Moschouris Hippocrates, Malagari Katerina, Marinis Athanasios, Kornezos Ioannis, Stamatiou Konstantinos, Nikas Georgios, Papadaki Marina Georgiou, Gkoutzios Panagiotis
Hippocrates Moschouris, Ioannis Kornezos, Georgios Nikas, Marina Georgiou Papadaki, Department of Radiology, Tzaneion General Hospital, 18536 Piraeus, Greece.
World J Radiol. 2012 Aug 28;4(8):379-86. doi: 10.4329/wjr.v4.i8.379.
To evaluate the response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE) using a simplified protocol of parametric contrast-enhanced ultrasound (pCEUS).
Eighteen patients with HCC (18 target tumors, diameter: 2.8-12 cm) were evaluated before, and 20 d after TACE. The distribution and morphology of TACE-induced necrosis in these tumors precluded accurate evaluation by visual assessment or by simple measurements. For pCEUS, a 4.8 mL bolus of SonoVue (Bracco, Milan, Italy) was intravenously administered and analysis of tumor perfusion during the initial phase of enhancement (0-30 s post injection) was performed with dedicated software (Qontrast, Bracco, Milan, Italy). Time-intensity curves were plotted and three parameters were calculated: peak intensity (PI, in percentage %), time to peak (TTP in seconds, s) and area under the curve during wash-in (AUC-WI, in arbitrary units, a.u). Magnetic resonance imaging was the standard imaging modality for post-treatment evaluation. Changes in tumor size were recorded and response was assessed according to response evaluation criteria in solid tumors criteria.
A statistically significant decrease in PI and AUC-WI was observed in the treated tumors post TACE; PIpre: 21.5% ± 8.7% (mean ± SD), PIpost: 12.7% ± 6.7%, P < 0.001, AUC-WI pre: 17493 ± 9563 a.u, AUC-WI post: 9585 ± 5494 a.u, P < 0.001. A slight increase in TTP was noted post TACE, but this was not statistically significant; TTP pre: 13.1 ± 4.3 s, TTP post: 13.6 ± 4.2 s , P = 0.058). The changes in the aforementioned parameters were not accompanied by significant tumor shrinkage.
pCEUS, even when limited to the study of the arterial phase of tumoral enhancement, can detect and quantify early perfusional changes in HCC post TACE.
使用简化的参数对比增强超声（pCEUS）方案评估肝细胞癌（HCC）对经动脉化疗栓塞术（TACE）的反应。
18例HCC患者（18个靶肿瘤，直径2.8 - 12 cm）在TACE术前及术后20天接受评估。这些肿瘤中TACE诱导坏死的分布和形态，使得通过视觉评估或简单测量难以进行准确评估。对于pCEUS，静脉注射4.8 mL声诺维（意大利米兰的博莱科公司），并使用专用软件（意大利米兰博莱科公司的Qontrast）对增强初始阶段（注射后0 - 30秒）的肿瘤灌注进行分析。绘制时间 - 强度曲线并计算三个参数：峰值强度（PI，百分比%）、达峰时间（TTP，秒，s）和动脉期曲线下面积（AUC - WI，任意单位，a.u）。磁共振成像为治疗后评估的标准成像方式。记录肿瘤大小变化，并根据实体瘤疗效评价标准评估反应。
TACE术后，治疗的肿瘤中PI和AUC - WI有统计学意义的下降；PI术前：21.5% ± 8.7%（均值 ± 标准差），PI术后：12.7% ± 6.7%，P < 0.001，AUC - WI术前：17493 ± 9563 a.u，AUC - WI术后：9585 ± 5494 a.u，P < 0.001。TACE术后TTP略有增加，但无统计学意义；TTP术前：13.1 ± 4.3 s，TTP术后：13.6 ± 4.2 s，P = 0.058）。上述参数的变化未伴有明显的肿瘤缩小。
即使仅限于研究肿瘤增强的动脉期，pCEUS也能检测并量化HCC患者TACE术后早期灌注变化。
