超声造影定量分析评价HCC行TACE术后局部疗效的影响因素

Hepatocellular carcinoma treated with transcatheter arterial chemoembolization: influence factors of local efficacy analyzed by parametric contrast enhanced ultrasound

目的研究超声及超声造影定量分析技术在评价经导管肝动脉栓塞化疗(TACE)疗效中的价值,评估TACE局部疗效的影响因素。方法从2011年8月至2014年3月,共61例[男60例,女1例,年龄18~76(53±13)岁]接受一次TACE治疗的原发性肝细胞肝癌(HCC)患者纳入本前瞻性研究。所有病例在TACE治疗前1~7 d内及术后(3、15 d及30 d)接受多次超声造影(CEUS)检查。随后利用定量分析软件(Sono Liver)进行离线定量分析,获取定量参数。TACE术后30 d,依照改良实体瘤疗效评估标准(mRECIST),用对比增强CT(CECT)及CEUS评估TACE疗效,以其作为局部疗效的参考标准。结果相关性分析显示,术前的肝动脉峰值流速(PSV)与参考标准呈中度负相关(rs=-0.436,P=0.011)。参考区术后3 d及分析区术前的达峰时间(TTP)与参考标准呈低度负相关(rs=-0.264及-0.268,P=0.047及P=0.037)。结论部分超声指标及超声造影定量分析参数可用于预测TACE的局部疗效。

Objective To analyze the influence factors of local efficacy by parametric contrast enhanced ultrasound (CEUS) of the hepatocellular carcinoma (HCC) patient treated with transcatheter arterial chemoembolization (TACE),and to investigate the application value of parametric CEUS in TACE.Methods From August 2011 to March 2014,a total of 61 HCC patients [60 men,1 women;age range: 18-76 years,mean age:(53±13)years old] who underwent one procedure of TACE were enrolled in this prospective study.All cases were scanned by CEUS 1-7 days before and after TACE (3 days,15 days and 30 days post-TACE).Analysis of tumor perfusion during the procedure of CEUS was performed with dedicated software (SonoLiver,TomTec,Germany and Bracco,Italy).Time-intensity curves were plotted and parameters were extracted.According to modified response evaluation criteria in solid tumors (mRECIST),we evaluated the response of TACE using contrast-enhanced computed tomography (CECT) and CEUS 30 days after TACE,which was as reference standard.Results There was a middle negative correlation between the reference standard and the PSV of the hepatic artery pre-TACE,and the correlation coefficient was 0.436 (P=0.011).There was a low negative correlation between the reference standard and the TTP of the reference region on 3 days post-TACE and the analysis region pre-TACE,and the correlation coefficient was -0.264 and -0.268 (P=0.047,P=0.037).Conclusions Our preliminary study suggests,some parameters of CEUS can predict the local response of TACE.