早期评估晚期肝细胞癌患者经动脉化疗栓塞治疗反应：动态三维对比增强超声的作用。

Early evaluation of treatment response to transarterial chemoembolization in patients with advanced hepatocellular carcinoma: The role of dynamic three-dimensional contrast-enhanced ultrasound.

机构信息

Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.

Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Clin Hemorheol Microcirc. 2021;78(4):365-377. doi: 10.3233/CH-201086.

DOI:10.3233/CH-201086

PMID:33682701

Abstract

BACKGROUND

Dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) with quantitative analysis is available in recent years. It can reduce the quantitative sampling error caused by the inconsistency of different sections in order to evaluate local treatment response of hepatocellular carcinoma (HCC) accurately.

OBJECTIVE

To investigate the value of dynamic 3D-CEUS in evaluating the early response to transarterial chemoembolization (TACE) treatment in patients with advanced HCC lesions.

METHODS

In this prospective study, both two-dimensional (2D) CEUS and dynamic 3D-CEUS were performed on 40 HCC patients who scheduled for TACE at baseline (T0) and 1-3 days (T1) after treatment. Tumor microvascular perfusion changes were assessed by CEUS time-intensity curve (TIC) and quantitative parameters. According to contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging 1 month after treatment results, patients were divided into responders and non-responders groups. The changes of perfusion parameters of both 2D-CEUS and 3D-CEUS were compared between responders and non-responders groups before and after TACE treatment.

RESULTS

Before and after TACE treatment, no significant difference in maximum diameter of HCC lesions between the two groups could be found. There were more significant differences and ratios of perfusion parameters in 3D-CEUS quantitative analysis than in 2D-CEUS. The mutual significant differences and ratios of 2D-CEUS and 3D-CEUS included peak intensity (PI) difference, PI ratio, ratio of area under the curve (A), ratio of area under the wash-out part (AWO) and slope (S) difference. The former 4 corresponding parameters were better on 3D-CEUS than on 2D-CEUS.

CONCLUSION

Dynamic 3D-CEUS can be used as a potential imaging method to evaluate early treatment response to TACE in advanced HCC patients.

摘要

背景

近年来，动态三维对比增强超声（3D-CEUS）及其定量分析技术已经问世。该技术可以减少由于不同节段的不一致性而导致的定量采样误差，从而更准确地评估肝细胞癌（HCC）的局部治疗反应。

目的

探讨动态 3D-CEUS 评估晚期 HCC 患者经动脉化疗栓塞（TACE）治疗早期疗效的价值。

方法

前瞻性研究纳入 40 例行 TACE 治疗的 HCC 患者，于基线（T0）和治疗后 1-3 天（T1）分别行二维（2D）CEUS 和动态 3D-CEUS。通过 CEUS 时间-强度曲线（TIC）及其定量参数评估肿瘤微血管灌注变化。根据治疗后 1 个月增强 CT 和磁共振成像（MR）结果，将患者分为有效组和无效组。比较两组患者 TACE 治疗前后 2D-CEUS 和 3D-CEUS 灌注参数的变化。

结果

TACE 治疗前后，两组 HCC 最大直径差异均无统计学意义。3D-CEUS 定量分析的灌注参数差异和比值较 2D-CEUS 更显著。2D-CEUS 和 3D-CEUS 的相互显著差异和比值包括：峰值强度（PI）差值、PI 比值、曲线下面积（A）比值、洗脱部分曲线下面积（AWO）比值和斜率（S）差值。前 4 个参数在 3D-CEUS 上的表现优于 2D-CEUS。