超声造影对原发性肝癌数字减影血管造影引导下肝动脉化疗栓塞治疗的疗效评估价值

The Value of Contrast-enhanced Ultrasound in the Evaluation of Transcatheter Arterial Chemoembolization Guided by Digital Subtraction Angiography in Hepatocellular Carcinoma

目的:探讨超声造影评估原发性肝癌(HCC)数字减影血管造影(DSA)引导下肝动脉化疗栓塞(TACE)治疗疗效的价值。方法:选择2016年10月至2018年10月我院收治的77例HCC患者,均在DSA引导下行TACE治疗,治疗前后采用超声造影评价疗效。结果:77例HCC患者均顺利完成TACE治疗,治疗后始增强度、增强速率降低(P<0.05),始增时间、达峰时间、峰值加速时间增加(P<0.05)。治疗后完全缓解(CR)+部分缓解(PR)为有效共46例(有效组),稳定(SD)+进展(PD)为无效共31例(无效组),有效组治疗后始增强度、增强速率低于无效组(P<0.05),始增时间、达峰时间、峰值加速时间多于无效组(P<0.05)。受试者工作特征曲线(ROC)分析结果显示,始增时间、达峰时间、峰值加速时间、始增强度、增强速率预测HCC患者DSA引导下TACE治疗疗效的曲线下面积(AUC)分别为0.658、0.717、0.64、0.668、0.713。结论:超声造影定量参数在HCC患者DSA引导下TACE治疗前后有着较为明显的变化,其超声参数达峰时间、增强速率对DSA引导下TACE治疗疗效的预测效能较好。

Objective: To explore the value of contrast-enhanced ultrasonography in evaluating the efficacy of digital subtraction angiography(DSA) guided transcatheter arterial chemoembolization(TACE) in the treatment of hepatocellular carcinoma(HCC). Methods:77 HCC patients admitted to our hospital from October 2016 to October 2018 were selected, all received DSA-guided TACE treatment,and the efficacy was evaluated by contrast-enhanced ultrasonography before and after treatment. Results: All of the 77 HCC patients successfully completed TACE treatment, enhancement degree and enhancement rate decreased after treatment(P<0.05), and initiation time,peak arrival time and peak acceleration time increased(P<0.05). After treatment, complete response(CR)+ partial response(PR) was effective in 46 cases, and stable response(SD)+ progressive response(PD) was ineffective in 31 cases. After treatment, the enhancement degree and enhancement rate of the effective group were lower than that of the ineffective group(P<0.05), and the initiation time, peak arrival time and peak acceleration time was longerer than that of the ineffective group(P<0.05). The results of ROC analysis showed that the area under the curve(AUC) of enhancement degree,enhancement rate, initiation time, peak arrival time and peak acceleration time for predicting the efficacy of DSA guided TACE in HCC patients was 0.658, 0.717, 0.641, 0.668 and 0.713 respectively. Conclusion:Quantitative parameters of contrast-enhanced ultrasonography are of high value in evaluating the efficacy of DSA-guided TACE in HCC patients, and have certain clinical application value.