Department of Radiology, University Hospital Regensburg, Germany.
Department of Internal Medicine, Infectious Diseases, University Hospital Regensburg, Germany.
Ultraschall Med. 2018 Aug;39(4):440-447. doi: 10.1055/s-0043-119353. Epub 2017 Sep 25.
Using new perfusion software for evaluation of the success of percutaneous treatments of malignant liver tumors with CEUS.
Retrospective analysis of 88 patients (74 male, 14 female; 30 - 84 years) with 165 malignant liver lesions. The lesions were 57 metastases and 108 HCCs. The success of interventional treatment (IRE n = 47; RFA n = 38; MWA n = 44; TACE n = 36) was evaluated by CEUS and perfusion software (VueBox). CEUS was performed after injection of 1 - 2.4 ml of sulfur hexafluoride microbubbles (SonoVue) using a 1 - 5 MHz convex probe. DICOM loops up to 1 min. in the ablation area were stored digitally in the PACS. Regions of interest (ROI) were manually placed in the center, the margins of the lesions as well as in the surrounding tissue. Using VueBox peak, time to peak (TTP), mean transit time (mTT), rise time (RT), the wash-in and wash-out rate were calculated for the regions, in order to evaluate the success of the percutaneous treatment after the ablation in comparison to the ceCT/ceMRI up to 6 months after the treatment.
There were significant differences in all cases between the center compared to the margins for the main perfusion parameters (peak, mTT, RT) (p < 0.001). Peak, wash-in and wash-out ratios were further analyzed with the type of lesion and the method of ablation. All parameters were significantly different between lesions treated successfully vs. lesions with recurrence.
A combination of CEUS with perfusion imaging enables critical assessment of successful treatment after percutaneous interventional procedures for a malignant liver lesion.
使用新的灌注软件评估超声造影引导下经皮治疗恶性肝肿瘤的疗效。
回顾性分析 88 例（男 74 例，女 14 例；年龄 30-84 岁）患者的 165 个恶性肝肿瘤病灶。病灶为 57 个转移瘤和 108 个 HCC。采用 CEUS 和灌注软件（VueBox）评估介入治疗（IRE n=47；RFA n=38；MWA n=44；TACE n=36）的疗效。经 1-2.4ml 六氟化硫微泡（声诺维）注射后，使用 1-5MHz 凸阵探头行 CEUS。将消融区域内的 DICOM 循环最多 1 分钟数字化存储在 PACS 中。手动将 ROI 放置在病灶中心、边缘及周围组织。使用 VueBox 计算病灶中心、边缘及周围组织的峰值、达峰时间（TTP）、平均渡越时间（mTT）、上升时间（RT）、灌注率和洗脱率，以评估消融治疗后 6 个月内的 CEUS 与 CT/MRI 结果。
所有病例中，病灶中心与边缘的主要灌注参数（峰值、mTT、RT）均存在显著差异（p<0.001）。进一步分析了病变类型和消融方法对峰值、灌注率和洗脱率的影响。成功治疗与复发的病灶之间，所有参数均存在显著差异。
CEUS 联合灌注成像可对经皮介入治疗恶性肝肿瘤的疗效进行评估。
