| Background:Hepatocellular carcinoma(HCC)is the most common primary malignant tumor of liver.HCC mainly develops from nodules of hepatitis B cirrhosis nodules.Screening of hepatitis B,chronic liver disease and other high risk groups of HCC is helpful for early diagnosis and treatment of HCC,so as to improve the treatment effect and the life quality of patients with liver cancer.Ultrasound(US)has become the most common imaging examination method for screening and follow-up of high-risk groups of HCC due to its advantages of convenience and real-time dynamic image.However,the sensitivity of conventional US for the diagnosis of some HCCs is relatively low,so it is necessary to combine with other imaging methods to make a diagnosis.Contrast-enhanced ultrasound(CEUS)technology and gadoliniumethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(Gd-EOB-DTPA MRI)are two emerging imaging techniques in recent year,CEUS technology can dynamically display the perfusion characteristics in and around liver tumors in hepatic arterial phase,portal phase and delayed phase through intravenous injection of contrast agent.Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)is a specific contrast agent for T1-weighted MRI examination of liver tumors,also known as "liver tumor-specific contrast agent".It can obtain not only the above-mentioned three-phase enhanced images of intrahepatic tumors,but also the hepatobiliary specific phase,which provides information about normal hepatocyte function.Both the two imaging techniques have greatly increased the detection rate of HCC.However,their diagnostic accuracy in HCC as well as their respective advantages and disadvantages are still controversial,especially that the diagnostic accuracy of the two methods in different sizes still needs further studied.Currently,hepatectomy,liver transplantation and local ablation are the main three methods for radical treatment of HCC.Although the preferred method is hepatectomy,most patients lose the opportunity of surgical resection due to poor liver function or in the middle or advanced stage.In recent years,radiofrequency ablation(RFA)as a representative of local ablation therapy is developing rapidly.Due to its advantages of small trauma,mild pain,and definite curative effect,some HCC patients who are not suitable for surgery operation have the opportunity to be treated.US has become the most commonly used guidance technique for liver RFA due to its advantages of simple convenience and real-time imaging.However,the narrow surgical field and operating space during RFA surgery increases the difficulty for clinicians to perform this type of surgery.The three-dimensional visualization model of liver is established based on CT,MRI and other imaging sections by using three-dimensional visualization technology,which can clearly show the relationship among the lesion,the surrounding important organs and large vessels.Designing the RFA puncture path on the three-dimensional visualization model of the liver and completing the simulated ablation operation will help improving the accuracy and safety of RFA treatment.Objective:(1)To analyze the imaging features of CEUS and GD-EOB-DTPA MRI of HCC and to compare the accuracy of the two in the diagnosis of HCC as well as their respective advantages and disadvantages were discussed.(2)To establish the personalized three-dimensional visualization model of the liver based on the GD-EOB-DTPA,and then,choose a safe virtual puncture path of RFA according to the characteristics of US guidance,and evaluate the application value in precise guidance of RFA for liver cancer.Methods:This study is divided into the following two parts:1.Clinical value of CEUS and Gd-EOB-DTPA MRI in the diagnosis of HCC: The clinicand pathological data of 274 intrahepatic lesions in 250 patients with liver tumors of our hospital from January 2017 to December 2018 were retrospectively analyzed.All patients underwent CEUS and Gd-EOB-DTPA MRI examinations.All features of intrahepatic lesions were analyzed,and the sensitivity,specificity and accuracy of the two methods in the diagnosis of HCC were compared.Pathological results were obtained by puncture or surgical resection of all the lesions.2.Application of 3D Visualization model of liver based on MRI data combined with ultrasound in precise guidance of RFA of liver Cancer: Gd-EOB-DTPA MRI images of 21 patients treated with RFA in our hospital were collected.The skin,liver,hepatic artery,portal vein,hepatic vein,gallbladder,liver tumor and other structures were segmented to establish a personalized three-dimensional visualization model of the liver using Amira 5.2.1(France TGS company)software According to the characteristics of ultrasound guidance,RFA virtual puncture path were designed and planed.Application value of its combined US in accurately guiding RFA for liver cancer was studied.Results:1.Clinical value of CEUS and Gd-EOB-DTPA MRI examination in the diagnosis of HCC:(1)Image feature analysis of the two HCC examinations in different phases: Of the 274 lesions,223 were HCC and 51 were non-HCC.During CEUS for HCC,out of 223 lesions,167 lesions were associated with the image characterization of "fast in and fast out",7 lesions were missed diagnose and 49 lesions were misdiagnosed.During Gd-EOB-DTPA MRI for HCC,out of 223 lesions,178 lesions were accorded associated with the image characterization of "fast in and fast out",1 lesion were missed diagnose and 44 lesions were misdiagnosed.In arterial phase,92.83%(207/223)of the lesions displayed hyper-enhanced on CEUS,and 80.72%(180/223)of the lesions displayed hyper-enhanced on Gd-EOB-DTPA MRI(P < 0.05).In portal vein phase and delayed phase,78.48%(175/223)of the lesions displayed hypo-enhanced on CEUS,and 96.41%(215/223)of the lesions displayed hypo-enhanced on Gd-EOB-DTPA MRI(P < 0.05).On Gd-EOB-DTPA MRI,98.2%(219/223)of the lesions displayed hypo-enhanced in hepatobiliary phase,and 96.41%(215/223)of the lesions displayed hypo-enhanced in portal vein phase and delayed phase(P(29)0.05).(2)The diagnostic efficacy of the two methods and their combined diagnostic efficacy in≤ 5cm HCC: In all lesions and in lesions with diameter ≤ 2 cm,>2 cm and ≤ 3 cm,>3 cm and≤ 5,there were no significant differences in the sensitivities,specificities and accuracy rates for HCC diagnosis between the methods(all correted P > 0.05),the sensitivity and accuracy of the combined for HCC diagnosis were both higher than that of CEUS alone(correted P <0.05),while the difference in diagnostic specificity was not statistically significant(correted P > 0.05).2.Application of 3D Visualization model of Liver based on MRI data combined with US in precise guidance of RFA of liver Cancer:(1)The construction of a personalized three-dimensional visualization model of the liver:A personalized three-dimensional visualization model of the liver was construct on the basis of the GD-EOB-DTPA MRI images set of HCC patients in which,the tumor and its surrounding blood vessels and important organs in the liver can be clearly and three-dimensionally displayed,it can perform interactive operations such as rotation,dragging,and size adjustment in any direction,which is conducive to comprehensive observation of the position of the tumor.Additionally,a safe virtual puncture path of RFA can be designed according to the characteristics of ultrasound guidance.(2)Clinical verifications: The personalized liver three-dimensional visualization model is help for designing the RFA safe needle access path according to the characteristics of US guidance,which can effectively guide the implementation of RFA and improve the successment rate of ablation.In this study,under the guidance of personalized three-dimensional liver model,only 1 needle was needed to the tumor center for RFA treatment in all 21 patients,and no complications occurred in any of them.Conclusion:1.CEUS and GD-EOB-DTPA MRI have their own advantages in the diagnosis of HCC≤ 5 cm.The real-time monitoring ability of CEUS for arterial wash in of contrast agent of CEUS is superior to that of Gd-EOB-DTPA MRI,and the evaluation of wash out of contrast agent Gd-EOB-DTPA MRI is superior to that of CEUS.Both of them have good diagnostic accuracy for HCC of different sizes less than 5 cm.CEUS combined with Gd-EOB-DTPA MRI can significantly improve the sensitivity and accuracy of CEUS alone in the diagnosis of HCC.2.The personalized three-dimensional visualization model of the liver established in this study can assist clinicians to perform precise RFA puncture path,which lays a foundation for the realization of precise treatment of RAF for liver cancer.It also lays a foundation for further research on the integrated function of diagnosis and treatment of US combining the advantages of MRI,CT and other imaging. |
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