超声造影定量分析评估原发性肝细胞肝癌患者行经导管肝动脉化疗栓塞术前后血流灌注的改变

Quantitative analysis of perfusion changes of hepatocellular carcinoma treated by transcatheter arterial chemoembolization using contrast enhanced ultrasound

目的 通过超声造影定量分析技术评价原发性肝细胞肝癌(HCC)接受经导管肝动脉化疗栓塞(TACE)术后1个月内残余肿瘤血流灌注随时间变化情况,探讨其在TACE中的应用价值。方法 选取2011年8月至2014年3月在广东省广州市中山大学附属第一医院接受一次TACE治疗的HCC患者61例纳入本前瞻性研究。其中,男性60例,女性1例,年龄18~76岁,平均年龄(53±13)岁。纳入病例在TACE术前及术后接受多次超声造影(CEUS)检查。利用定量分析软件进行脱机分析,提取出各个定量参数,采用wilcoxon符号秩和检验及配对t检验进行比较。结果 TACE术前的峰值强度(IMAX)及灌注指数(PI)明显高于术后3 d,差异均有统计学意义(Z=-4.852、-3.723,P均<0.01)。TACE术后3 d的PI低于术后30 d,差异有统计学意义(Z=-2.272,P=0.009)。TACE前后峰值强度及灌注指数的变化大致表现为术后3 d IMAX及PI值显著下降,术后15 d较术后3 d略有上升,术后30 d较术后3 d则有较明显上升,但仍低于术前。结论 TACE术后残余病灶的血流灌注水平在术后3~15 d范围内处于最低。超声造影定量分析技术提供了一种评估TACE术后血流灌注改变的无创性方法。

Objective To analyze the perfusion change of hepatocellular carcinoma(HCC)treated by transcatheter arterial chemoembolization(TACE)using parametric contrast enhanced ultrasound(CEUS),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 and 1 women;age range:18-76 years,mean age:53±13 years)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).Then,tumor perfusion during the procedure of CEUS was analyzed with dedicated software.Time-intensity curves were plotted and parameters including rise time(RT),time to peak(TTP),maximum of intensity(IMAX),and mean transit time(mTT)were extracted.Results The IMAX and perfusion index(PI)pre-TACE were significantly higher than that those at 3 days post-TACE(all P<0.01).The PI at 3 days post-TACE was lower than that at 30 days post-TACE(P=0.009).According to the quantitative parameters at 15 days post-TACE,the IMAX and PI decreased at 3 days post-TACE,then increased a little at 15 days,and increased obviously at 30 days but was still lower than that pre-TACE.Conclusion The perfusion level of residual tumors after TACE is the lowest during 3-15 days post-TACE.CEUS provides a noninvasive tool to evaluate the perfusion change of HCC after TACE.