动态超声造影监测高强度聚焦超声治疗腹部恶性肿瘤疗效的临床价值

Clinical value of dynamic contrasted enhanced ultrasound in monitoring therapeutic effect of high-intensity focused ultrasound in abdominal malignant tumor

目的通过比较腹部恶性肿瘤在高强度聚焦超声(high-intensity focused ultrasound,HIFU)治疗前后的动态超声造影(dynamic contrast enhanced ultrasound,DCEUS)定量分析曲线及灌注参数,探讨DCEUS技术在HIFU治疗腹部恶性肿瘤疗效随访中的临床应用价值。方法从2018年9月到2021年5月,前瞻性地纳入计划接受HIFU治疗的腹部恶性肿瘤患者,所有的病灶经穿刺或手术病理证实,且临床诊断为晚期恶性肿瘤。在HIFU开始治疗前1天及4周后分别进行超声造影(contrast enhanced ultrasound,CEUS)检查。Vuebox图像分析软件分析CEUS检查过程并生成时间-强度曲线(time intensity curve,TIC),并得到定量参数,包括峰值强度(peak enhancement,PE)、上升时间(rise time,RT)、达峰时间(time to peak,TTP)、平均渡越时间(mean transit time,mTT)及曲线下面积(area under curve,AUC)。比较HIFU治疗前后腹部恶性肿瘤病灶大小、CEUS增强-消退表现、TIC曲线、定量参数及肿瘤标志物的差异。结果本研究最终纳入患者共19例。HIFU治疗前后,患者肿瘤标记物及病灶大小及CEUS表现均无明显变化。DCEUS分析结果显示,相较于HIFU治疗前,HIFU治疗后肿瘤病灶的TIC曲线峰值强度降低、曲线下面积缩小。在所有DCEUS定量参数中,PE[(32920.63±24822.71)a.u vs.(17296.11±16570.41)a.u,P=0.001]及AUC[(624665.28±593711.71)a.u vs.(309148.00±366938.07)a.u,P=0.002]均显著低于治疗前。结论DCEUS可在评估HIFU治疗腹部恶性肿瘤疗效时监测病灶微循环血流灌注,定量参数PE及AUC是具有潜在意义的评估参数。

Objective To evaluate the clinical value of dynamic contrast enhanced ultrasound(DCEUS)in monitoring therapeutic effect of high-intensity focused ultrasound(HIFU)in patients with solid abdominal malignant tumors by compare the quantitative ananlysis curve and perfusion parametters.Methods From Sep 2018 to May 2021,patients with histopathologically confirmed advanced abdominal malignant tumors and planned to receive HIFU treatment were prospectively included.Contrast enhanced ultrasound(CEUS)examinations were performed 1 day before and 4 weeks after the initiation of HIFU treatment.CEUS cines in DICOM form were converted into time intensity curves(TICs)using Vuebox software.Various quantitative CEUS parameters were generated after curve fitting,including peak enhancement(PE),rise time(RT),time to peak(TTP),mean transit time(m TT)and area under curve(AUC).Comparisons of sizes,CEUS enhancement patterns,shape of TICs,quantitative CEUS parameters and serum tumor marker levels were conducted before and after HIFU treatment.Results A total of 19patients were prospectively enrolled(10 women,9 men;average age,58.84±10.08 years).While comparing before and after HIFU treatment,no significant difference was observed on mean size of lesions,CEUS features or serum tumor markers.After HIFU treatment,TICs showed decreased enhancement,and AUC decreased either.Among all CEUS quantitative parameters,significant decrease could be found in PE[(32920.63±24822.71)a.u vs.(17296.11±16570.41)a.u,P=0.001]and AUC[(624665.28±593711.71)a.u vs.(309148.00±366938.07)a.u,P=0.002].Conclusion DCEUS may be a potential imaging method in detecting microvascular change of HIFU in patients with abdominal solid malignant tumor lesions.PE and AUC might be useful DCEUS quantitative parameters.