Quantitative Analysis And Study On Liver Neoplasms By Contrast-enhanced Ultrasonography

Objective: To study the pattern of perfusion of 50 patients with hepatic tumors in the arterial phase with pulse inversion harmonic imaging(PIH) technique, the shape feature and the acoustic quantified parameters were analyzed according to the TIC, then compare the flow rank and mean flow density (MFD) before and after contrast enhanced ultrasound(CEUS). To investigate the clinical value of the acoustic quantified parameters of CEUS in the evaluation of perfusion of hepatic benign and malignant tumors.Methods: In this study, fifty patients with hepatic lesions (15 hepatocellular carcinoma, 15 metastatic liver tumors, 20 hepatic hemangioma) were examined with PIH imaging after an intravenous administration of SonoVue. For all the patients, the first step was to detect the liver by the using of conventional two-dimensional ultrasonography, recording the location, diameter, echo phenomenon of local lesions etc;then the blood flow signals in the lesions or at the fringe of them were observed by switching on the color power angiography(CPA), and were measured by pulse Doppler ; then the primary diagnoses were obtained before the CEUS. Contrast enhancing 2.4ml of SonoVue contrast agent was injected quickly through superficial vein of the elbow in 3-5s, and then rinsed by 5ml of physiological saline solution. When the rapid of injecting of contrast agent, the real-time contrast-enhanced ultrasonography state was launched simultaneously after the choice of optimal section for observation , then the dynamic injection transformation of lesion was observed continually on the real time. In the late phase of CEUS (after 240s), the blood flow signals in the lesion were observed by switching on the color power angiography (CPA) again. All active data of the CEUS were store in the computer hardware. When the CEUS finished, the images were analyzed. Observe the pattern of perfusion of 50 patients with hepatic tumors in the arterial phase, and the quantity of perfusion of hepatic tumors was analyzed according to the acoustic quantified parameters of the time-intensity cure(TIC). The MFD was the quantitative index of blow flows with before CEUS CPA , on the peak time CPA and the last phase of CEUS CPA, which was calculated using Auto CAD2004. The results above were analyzed statistically.Results: 1 The pattern of perfusion of different hepatic tumors in the arterial phase. 53% of hepatocelluler carcinoma (HCC) and 40% of metastasis liver cancer (MLC) showed holistic inhomogeneous enhancement; 47% of HCC and 33% of MLC showed homogeneous enhancement; 27% of MLC showed peripheral enhancement; 95% of hepatic hemangioma (HCH) showed peripheral and centripetal enhancement.2 Characters of benign and malignant hepatic tumors in TIC. TIC appeared slow-up and slow-down type in the benign lesion, but quick-up and quick-down type in the malignant lesion.3 Comparision of perfusion parameters between benign and malignant hepatic tumors. The accelerating time(AT) in the malignant lesions were significantly shorter than the benign lesions, the ascending slope of the cure(β) and the product of A(amplitude of peak intensity) andβin the malignant lesions were significantly higher than those in the benign lesions (P<0.001), there was no significant difference of A between benign and malignant lesion.4 The flows in benign and malignant hepatic tumors were graded half-quantificationally. Before CEUS CPA 50 hepatic tumors showed short wirelike or strip like flow message at the periphery, no significant flow signal or punctuate flow messages inside of those lesions. In the late phase, CPA showed the number of punctate or strip like flow messages increased both at the periphery and inside of those lesions, and some signals were clearly found encircling the lesions. After CEUS, CPA showed a significant increase at gradeⅡorⅢfrom 13 to 41.5 Quantitative comparision of MFD between benign and malignant hepatic tumors before and after CEUS. Before CEUS CPA showed MFD of the benign and malignant lesions were 0.04±0.04 and 0.08±0.07 respectively. The latter was significantly higher than the former(P<0.05). On the peak time of CEUS, MFD of the benign and malignant lesions were 0.56±0.12 and 0.79±0.16 respectively. The latter was significantly higher than the former(P<0.001). In the late phase of CEUS, MFD of the benign and malignant lesions were 0.08±0.06 and 0.17±0.10 respectively. The latter was significantly higher than the former(P<0.05). MFD of the hepatic tumors on the peak time and in the late phase of CEUS was significantly higher than those before CEUS in 50 cases (P<0.05,P<0.001)Conclusions: 1 CEUS could significantly enhance the signal of blood flows in hepatic tumors, show the tiny vessels and truly reflect the growth and distribution of tumors'vessels.2 After CEUS, as a result of benign and malignant hepatic tumors have blood support and vary of vascularity inside of lesion, they showed different perfusion and enhance pattern. A second-generation contrast equiped with low mechanical index grey-scale imaging delineated clearly the dynamic enhancement in order that the ability to diagnose the hepatic tumor was obviously increased.3 TIC of CEUS has good correlation with the change of blood flow. The cure reflect the change of contrast agent follow the time and quantify the image which our eyes saw.4 Contrast and analyze of flow rank and quantitative index MFD of hepatic tumor before and after CEUS, with a quantitative method impersonal reflect enhanced effect to flow message. It is important to diagnose, prognosis and curative effect after operation by investigating hepatic tumor'blood supply.5 CEUS quantitative analysis is valuable for the diagnosis of malignant and benign tumors.