Contrast-Enhanced Ultrasonographic Appearance Of Gastric Carcinoma And The Relationship Between Enhanced Intensity And Microvessel Density

Gastric carcinoma is one of the most popular carcinoma,the case fatality rate of gastric carcinoma ranking the first place of all malignant carcinoma in China,angiogenesis in gastric carcinoma can be regard as the basic of tumor invasion and growth,microvessel density(MVD) is an important factor which reflects the activity and strength of angiogenesis,and MVD can be regarded as an important and independent prognosis factor.MVD of gastric carcinoma is becoming increasingly important,but the results of MVD can only obtained through surgery or biopsy. In our study,patients were examined by contrast enhanced ultrasonography(CEUS) before surgery operation,discussed the enhanced appearance of CEUS,the relationship between the enhanced intensity(EI) of CEUS and MVD of the resection specimen was also discussed in our study.Methods37 gastric carcinoma patients were examined by CEUS,and confirmed by surgery pathology,22 male,15 female.GE LOGIQ 9 color sonography system,with 4C probe,its frequency was 2-4MHz,mechanic index was 0.07-0.10,and equipped with contrast pulse sequence contrast enhanced software,Tru agent detection and acoustic quantitative analysis software.Contrast agent Sonovue (Bracco,Italy) consists of sulfur hexafluoride(SF6) surrounded by phospholipids.The stomach was scanned with a conventional sonogram to select an appropriate section,then using contrast enhanced sonograme mode,frame rate was 15,dynamic range was 40,Sonovue was injected as a bonus of 2.4ml through the antecubital vein,the entire scanning process was recorded for 5-8 min.The enhancement patterns were analyzed by two physicians,region of interest(ROI) was placed in gastric carcinoma lesions and normal gastric wall,to obtain the time-intensity curve(TIC),record the peak intensity (PI),basic intensity(BI),and calculate the enhanced intensity (EI):EI=PI-BI.Move the ROI into the same position of gastric carcinoma lesions and normal gastric wall frame by frame if stomach peristaltic.The gastric carcinoma lesions and normal gastric wall slices were stained by CD34 with immunohisto-chemical techniques(S-P technique),and count MVD.Weidner method or Taniganwa method was used.Analyze the correlation between El of CEUS and MVD.Results1.37 cases of gastric carcinoma lesions and normal gastric wall can clearly display in CEUS.2.37 gastric carcinoma lesions enhanced in the artery phase homogeneously or heterogeneously,and quickly washed out in the venous phase.Triple-layer structure of gastric wall were identified after Sonovue was intravenously injected,the inner layer with high enhanced,the middle layer with low enhanced,and the outer layer with high enhanced.3.The El in gastric carcinoma was higher than that in normal gastric wall,the difference was significant(P<0.05).MVD in gastric carcinoma was higher than that in normal gastric wall,the difference was significant(P<0.05).4.There was a positively linear correlation between El and MVD in gastric carcinoma lesions (r=0.77, P<0.01).Conclusions1.The enhancement appearance of gastric carcinoma lesions and normal gastric wall is different,CEUS can clearly display the boundaries and scope of gastric carcinoma lesions.2.The El of gastric carcinoma is correlated to MVD,the parameters of TIC obtained preoperation can evaluate haemodynamic circulation,indirectly reflect the generation of neoangiogenesis.