Wiesinger I, Jung W, Zausig N, Wohlgemuth W A, Pregler B, Wiggermann P, Stroszczynski C, Jung E M
Institute of Radiology, University Medical Center Regensburg, Germany.
Clin Hemorheol Microcirc. 2018;69(1-2):45-57. doi: 10.3233/CH-189118.
The aim of this follow-up study was to demonstrate the effect of percutaneous interventional treatment on local microcirculation of peripheral vascular malformations using CEUS and TIC analysis.
Retrospective analysis of 197 patients (136 female; 61 male; 3-86 years) with 135 venous (VM), 39 arterio-venous (AVM), 8 lymphatic and 15 veno-lymphatic peripheral vascular malformations before and after the first percutaneous treatment.CEUS was performed after i.v. injection of 1-2.4 ml of sulfur hexafluoride microbubbles (SonoVue®) using a 6-9 MHz linear probe. Digitally stored cine loops (starting in the early arterial phase for 60 sec) were read by independent readers in consensus. Regions of interest (ROI) were defined in the center and at the margins of the malformation, as well as in the healthy surrounding tissue. TIC analyses with Time to Peak (TTP) and Area under the Curve (AUC) were calculated using integrated perfusion software.
After the treatment there was a significant decrease for median AUC in VM in the center from 297.8 (14.5-2167.6) rU down to 243.3 (0.1-1678.8) rU (p = 0.043) and in the surrounding tissue down to 107.7 (20.2-660.2) rU (p = 0.018). For the other malformations AUC decreased in the center and the margins as well. TTP rose, however these changes did not reach the level of significance.
Analyzing the capillary microcirculation TICs offer a possibility of monitoring therapy-induced capillary changes of vascular malformations.
本随访研究的目的是利用超声造影（CEUS）和时间强度曲线（TIC）分析，证明经皮介入治疗对周围血管畸形局部微循环的影响。
回顾性分析197例患者（女性136例；男性61例；年龄3 - 86岁），这些患者患有135例静脉畸形（VM）、39例动静脉畸形（AVM）、8例淋巴管畸形和15例静脉 - 淋巴管周围血管畸形，分析首次经皮治疗前后的情况。经静脉注射1 - 2.4毫升六氟化硫微泡（声诺维®）后，使用6 - 9兆赫线性探头进行CEUS检查。由独立阅片者共同读取数字存储的动态图像（从动脉早期开始持续60秒）。在畸形中心、边缘以及健康周围组织中定义感兴趣区域（ROI）。使用集成灌注软件计算具有达峰时间（TTP）和曲线下面积（AUC）的TIC分析。
治疗后，VM中心的中位AUC从297.8（14.5 - 2167.6）rU显著降至243.3（0.1 - 1678.8）rU（p = 0.043），周围组织降至107.7（20.2 - 660.2）rU（p = 0.018）。对于其他畸形，中心和边缘的AUC也降低。TTP升高，但这些变化未达到显著水平。
通过分析毛细血管微循环TIC，有可能监测治疗引起的血管畸形毛细血管变化。
