jingzhe , LIN Huimin , WU Xinyu , DENG Rong , LIU Peng , YANG Yuchen , YAN Fuhua . Prospective study on value of 31P magnetic resonance spectroscopic imaging in evaluating efficacy of hepatic arterial infusion chemotherapy for advanced-stage hepatocellular carcinoma[J]. Journal of Diagnostics Concepts & Practice, 2026 , 25(03) : 337 -345 . DOI: 10.16150/j.1671-2870.2026.03.010

References

[1] 王嘉琛, 何思怡, 曹梦迪, 等. 1990—2021年中国人群5种常见消化系统恶性肿瘤疾病负担变化趋势分析[J]. 中华消化外科杂志, 2025, 24(2):213-222.
  WANG J C, HE S Y, CAO M D, et al. Analysis of the change trend in the burden of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021[J]. Chin J Dig Surg, 2025, 24(2):213-222.
[2] LYU N, KONG Y, MU L, et al. Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma[J]. J Hepatol, 2018, 69(1):60-69.
[3] LI Q J, HE M K, CHEN H W, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: A randomized phase Ⅲ trial[J]. J Clin Oncol, 2022, 40(2):150-160.
[4] EISENHAUER E A, THERASSE P, BOGAERTS J, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2):228-247.
[5] DENG M, ZHONG C, LI D, et al. Hepatic arterial infusion chemotherapy-based conversion hepatectomy in responders versus nonresponders with hepatocellular carcinoma: A multicenter cohort study[J]. Int J Surg, 2025, 111(1):135-145.
[6] ZHAO M, GUO Z, ZOU Y H, et al. Arterial chemotherapy for hepatocellular carcinoma in China: Consensus recommendations[J]. Hepatol Int, 2024, 18(1):4-31.
[7] VAN DEN WILDENBERG L, RUNDERKAMP B A, SEELEN L W F, et al. Measurement of metabolite levels and treatment-induced changes in hepatic metastases of gastro-esophageal cancer using 7-T phosphorus magnetic resonance spectroscopic imaging[J]. NMR Biomed, 2024, 37(9):e5155.
[8] BELL J D, BHAKOO K K. Metabolic changes underlying 31P MR spectral alterations in human hepatic tumours[J]. NMR Biomed, 1998, 11(7):354-359.
[9] SEELEN L W F, VAN DEN WILDENBERG L, VAN DER KEMP W J M, et al. Prospective of 31P MR spectroscopy in hepatopancreatobiliary cancer: A systematic review of the literature[J]. Magnetic Resonance Imaging, 2023, 57(4):1144-1155.
[10] MEYERHOFF D J, KARCZMAR G S, VALONE F, et al. Hepatic cancers and their response to chemoembolization therapy: Quantitative image-guided 31P magnetic resonance spectroscopy[J]. Investig Radiol, 1992, 27(6):456-464.
[11] SCHILLING A, GEWIESE B, BERGER G, et al. Liver tumors: Follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization[J]. Radiology, 1992, 182(3):887-890.
[12] MARRERO J A, KULIK L M, SIRLIN C B, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American association for the study of liver diseases[J]. Hepatology, 2018, 68(2):723-750.
[13] REIG M, FORNER A, RIMOLA J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update[J]. J Hepatol, 2022, 76(3):681-693.
[14] JONUSCHEIT M, WIERICHS S, ROTHE M, et al. Reproducibility of absolute quantification of adenosine triphosphate and inorganic phosphate in the liver with localized 31P-magnetic resonance spectroscopy at 3-T using differe-nt coils[J]. NMR Biomed, 2024, 37(8):e5120.
[15] LIN A, ANDRONESI O, BOGNER W, et al. Minimum reporting standards for in vivo magnetic resonance spectroscopy (MRSinMRS): Experts' consensus recommendations[J]. NMR Biomed, 2021, 34(5):e4484.
[16] SEVASTIANOVA K, HAKKARAINEN A, KOTRONEN A, et al. Nonalcoholic fatty liver disease: Detection of elevated nicotinamide adenine dinucleotide phosphate with in vivo 3.0-T31P MR spectroscopy with proton decoupling[J]. Radiology, 2010, 256(2):466-473.
[17] VAN DEN WILDENBERG L, GURSAN A, SEELEN L W F, et al. In vivo phosphorus magnetic resonance spectroscopic imaging of the whole human liver at 7T using a phosphorus whole-body transmit coil and 16-channel receive array: Repeatability and effects of principal component analysis-based denoising[J]. NMR Biomed, 2023, 36(5):e4877.
[18] MARJA?SKA M, DEELCHAND D K, KREIS R. Results and interpretation of a fitting challenge for MR spectroscopy set up by the MRS study group of ISMRM[J]. Magn Reson Med, 2022, 87(1):11-32.
[19] ZHANG Y, SHEN J. Smoothness of in vivo spectral baseline determined by mean-square error: Smoothness of in Vivo Spectral Baseline[J]. Magn Reson Med, 2014, 72(4):913-922.
[20] YANG C, CHEN Y, SHENG L, et al. Prediction of pathologic response in unresectable hepatocellular carcinoma after downstaging with locoregional and systemic combination therapy[J]. J Hepatocell Carcinoma, 2025,12:43-58.
[21] LENCIONI R, LLOVET J. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J]. Semin Liver Dis 2010, 30(1):52-60.
[22] WANG Z, FAN J, ZHOU S, et al. Perioperative camrelizumab plus rivoceranib versus surgery alone in patients with resectable hepatocellular carcinoma at intermediate or high risk of recurrence (CARES-009): A randomised phase 2/3 trial[J]. Lancet, 2025, 406(10515):2089-2099.
[23] NAKAGAWA S. A farewell to Bonferroni: The problems of low statistical power and publication bias[J]. Behav Ecol, 2004, 15(6):1044-1045.
[24] LOHITESH K, CHOWDHURY R, MUKHERJEE S. Resistance a major hindrance to chemotherapy in hepatocellular carcinoma: An insight[J]. Cancer Cell Int, 2018, 18(1):44.
[25] YIN X, TANG B, LI J H, et al. ID1 promotes hepatocellular carcinoma proliferation and confers chemoresistance to oxaliplatin by activating pentose phosphate pathway[J]. J Exp Clin Cancer Res, 2017, 36(1):166.
[26] WEN S Y, LIU Y T, WEI B Y, et al. PDCD6 Promotes hepatocellular carcinoma cell proliferation and metastasis through the AKT/GSK3β/β-catenin pathway[J]. Biomed Environ Sci, 2023, 36(3):241-252.
[27] GAO Z X, ZHANG Z S, QIN J, et al. Aucubin enhances the antitumor activity of cisplatin through the inhibition of PD-L1 expression in hepatocellular carcinoma[J]. Phytomedicine, 2023,112:154715.
[28] LEI Y, CAI S, ZHANG J K, et al. The role and mechanism of fatty acid oxidation in cancer drug resistance[J]. Cell Death Discov, 2025,11:277.
[29] ZHU Y, YAN W, TONG L, et al. Metabolic reprogramming: A crucial contributor to anticancer drug resistance[J]. MedComm, 2025, 6(9):e70358.
[30] PIATRIKOVA V, KOCIANOVA E, SKVARKOVA L, et al. Fuelling resistance: Lipid metabolic rewiring in cancer response to chemotherapy and radiotherapy[J]. Biomed Pharmacother, 2025,193:118715.
[31] 中国抗癌协会肝癌专业委员会转化治疗协作组. 中国肝癌转化治疗中心建设参考标准(2024版)[J]. 中华消化外科杂志, 2025, 24(1):41-47.
  Alliance of Liver Cancer Conversion Therapy, Committee of Liver Cancer, China Anti‐Cancer Association. Chinese reference standard of conversion therapy center construction for liver cancer (2024 edition)[J]. Chin J Dig Surg, 2025, 24(1):41-47.
[32] 中国抗癌协会肝癌专业委员会病理学组, 中国抗癌协会肿瘤病理专业委员会肝癌学组. 肝细胞癌新辅助及转化治疗后疗效病理学评估专家共识(2025版)[J]. 中华消化外科杂志, 2025, 24(9):1117-1123.
  Pathology Group of Liver Cancer Professional Committee of the Chinese Anti-Cancer Association, Liver Cancer Group of Oncology Pathology Professional Committee of the Chinese Anti-Cancer Association. Expert consensus on pathological evaluation of efficacy after neoadjuvant and conversion therapy for hepatocellular carcinoma (2025 edition)[J]. Chin J Dig Surg, 2025, 24(8):1117-1123.
[33] YUAN Z, YE X D, DONG S, et al. Evaluation of early imaging response after chemoembolization of hepatocellular carcinoma by phosphorus-31 magnetic resonance spectroscopy: Initial experience[J]. J Vasc Interv Radiol, 2011, 22(8):1166-1173.
[34] GIBELLINI F, SMITH T K. The Kennedy pathway: De novo synthesis of phosphatidylethanolamine and phosphatidylcholine[J]. IUBMB Life, 2010, 62(6):414-428.
[35] PULICA R, AQUIB A, VARSANYI C, et al. Dys-regulated phosphatidylserine externalization as a cell intrinsic immune escape mechanism in cancer[J]. Cell Commun Signal, 2025, 23(1):131.
[36] PRETA G. New insights into targeting membrane lipids for cancer therapy[J]. Front Cell Dev Biol, 2020,8:571237.
Options
Outlines

/

〈 〉