Wu Wen-Qing, Wang Xi, Dong Cai-Hong, Mao Li-Juan, Wang Han-Tao, Lu Qing
Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2024 Jan 3;14(1):548-565. doi: 10.21037/qims-23-1027. Epub 2023 Nov 7.
Though contrast-enhanced ultrasound (CEUS) perfusion parameters have been approved to be potential indicators for response to chemotherapy in solid tumors, their ability in assessment of colorectal liver metastasis (CRLM) to chemotherapy with bevacizumab (Bev) has rarely been investigated.
From March 2021 to May 2022, 115 consecutive CRLM patients with CEUS pre- and post-2 months' chemotherapy with Bev were prospectively enrolled. One target lesion per patient underwent CEUS quantitative analysis with SonoLiver software. Rise time, time-to-peak, mean transit time, maximal intensity (IMAX), and area under the time-intensity curve (AUC) were assessed with region of interest (ROI) selected on whole lesion, lesion periphery, and internal lesion, respectively. The reduction and ratio of post- to pre-treatment in parameters were investigated in development cohort (n=89) and validated in internal validation cohort (n=26) according to the chronological order.
With modified Response Evaluation Criteria in Solid Tumor as reference, 48, 14 responders and 41, 12 non-responders were included in development and validation cohort, respectively. Significantly smaller values of IMAX and AUC on ROIwhole, ROIperipheral, and ROIinternal, were observed post-treatment in development cohort (all P<0.05). In predicting treatment response, the influence of ROI selection was observed when using ∆IMAX and ∆AUC, while no influence was observed using ratios. Areas under the receiver operating characteristic curve (AUROCs) for ∆IMAX and ∆AUC on ROIperipheral were 0.939 (0.867-0.979), 0.951 (0.883-0.985), and 0.917 (0.740-0.988), 0.923 (0.748-0.990) in development and validation cohort, respectively. For ratios of IMAX and AUC, AUROCs were 0.976 (0.919-0.997), 0.938 (0.865-0.978), and 0.899 (0.717-0.982), 0.982 (0.836-1.000) in development and validation cohort, respectively.
IMAX and AUC showed significant reductions in responders, and different analyses ROIs influence the performance of ∆IMAX and ∆AUC in response assessment. Parameters derived from ROI peripheral exhibited the most promising results in predicting treatment response.
尽管超声造影（CEUS）灌注参数已被认可为实体瘤化疗反应的潜在指标，但它们在评估结直肠癌肝转移（CRLM）对贝伐单抗（Bev）化疗反应中的能力鲜有研究。
2021年3月至2022年5月，前瞻性纳入115例连续的CRLM患者，这些患者在接受Bev化疗前和化疗2个月后均接受了CEUS检查。每位患者的一个靶病灶使用SonoLiver软件进行CEUS定量分析。分别在整个病灶、病灶周边和病灶内部选择感兴趣区（ROI），评估上升时间、达峰时间、平均通过时间、最大强度（IMAX）和时间-强度曲线下面积（AUC）。根据时间顺序，在开发队列（n=89）中研究参数治疗后较治疗前的降低值和比值，并在内部验证队列（n=26）中进行验证。
以实体瘤改良反应评估标准为参照，开发队列和验证队列分别纳入48例、14例反应者和41例、12例无反应者。在开发队列中，治疗后观察到ROI整体、ROI周边和ROI内部的IMAX和AUC值显著更小（均P<0.05）。在预测治疗反应时，使用∆IMAX和∆AUC时观察到ROI选择的影响，而使用比值时未观察到影响。开发队列和验证队列中，ROI周边的∆IMAX和∆AUC的受试者工作特征曲线下面积（AUROC）分别为0.939（0.867-0.979）、0.951（0.883-0.985）和0.917（0.740-0.988）、0.923（0.748-0.990）。对于IMAX和AUC的比值，开发队列和验证队列的AUROC分别为0.976（0.919-0.997）、0.938（0.865-0.978）和0.899（0.717-0.982）、0.982（0.836-1.000）。
反应者的IMAX和AUC显著降低，不同的分析ROI会影响∆IMAX和∆AUC在反应评估中的性能。来自ROI周边的参数在预测治疗反应方面显示出最有前景的结果。
