The Value Of Contrast-enhanced Ultrasound In Evaluating Therapeutic Effects Of Malignant Hepatic Masses Treated By Focal Ablation Therapy

PART ONEA comparative study of contrast-enhanced ultrasound and contrast-enhaced MRI in evaluating the therapeutic response of liver cancer treated by microwave ablationObjective To investigate the role of contrast-enhanced ultrasound and contrast-enhanced MRI in evaluating the therapeutic response of liver cancer treated by microwave ablation (MA).Materiala and Methods Fifty-nine patients with a total of 77 lesions underwent contrast-enhanced ultrasound using the microbubble contrast agent Sonovue after focal ablation treatment. All of the lesions were confirmed by fine-needle biopsy or operation. Before treatment 53 patients of 71 lesions were diagnosed as hepatocelluar carcinoma,6 patients of 6 lesions were metastases. The results of contrast-enhanced ultrasound was compared with those of contrast-enhanced MRI with 2 weeks. The absence of enhancement in or around ablation zone was diagnosed as completely necrosis.However,the presence of enhancement in or around the ablation zone was diagnosed as focal remnant or recurrence. The final diagnosis should be made by two kinds of contrast-enhanced imaging exzamination combining the level of blood serum tumor marker, fine-needle biopsy guided by ultrasound or follow-up at least 6 months.Result Taking the final diagnosis as the gold standard, 64 lesions were diagnosed as completely necrosis, 13 lesions were diagnosed as remnant or recurrencement. 69 lesions of the 77 have reached agreement by two exzaminations.62 have got adequate treatment, 7 were not.67 lesions (87.1%)and 65 lesions (84.4%) were diagnosed as necrosis by CEUS and CEMRI respectively. 10 lesions (12.9%)and 12 lesions (15.6%) showing local enhancement in arterial phase and abaissement in late phase were diagnosed as necrosis by CEUS and CEMRI respectively. The sensitivity in evaluating the therapeutic effect of malignant hepatic masses with CEUS and CEMRI were 68.4% vs 73.7%; specificity 98.1% vs 96.3%; accuracy 90.4% vs 90.4%.There were no significant statistical disparity between CEUS and CEMRI (P > 0.05).The sensitivity and specificity in evaluation the therapeutic effect of malignant hepatic masses has been 92.9%和95.3% when combining with CEUS and CEMRI in enaluating therapeutic response (P>0.05) .Conclusion Detecting blood signal in the tumor is one of the measures to access therapeutic response of maligment hepatic masses treated by local ablation therapy. CEUS can show the hemoperfusion of lesions treated by local ablation sensitively, and is of certain evaluation in clinical applycation. Combining with CEUS and CEMRI can greatly increase the sensitivity of diagnosis, so it would be of promising prospect in clinic.PART TWOA Primary study on relationship between contrast-enhanced ultrasonography signs and turnover of malignant hepatic masses treated with local microwave ablation.Purpose To sduty the relationship between contrast-enhanced ultrasound signs and turnover of tumors treated with focalmicrowave ablation.Materials and methods Contrast-enhanced ultrasound were performed on 96 patients with a total of 108 tumors treated by microwave ablation after 1 month. Observing these signs such as:1,enhancement in or around the microwave area; 2,the enhancement style of those abnormal area; 3,the shape of the lesion; 4,the magin of hyperemia; 5,whether those enhancement areas are adjecent to important organs or not. The final diagnosis are confirmed by fine-needle biopsy guided by ultrasound or more than 3 months follow-up. 16 lesions were certified as focal remnant or recurrence.92 lesions were confirmed totally necrosis. Results Single-variable analysis showed that the shape of microwave ablation area(p=0.943) and hyperemia (p=0.823) has no analysis discrepancy between the localrenament or recurrent group and non-recurrent group. Enhancement in or around themicrowave area (p=0.000), the enhancement style of those abnormal area (p=0.004)and wether those enhancement arers are adjecent to important organs or not(p=0.026) has statistical discrepency.Conclusion Contrast-enhanced ultrasound show different signs of hepatic neoplasms treated by local ablation therapy, these signs has certain guide significance to assess the therapeutic effect and turnover,but some untypical lesions should still be follow-up intimately or confirmed by fine-needle biopsy guided by ultrasound.