Ueda Naoyuki, Nagira Haruki, Sannomiya Naoko, Ikunishi Saeko, Hattori Yuiko, Kamida Akira, Koyanagi Yuki, Shimabayashi Kenta, Sato Kengo, Saito Hiroaki, Hirooka Yasuaki
Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
†Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.
Yonago Acta Med. 2016 Dec 26;59(4):255-261. eCollection 2016 Dec.
The therapeutic effect of chemotherapy for liver metastases is currently determined by changes in tumor diameter depicted on computed tomography (CT) and magnetic resonance imaging, but it cannot accurately determine if there is central necrosis. Furthermore, due to the risk of radiation exposure and high cost, frequent examination using these methods places a heavy burden on patients. Meanwhile, real-time observation of blood flow and vessel morphology within tumors has become possible by contrast-enhanced ultrasonography (CEUS). However, use of CEUS in evaluating the therapeutic effect of anticancer chemotherapy has rarely been investigated. This study investigated whether changes in the time-intensity curve (TIC) of CEUS are useful indicators of the therapeutic effect of chemotherapy.
Five patients with liver metastases who had undergone CEUS before and after chemotherapy were included in this study. The TIC of each time point was prepared to examine whether the following five TIC parameters serve as indicators of the therapeutic effect of chemotherapy: peak intensity, time to wash-in, time to peak intensity, slope of wash-in, and area under the curve. In each parameter, rate of change (ROC) was calculated by the expression [(values before chemotherapy minus those after chemotherapy)/those before chemotherapy × 100(%)].
(i) Among the five TIC parameters tested, ROC of the slope of wash-in and the area under the curve reflected the therapeutic effect of chemotherapy better than the remaining three parameters. (ii) TIC parameters after one cycle of chemotherapy were examined in two of five patients, and changes in the slope of wash-in and the area under the curve were in good agreement with the computed tomography findings indicative of the therapeutic effect after the fourth chemotherapy cycle.
The findings of this study suggest that ROC of the slope of wash-in and the area under the curve of the TIC are useful in evaluating the therapeutic effect of chemotherapy. Furthermore, there is a possibility that TIC analysis may enable early prediction of the therapeutic effect.
目前，化疗对肝转移瘤的治疗效果是通过计算机断层扫描（CT）和磁共振成像所显示的肿瘤直径变化来确定的，但它无法准确判断是否存在中心坏死。此外，由于存在辐射暴露风险和成本高昂，频繁使用这些方法进行检查给患者带来了沉重负担。与此同时，通过超声造影（CEUS）可以实现对肿瘤内部血流和血管形态的实时观察。然而，CEUS在评估抗癌化疗治疗效果方面的应用很少被研究。本研究调查了CEUS的时间-强度曲线（TIC）变化是否是化疗治疗效果的有用指标。
本研究纳入了5例化疗前后均接受过CEUS检查的肝转移瘤患者。准备每个时间点的TIC，以检查以下五个TIC参数是否可作为化疗治疗效果的指标：峰值强度、流入时间、达到峰值强度的时间、流入斜率和曲线下面积。在每个参数中，变化率（ROC）通过表达式[（化疗前值减去化疗后值）/化疗前值×100（%）]计算得出。
（i）在测试的五个TIC参数中，流入斜率和曲线下面积的ROC比其余三个参数更能反映化疗的治疗效果。（ii）在五名患者中的两名患者中检查了一个化疗周期后的TIC参数，流入斜率和曲线下面积的变化与CT结果高度一致，CT结果表明第四个化疗周期后的治疗效果。
本研究结果表明，流入斜率的ROC和TIC的曲线下面积可用于评估化疗的治疗效果。此外，TIC分析有可能实现对治疗效果的早期预测。
