Guo Suping, Xu Pan, Zhou Aiyun, Wang Gongxian, Chen Weimin, Mei Jinhong, Xiao Fan, Liu Juan, Zhang Cheng
Department of Ultrasonography, First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Urology Surgery, First Affiliated Hospital of Nanchang University, Nanchang, China.
J Ultrasound Med. 2017 Nov;36(11):2287-2297. doi: 10.1002/jum.14262. Epub 2017 May 27.
Time-intensity curves (TICs) of contrast-enhanced ultrasound (CEUS) were analyzed retrospectively to differentiate between low-grade and high-grade bladder urothelial carcinoma, and to investigate correlation with tumor microvessel density (MVD).
The data of 105 patients with pathologically confirmed bladder urothelial carcinoma (55 low-grade and 50 high-grade) were reviewed. Lesions were examined before surgery using conventional ultrasound and CEUS with TIC analysis. The TIC parameters time from peak to one-half the signal intensity (TPH) and the corresponding descending slope (DS) of the low-grade and high-grade groups were compared, and receiver operating characteristic curves constructed. The MVDs of the resectioned tissue specimens were quantified via immunohistochemistry for CD34.
Based on conventional ultrasound, the low-grade and high-grade groups were similar in tumor shape, number, topography, internal echo, height, width, and vascularity. The TPH of the high-grade group was significantly longer than that of the low-grade group, and the DS was lower. The cutoff points of TPH and DS for differentiating low-grade and high-grade bladder urothelial carcinoma were 48.06 seconds and 0.15 dB/seconds, respectively (area under the receiver operating characteristic curve = 0.79 for both). The mean MVDs per high-power field of the low-grade and high-grade groups were 41.39 16.65 and 51.03 20.16, respectively (P = .009). The TPH correlated linearly with MVD (P < .01), as did the DS (P < .01).
Contrast-enhanced ultrasound can be used to differentiate low from high-grade bladder urothelial carcinoma. The TIC parameters of CEUS reflect the MVD of bladder urothelial tumors and may be helpful for evaluating tumor angiogenesis, with implications for clinical diagnosis, treatment, and prognosis.
回顾性分析超声造影（CEUS）的时间-强度曲线（TICs），以鉴别低级别和高级别膀胱尿路上皮癌，并研究其与肿瘤微血管密度（MVD）的相关性。
回顾性分析105例经病理证实的膀胱尿路上皮癌患者（55例低级别和50例高级别）的数据。术前采用常规超声和CEUS并进行TIC分析检查病变。比较低级别和高级别组的TIC参数从峰值到信号强度一半的时间（TPH）及相应的下降斜率（DS），并构建受试者工作特征曲线。通过免疫组织化学检测CD34对切除的组织标本的MVD进行定量分析。
基于常规超声，低级别和高级别组在肿瘤形状、数量、位置、内部回声、高度、宽度和血管分布方面相似。高级别组的TPH明显长于低级别组，且DS更低。鉴别低级别和高级别膀胱尿路上皮癌的TPH和DS的截断点分别为48.06秒和0.15 dB/秒（受试者工作特征曲线下面积均为0.79）。低级别和高级别组每高倍视野的平均MVD分别为41.39±16.65和51.03±20.16（P = 0.009）。TPH与MVD呈线性相关（P < 0.01），DS与MVD也呈线性相关（P < 0.01）。
超声造影可用于鉴别低级别和高级别膀胱尿路上皮癌。CEUS的TIC参数反映膀胱尿路上皮肿瘤的MVD，可能有助于评估肿瘤血管生成，对临床诊断、治疗和预后具有重要意义。
