Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, 200032, China.
Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
Abdom Radiol (NY). 2024 Feb;49(2):414-424. doi: 10.1007/s00261-023-04055-0. Epub 2023 Oct 18.
To investigate the clinical value of pre-treatment quantitative contrast-enhanced ultrasound (CEUS) in assessing the response of colorectal liver metastases (CRLM) to chemotherapy plus targeted therapy.
This study retrospectively enrolled 50 CRLM patients from the Zhongshan Hospital, Fudan University as the training cohort and 14 patients from Shanghai Tenth People's Hospital as the testing cohort. Patients underwent the CEUS examination before receiving chemotherapy (CAPOX, FOLFOX, FOLFIRI, or FOLFOXIRI) plus targeted therapy (Bevacizumab or Cetuximab). The therapy response was determined according to Response Evaluation Criteria in Solid Tumors version 1.1 based on pre-treatment CT and 3-month follow-up CT after therapy. Dynamic analysis was performed by VueBox® software. Time-intensity curves with quantitative perfusion parameters were obtained. In the training cohort, univariable and multivariable logistic regression analyses were used to develop the predictive model of therapy response. The predictive performance of the developed model was validated in the testing cohort.
After the logistic regression analyses, the peak enhancement (PE) (odds ratio = 1.640; 95% confidence intervals [CI] 1.022-2.633) and time to peak (TTP) (odds ratio = 0.495; 95% CI 0.246-0.996) were determined as independent predictive factors. PE and TTP generated from VueBox® were not affected by ultrasound instruments and contrast agent dosage in therapy response evaluation (P > 0.05). The logistic regression model achieved satisfactory prediction performance (area under the curve: 0.923 in the training cohort and 0.854 in the testing cohort).
CEUS with dynamic quantitative perfusion analysis, which presents high consistency, has potential practical value in predicting the response of CRLM to chemotherapy plus targeted therapy.
研究治疗前定量对比增强超声（CEUS）评估结直肠癌肝转移（CRLM）对化疗联合靶向治疗反应的临床价值。
本研究回顾性纳入复旦大学中山医院 50 例 CRLM 患者作为训练队列，上海第十人民医院 14 例患者作为测试队列。患者在接受化疗（CAPOX、FOLFOX、FOLFIRI 或 FOLFOXIRI）联合靶向治疗（贝伐珠单抗或西妥昔单抗）前接受 CEUS 检查。根据治疗前 CT 和治疗后 3 个月随访 CT，采用实体瘤反应评价标准 1.1 确定治疗反应。VueBox®软件进行动态分析，获得定量灌注参数的时间强度曲线。在训练队列中，采用单变量和多变量逻辑回归分析建立治疗反应的预测模型，并在测试队列中验证该模型的预测性能。
经过逻辑回归分析，峰值增强（PE）（比值比=1.640；95%置信区间 [CI] 1.022-2.633）和达峰时间（TTP）（比值比=0.495；95%CI 0.246-0.996）被确定为独立预测因素。VueBox® 生成的 PE 和 TTP 不受治疗反应评估中超声仪器和对比剂剂量的影响（P>0.05）。逻辑回归模型在训练队列中的预测性能良好（曲线下面积：0.923），在测试队列中也具有良好的预测性能（曲线下面积：0.854）。
CEUS 具有高一致性的动态定量灌注分析，在预测 CRLM 对化疗联合靶向治疗的反应方面具有潜在的实用价值。
