三维超声造影定量分析评价肝细胞肝癌血流灌注的可行性研究

Feasibility of the quantitative assessment of blood perfusion in hepatocellular carcinoma by using three-dimensional contrast-enhanced ultrasound

目的探讨三维超声造影(three-dimensional contrast-enhanced ultrasound,3D-CEUS)定量分析评价肝细胞肝癌(hepatocellular carcinoma,HCC)血流灌注特征的可行性。方法选取2020年1月至2021年8月于复旦大学附属中山医院经病理及临床证实的36例初发且未经任何治疗的HCC患者(共39个病灶),分别行二维超声造影(two-dimensional contrast-enhanced ultrasound,2D-CEUS)和3D-CEUS检查。持续造影150 s并存盘,应用仪器内置的定量分析软件对原始数据进行分析。取整个病灶为感兴趣区,生成时间-强度曲线(time-intensity curve,TIC)并获得以下定量参数:峰值强度(peak intensity,PI)、达峰时间(time to peak,TTP)、平均渡越时间(mean transit time,MTT)、上升支斜率(ascending slope,AS)和曲线下面积(area under the curve,AUC)。计算曲线与原始数据的拟合度(quality of fit,QOF)。比较同一医师两次进行图像分析得到的3D-CEUS定量参数并分析其可重复性;对QOF>75%病灶的3D-CEUS和2D-CEUS定量参数进行一致性评价和Spearman相关分析;比较不同分组(按病灶深度分为≤8 cm和>8 cm两组,按病灶坏死率分为≤50%和>50%两组)病灶3D-CEUS定量参数的差异。结果所有病灶中有38个(97.4%,38/39)TIC的QOF>75%。医师组内行图像分析获取3D-CEUS定量参数的组内相关系数(intraclass correlation efficient,ICC)值为0.85~0.99。QOF>75%的病灶3D-CEUS与2D-CEUS时间定量参数TTP和MTT的ICC分别为0.87和0.91,病灶3D-CEUS与2D-CEUS强度定量参数PI、AS和AUC的rs值分别为0.71、0.72和0.71。不同深度两组病灶的3D-CEUS定量参数差异有统计学意义(均P<0.05);不同坏死率两组病灶的3D-CEUS定量参数差异无统计学意义(均P>0.05)。结论3D-CEUS定量分析用于评价病灶深度≤8 cm的HCC血流灌注具有良好的可重复性,有临床应用价值。

Objective To investigate the clinical feasibility of three-dimensional contrast-enhanced ultrasound(3D-CEUS)in the quantitative assessment of blood perfusion of hepatocellular carcinoma(HCC).Methods Between January 2020 and August 2021,36 HCC patients(39 lesions in total)confirmed by pathology and clinical diagnosis without any treatment from Zhongshan Hospital,Fudan University were enrolled and underwent both 2D-CEUS and 3D-CEUS examinations.Each examination last for 150 s and all images were recorded,and then the data were analyzed.A region of interest was manually drawn along the margin of the whole tumor and then the time-intensity curve(TIC)generated.The following perfusion parameters were extracted:peak intensity(PI),peak time(TTP),ascending slope(AS),mean transit time(MTT)and area under the curve(AUC).After calculating the quality of fit(QOF)of the curve,the intraobserver agreement of the 3D-CEUS quantitative parameters obtained by the same doctor between two times were assessed,and the consistency of the 3D-CEUS and 2D-CEUS quantitative parameters was evaluated when QOF>75%.The differences of the quantitative parameters between different groups(divided by depth of 8 cm and necrosis rate of 50%,respectively)in 3D-CEUS were compared.Results There were 38 lesions(97.4%,38/39)with QOF>75%in 3D-CEUS.The intraobserver agreement was excellent,the intraclass correlation efficient(ICC)values was 0.85-0.99.The consistency of the time quantitative parameters(TTP and MTT)were high(the ICC values of 0.87 and 0.91),and the correlation of intensity quantitative parameters were substantial,the rs values were 0.71,0.72 and 0.71.The differences in 3D-CEUS quantitative parameters of the two groups of lesions with different depths were statistically significant(all P<0.05);but there were no significant differences in quantitative parameters between the two groups with different necrosis rate(all P>0.05).Conclusions Quantitative 3D-CEUS is an useful and creditable tool in evaluating the blood perfusion of HCC,especially when the depth of lesion was less than 8 cm.