Correlation Between Contrast-enhanced Ultrasound Mode And Clinical Prognosis Of Pancreatic Cancer

Objective1.To observe the characteristics of pancreatic cancer(PDAC)lesions in conventional ultrasound and contrast-enhanced ultrasound,and analyze the characteristics of the enhanced mode;2.To analyze the correlation between different ultrasound enhanced modes of PDAC and overall survival(prognosis);3.To analyze the correlation between the parameters of PDAC contrast-enhanced time-intensity curve and patient survival(OS)and contrast-enhanced mode,and explore the differences of the parameters and verify their effectiveness.4.To explore the correlation between ultrasound enhancement mode,tumor angiogenesis and fibrosis potential.Data and Methods50 patients was enrolled in Peking Union Medical College Hospital from January 2014 to June 2018.50 cases were confirmed of locally advanced PDAC by ultrasound-guided percutaneous biopsy.All patients underwent conventional ultrasound and CEUS before pathological results were obtained.And enhanced contrast-enhanced ultrasound modes were summerized.Clinical data such as age,gender,tumor size and serum CA199 level were collected.The overall survival of the patients was traced back by telephone(the follow-up time was up to February 2019).Ultrasound contrast enhanced dynamic images were analyzed by image processing software QONTRAXT.Time-intensity curves and parameters such as peak,TP,sharpness and AUC were collected to analyze the correlation between parameters,enhancement mode and overall survival.Immunohistochemical staining was performed on lesion tissue which obtained large needle histological specimens to assess the expression levels of EGFR,SMA,VEGF,and integrin β1.Result1.In this study,50 cases of PDAC lesions showed low echo and poor border,the maximum diameter was 4.63±1.05cm,and necrosis occurred in 10%lesion.CDFI showed no blood flow signal detected in 78%(39/50)of the lesions.In CEUS,100%of PDAC lesions showed rapid enhancement in arterial phase and rapid decline in venous phase.28%of the lesions showed an increase in arterial phase,and the remaining 72%showed low enhancement.The arterial phase enhanced pattern and patient gender,age of onset,and lesions.There is no significant correlation in size.2.The overall survival(median overall survival 627.1±311.6 days)of hyperenhanced group of patients with PDAC lesions was significantly longer than that of the hypoenhanced group(median overall survival 321.0±205.5 days),There was no significant correlation between lesion size,the survival period,patient gender and age of onset.3.①Some of the ultrasound contrast time-intensity curve parameters including absolute peak intensity(AEpeak),relative peak intensity(REpeak)and absolute curve sharpness(AEsharpness)were negatively correlated with patient survival;tumor tissue sharpness(sharpnesstumor)was positively correlated with patient survival.②The peak intensity of the tumor tissue(peaktumor)in hyperenhanced group was higher in the hypoenhanced group on CEUS;tumor tissue sharpness(sharpnesstumor),the absolute curve sharpness(AEsharpness),and the relative curve sharpness(REsharpness)in the hypoenhanced group was lower in hyperenhanced group.③Contrast-enhanced time-intensity curve parameters,including peaktumor,sharpnesstumor,AEpeak,AEsharpness and REsharpness,can objectively distinguish contrast-enhanced contrast mode,in which AEpeak has higher sensitivity and specificity than other parameters,respectively 92.9%and 86.1%④According to the contrast-enhanced curve-intensity curve parameters peaktumor and AEpeak to distinguish the contrast-enhanced contrast-enhanced mode,the prognosis of the hyperenhanced group was significantly better than hypoenhanced group.Patients with the parameter peaktumor>45.6,defined as hyperenhanced group has better prognosis;the parameter AEpeak>10.1,tends to hypoenhanced group has poor prognosis.4.10 cases of PDAC lesions were immunohistochemical staining,VEGF,integrinβ1 were negative,and there are no significance between EGFR and SMA on the CEUS enhanced mode.Conclusion1.The CEUS manifestations of PDAC are enhanced and low-enhanced modes of arterial phase,which are significantly associated with prognosis(survival),and patients with enhanced mode have longer survival.2.In the time-intensity curve parameters of CEUS,patients with higher peak intensity of(tumor tissue peaktumor>45.6)designed as hyperenhanced group,has better prognosis;the absolute peak intensity AEpeak>10.1,designed as hypoenhanced group has poor prognosis.AEpeak can be used as an objective indicator to distinguish CEUS enhanced mode,with sensitivity and specificity of 92.9%and 86.1%,respectively.3.Use CEUS to observe the enhanced mode of PDAC,and refer to its time-intensity curve parameters to conduct further risk stratification before PDAC patients’ chemotherapy,and to classify the efficacy.