Li Chen, Liu Yuan, Wu Mingxiao, Wei Junmin, Song Jinghai
Department of Ultrasonography, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Department of General Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):8131-8139. doi: 10.21037/qims-24-671. Epub 2024 Oct 31.
Not all malignant tumors, especially in hepatocellular carcinoma (HCC) patients with cirrhosis, can be detected by preoperative imaging methods. Therefore, it is urgently necessary to improve the intraoperative detectability of HCCs. Contrast-enhanced intraoperative ultrasonography (CE-IOUS) is an effective technique for detecting and characterizing occulting HCC lesions. We aimed to evaluate the performance of CE-IOUS with the Kupffer phase in the detection and diagnosis of HCC tumors.
From November 2019 to July 2022, we retrospectively enrolled 25 consecutive patients in the Department of General Surgery of Beijing Hospital who had HCC and were scheduled to undergo hepatic surgery. Preoperative magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) were performed pre-operatively. During laparoscopic or open surgery, intraoperative ultrasound (IOUS) and CE-IOUS with Sonazoid were scheduled, and the Kupffer phase was used to detect lesions. Each pathological diagnosis of neoplasm was compared with image information.
Among the total of 25 patients included in this study, there were 72 lesions including 57 HCCs and 15 others. The receiver operating characteristic (ROC) analysis of the four imaging methods was statistically significant. Based on the pairwise comparison of ROC curves, CE-IOUS showed the highest (96.5%) sensitivity, which did not differ significantly from MRI and CEUS (CE-IOUS MRI P=0.946, CE-IOU CEUS P=0.649, all P>0.05). The four imaging methods showed significantly different sensitivities in detecting HCC lesions (Cochran's Q 27.826, P<0.05).
CE-IOUS may be superior to other imaging methods in detecting potentially additional HCC lesions to be removed at the time of surgery. Thus, it can be used as an essential tool for patients with HCC to guide and modify surgical strategies.
并非所有恶性肿瘤，尤其是肝硬化的肝细胞癌（HCC）患者，术前影像学方法都能检测到。因此，迫切需要提高HCC的术中可检测性。术中超声造影（CE-IOUS）是检测和鉴别隐匿性HCC病变的有效技术。我们旨在评估CE-IOUS在Kupffer期对HCC肿瘤的检测和诊断性能。
2019年11月至2022年7月，我们回顾性纳入了北京医院普通外科连续25例患有HCC且计划接受肝脏手术的患者。术前进行了磁共振成像（MRI）和超声造影（CEUS）检查。在腹腔镜或开放手术期间，安排了术中超声（IOUS）和使用Sonazoid的CE-IOUS检查，并利用Kupffer期检测病变。将每个肿瘤的病理诊断与影像信息进行比较。
本研究共纳入25例患者，共有72个病变，其中包括57个HCC和15个其他病变。四种成像方法的受试者操作特征（ROC）分析具有统计学意义。基于ROC曲线的两两比较，CE-IOUS显示出最高的敏感性（96.5%），与MRI和CEUS相比无显著差异（CE-IOUS与MRI，P = 0.946；CE-IOUS与CEUS，P = 0.649，均P>0.05）。四种成像方法在检测HCC病变方面的敏感性存在显著差异（Cochran's Q = 27.826，P<0.05）。
CE-IOUS在检测手术时可能需要切除的潜在额外HCC病变方面可能优于其他成像方法。因此，它可作为HCC患者指导和调整手术策略的重要工具。
