The Study Of The Application Of Contrast-enhanced Ultrasonography Combining With Time-intensity Curve In Assessing Therapeutic Response In Microwave Ablation Of Hepatoma

Objective:We investigated the characteristic of contrast-enhanced ultrasonography (CEUS)with SonoVue in hepatoma before and after microwave ablation treatment (MWA)and compared the quantitative parameters of the time-intensity curve (TIC) of thelesions before and after MWA, aiming to explore the value of CEUS with SonoVueand the quantitative parameters of TIC in evaluating the effect of MWA in hepatoma.Thus, providing more reliable detection indexes for clinical evaluation of the effect ofMWA. So that we can detect the residual or recurrent lesions earlier, and prepare thenext treatment measures as soon as possible, so as to improve the survive rate ofpatients.Materials and methods:1.80hospitalized patients (92lesions,27women and53men; median age(55.9±11.5) years, range31-85years) who had liver cancer were selected in theSecond Affiliated Hospital of Nanchang University from March2012to November2013. All of the patients had CEUS examinations before MWA,1month,3monthand6month after MWA. A high resolution ultrasound machine equipped with a1–5MHz multi-frequency convex transducer was used for all sonographic examinations(iU22, Philips Healthcare, Bothell, WA, USA). SonoVue (Bracco, Milan, Italy) wasused.2. All patients received the examination of contrast-enhanced computedtomography (CECT) within two days of having CEUS. We divided the patients intotwo groups (completely inactivated group and residual or recurrent group) at the timeof1month after MWA,3month after MWA and6month after MWA respectivelyaccording to the results of CEUS, CECT, liver tissue biopsy and the level of serumtumor markers. TIC was analyzed. Through LDRW WIWO fitting, quantitativeanalysis parameters were obtained. Then we calculated how many lesions did CEUS and CECT find respectively before MWA; compared the parameters of the lesionswith the parameters of their surrounding liver parenchyma at the time ofpre-operation,1month after MWA,3month after MWA and6month after MWA;compared the parameters of the lesions before MWA with the parameters of thelesions1month after MWA; compared the parameters of the lesions before MWAwith the parameters3month after MWA and compared the parameters before MWAwith the parameters6month after MWA; compared the ability of discovering residualor recurrent lesions during simple CEUS, CEUS combined with TIC and CECT too.If residual or recurrence were discovered, the treatment of MWA would be madeagain. For the patients who had several times of treatment, the calculation of time wasreferred to the date of the first treatment.Results:1.92lesions were found by CEUS, and83lesions were found by CECT beforeMWA.All of the9lesions which were not found by CECT were hypovascular lesions.59cases of the80patients were hepatocellular carcinoma, and all of them were singlelesions,21cases (33lesions) were hepatic metastases.2.128times of MWA had been taken,52patients (52lesions) had MWA once,8patients (10lesions) twice, and20patients (30lesions) three times.71patients usedCECT to guide in MWA. All of the9patients with negative CT results used CEUS toguide in MWA. CEUS in1month,3month,6month later suggested that all of thelesions were completely inactivated.3. All lesions of patients in completely inactivated group were analyzedquantitatively by the use of TIC before MWA,1month,3month and6month afterMWA, and were compared with surrounding liver parenchyma. Results suggested thatthe parameters of RT, MTT and TTP of the tumors before MWA were obviously lessthan the liver parenchyma, the differences were statistically significant (P<0.05).However, the parameter of WIS before MWA was obviously more than the liverparenchyma in1month,3month and6month after MWA, the differences werestatistically significant (P<0.05). There were no significant intergroup differences inAUC, PI and DT/2(P>0.05). All of the TIC of completely inactivated group show up as a straight line in1month,3month and6month after MWA.4. All lesions of patients in the residual or recurrent group were analyzedquantitatively by the use of TIC before MWA,1month,3month and6month afterMWA, and were compared with surrounding liver parenchyma. The parameters of RT,MTT and TTP of the tumors before MWA,1month,3month and6month after MWAwere obviously less than the liver parenchyma, the differences were statisticallysignificant (P<0.05). The parameter of WIS was obviously more than the liverparenchyma, the differences were statistically significant (P<0.05). However, therewere no significant intergroup differences inAUC, PI and DT/2(P>0.05).5. Quantitative parameters of the residual or recurrent group before MWA werecompared with the parameters1month,3month and6month after the operationrespectively. Results revealed that there were no significant differences on thequantitative parameters between pre-operation and1month after MWA, betweenpre-operation and3month after MWA, between pre-operation and6month afterMWA(P>0.05).6. The results of CEUS and CECT, liver tissue biopsy and the level of serumtumor markers were used as the standard of the treatment effect of MWA. And wecompared CEUS with CECT in the ability of discovering residual or recurrent lesionsin1month,3month and6month after MWA. The results revealed that there weresignificant differences in the evaluation of treatment effect of MWA in liver cancerpatients between CEUS and CEUS combining with TIC1month,3month and6month after MWA (P<0.05), but no differences between CEUS combining with TICand CECT (P>0.05).Conclusion：1. CEUS can show the position, number and the relationship with the adjacentstructures, display the liver tumor blood vessels, therefore, provides valuableinformation for ablation range and selection of treatment strategy.2. CEUS can guide the needle during operation and monitor ablation rangereal-timely, not only ensuring the safety of the surrounding organizations, but alsodestroying the tumor tissue in maximum. It is particularly applicable for the lesions appeared as isodensity focus in CECT, so as to improve the one-time success rate ofMWA.3. TIC and acoustic quantified parameters of CEUS were beneficial to evaluatethe angiogenesis of liver tumors, and reflected the minute difference among the livertumors, the hepatic parenchyma, and the residual tumor. It played an important role indepicting residual or recurrent tumor immediately after MWAand follow-up.4. CEUS combining with TIC as a quantitative, economic, non-radioactive andreal-time technology, can accurately discriminate the coagulation necrosis fromresidual tumors after MWA. There is no difference in detecting residual or recurrenttumors between CEUS combining with TIC and CECT. Furthermore, CEUScombining with TIC is more sensitive in detecting tiny residual or recurrent focus. Itis an effective method to adequately assess the therapeutic response in MWA.