超声造影定量评估新辅助治疗后直肠癌的微循环血流及与微血管密度相关性

Quantitative assessment of microcirculation perfusion state of rectal cancer patients after neoadjuvant treatment by contrastenhanced ultrasound

背景新辅助治疗有助于进一步提高直肠癌患者的术后疗效,降低肿瘤复发率,改善患者生活质量.准确评估其疗效意义重大.超声造影(contrast-enhanced ultrasound,CEUS)作为一种能实时显示目标组织微循环状态的超声新技术,能为临床评估疗效提供可靠的血流动力学参考.目的探讨CEUS定量评估新辅助治疗后直肠癌的微循环血流灌注状态变化,及其与微血管密度(microvessel density,MVD)相关性.方法选取在我院行新辅助治疗的进展期直肠癌患者106例,所有患者于治疗前后行CEUS检查,测定病灶微循环血流灌注参数,并与手术后标本MVD进行比较分析.结果新辅助治疗后病灶最大直径较治疗前明显减少,差异有统计学意义(P<0.05);新辅助治疗后病灶曲线下面积(area under the curve,AUC)、峰值强度(peak intensity,PI)较治疗前明显下降,差异有统计学意义(P<0.05);新辅助治疗后病灶PI、AUC分别与MVD呈正相关(r=0.82,P<0.05;r=0.79,P<0.05).结论CEUS能客观反映直肠癌微循环血流灌注状态,其血流灌注参数与MVD有较好相关性,可为临床评估直肠癌新辅助治疗效果提供血流动力学参考.

BACKGROUND Neoadjuvant treatment is helpful to improve the postoperative curative effect,reduce the recurrence rate,and improve the life quality of patients with rectal cancer.It is of great significance to evaluate the curative effect accurately.As a new ultrasound technology,contrast-enhanced ultrasound(CEUS)can display the microcirculation state of target tissue in real time,thus providing reliable hemodynamic information for clinical evaluation.AIM To evaluate the changes of microcirculation perfusion state of rectal cancer patients after neoadjuvant treatment by CEUS,and its correlation with microvessel density(MVD).METHODS One hundred and six patients with advanced rectal cancer who underwent neoadjuvant treatment were selected at our hospital.All patients underwent CEUS before and after treatment.The parameters of microcirculation perfusion were measured by CEUS,and compared with MVD of the samples after the operation.RESULTS The maximum diameter of the lesion after treatment was significantly reduced than that before treatment(P<0.05).The area under the curve(AUC)and the peak intensity(PI)of the lesion after treatment were significantly decreased than those before treatment(P<0.05).The PI and AUC after treatment were positively correlated with MVD(r=0.82,P<0.05;r=0.79,P<0.05),respectively.CONCLUSION CEUS can objectively reflect the microcirculation perfusion state of rectal cancer patients,and its perfusion parameters have a good correlation with MVD,which can provide hemodynamic information for clinical evaluation of neoadjuvant treatment of rectal cancer.