Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, 200092, Shanghai, China.
Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China.
Eur J Radiol. 2024 Jun;175:111439. doi: 10.1016/j.ejrad.2024.111439. Epub 2024 Mar 23.
To evaluate the value of dynamic contrast-enhanced ultrasound (DCE-US) analysis in early prediction of tumor response to systemic treatment in patients with intrahepatic cholangiocarcinoma (ICC).
PATIENTS & METHODS: In this retrospective study, patients diagnosed with ICC by core needle biopsy and histopathological results were included. All patients were diagnosed as advanced stages (stage III/IV) by the 8th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) TNM staging system. Liver contrast-enhanced ultrasound (CEUS) examination, DCE-US analysis, CT/MRI, and blood tests were performed in all patients before and 2 months after systemic treatment. CEUS procedure was performed using an ultrasound system (ACUSON Sequoia; Siemens Medical Solutions, Germany) equipped with a 5C1 MHz convex array transducer. Time-intensity curves (TIC) and quantitative parameters were created with VueBox software. According to one-year results of the modified Response Evaluation Criteria in Solid Tumors (m-RECIST) based on CT/MRI, patients were divided into the responder group (RG) and the non-responder group (NRG). Before and 2 months after systemic therapy, the DCE-US perfusion parameters was compared using the paired-sample t test and the Wilcoxon test.
From September 2020 to December 2021, a total of 24 patients diagnosed with advanced ICC were included (11 males, 13 females, mean age 59.4 ± 1.8 years). According to the one year of m-RECIST results, 17 cases (70.8 %) were classified as non-responders by the final m-RECIST criteria, while 7 cases (19.2 %) were responders. Comparing before and 2 months after therapy, the RG took longer time to reach peak intensity, and the peak intensity of TIC was lower. While the TICs of NRG revealed faster enhancement after therapy. Among all DCE-US quantitative parameters, PE (peak enhancement), WiR (wash-in rate), WiPI (wash-in perfusion index) and WoR (wash-out rate) reduced significantly following 2 months of systemic therapy in RG (P < 0.05). Comparing to RG, PE and WiPI decreased slightly 2 months after therapy in NRG (P < 0.05).
The DCE-US analysis with quantitative parameters has the potential value to make early and quantitative evaluation of treatment response to systemic therapy in ICC patients.
评估动态对比增强超声（DCE-US）分析在预测肝内胆管癌（ICC）患者系统治疗肿瘤反应中的价值。
这是一项回顾性研究，纳入了经核心针活检和组织病理学结果诊断为 ICC 的患者。所有患者均根据第 8 版美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）TNM 分期系统被诊断为晚期（III/IV 期）。所有患者在系统治疗前和治疗后 2 个月均进行肝脏超声造影（CEUS）检查、DCE-US 分析、CT/MRI 和血液检查。CEUS 检查使用配备 5C1MHz 凸阵探头的超声系统（ACUSON Sequoia；西门子医疗解决方案公司，德国）进行。使用 VueBox 软件生成时间-强度曲线（TIC）和定量参数。根据 CT/MRI 基于改良实体瘤反应评估标准（m-RECIST）的一年结果，患者分为应答组（RG）和非应答组（NRG）。使用配对样本 t 检验和 Wilcoxon 检验比较系统治疗前后的 DCE-US 灌注参数。
2020 年 9 月至 2021 年 12 月，共纳入 24 例诊断为晚期 ICC 的患者（男性 11 例，女性 13 例，平均年龄 59.4±1.8 岁）。根据 m-RECIST 一年的结果，最终 m-RECIST 标准将 17 例（70.8%）患者归类为无应答者，而 7 例（19.2%）患者为应答者。与治疗前相比，RG 达到峰值强度的时间更长，TIC 的峰值强度更低。而 NRG 的 TIC 在治疗后增强更快。在所有 DCE-US 定量参数中，RG 在系统治疗 2 个月后 PE（峰值增强）、WiR（灌注上升率）、WiPI（灌注指数）和 WoR（灌注下降率）显著降低（P<0.05）。与 RG 相比，NRG 在治疗后 2 个月时 PE 和 WiPI 略有降低（P<0.05）。
DCE-US 分析结合定量参数有可能对 ICC 患者的系统治疗反应进行早期和定量评估。
