Abstract: Objective The aim of this study was to explore the clinical application of spectral CT virtual non-contrast (VNC) in evaluating postoperative efficacy of transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods A total of 107 patients with HCC were encountered in our hospital between January 2023 and May 2025, and all underwent TACE treatment. All patients underwent spectral CT scans before and after treatment to obtain true non-contrast (TNC) of lesions and VNC images at arterial phase, portal vein phase, and delayed phase by through post-processing. CT values of lesion by TNC and VNC at three-phases were recorded and compared. Serum alpha-fetoprotein (AFP) levels were detected by full-automatic chemiluminescence immunoanalyzer. Results By end of three-month treatment, Objective remission (OR) judged by mRECIST was found in 62 cases (57.9%)and stable disease or disease progression in 45 cases (42.1%) in our series; after treatment, the TNC, VNC CT value of lesions at arterial phase, portal vein phase, and delayed phase in patients with OR were(32.5±3.0)HU, (35.0±2.5)HU, (34.1±1.9)HU and (33.5±2.0)HU, all significantly lower than [(37.2±4.3)HU, (82.4±7.1)HU, (80.6±9.7)HU and (70.3±9.2)HU, respectively, P＜0.05] in those with non-OR; at presentation, serum AFP levels in the two groups were (749.2±53.1)ng/mL and (747.6±48.5)ng/mL(P>0.05), while after treatment, serum AFP level in OR group was (87.4±8.3)ng/mL, much lower than [(453.2±39.4)ng/mL,P<0.05] in non-OR group. Conclusion VNC could be an alternative tool for TNC to satisfactorily evaluate the curative efficacy of TACE in HCC patients, which might effectively reduce radiation doses, with a good clinical application.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Spectral CT virtual non-contrast, Therapy, Evaluation