| Objective:To investigate the correlation between quantitative parameters of co ntrast-enhanced ultrasound (CEUS) and the biologicalperformance (microthrombus, satellite foci, capsule, degree of differentiation, degree of cirrhosis, Ki67 an d expression of VEGF) in patients with primary hepato-cellular carcinoma (HCC); to explore the risk factors of HCC recurrence after radical surgical resection; to provide a theoretical basis for the study of CEUS, clinical features and pro gnosis of HCC.Materials and methods:(1) During Nov 2013 to Nov 2014, 45 patients with HCC underwent surgical res ection in PLA General Hospital, over the same period 45 patients with HCC un derwent interventional ultrasound-guided percutaneous thermal ablation in our dep artment. All the patients were at stage la (single nodule with a diameter ≤ 3 c m; no tumor thrombus or metastasis; Child A) or stage Ib (single nodule with a diameter ≤ 5 cm; no tumor thrombus or metastasis; Child A). The location o f the lesions in the group by ablation was more than 1 cm from the dangerous parts such as vessels, gastrointestinal duct, bile duct (gallbladder, bile duct). Pa tients are in good general condition with no serious vascular disease and diseas es of heart,brain,lung and kidney. Patients received no other anti-tumor treatment before and after the operation. and were followed-up at 1,3,6,9 and 12 mo nths and every six months thereafter by enhanced MRI/CT, CEUS, AFP, liver function,and we mainly focused on the intrahepatic and extrahepatic recurrence and metastasis.(2) Patients underwent preoperative ultrasound, CEUS and all the images were st ored in real-time video storage. We analyzed CEUS parameters of tumor and para tumor tissues by the software of SonoLiver.(3) We obtained complete specimen, fixed them by formalin and cut themby 2m m spacing layer. The cancer specimens were stained with HE, Ki67, VEGF immuno histochemistry. The biological performance of tumors were observed under micr oscope (microthrombus, satellite foci, capsule, degree of differentiation, degree o f cirrhosis, Ki67 and expression of VEGF).(4) Analyze the correlation between the quantitative parameters of CEUS,the en hancement mode, and microthrombus, satellite foci, capsule, degreeof differentia tion, degree of cirrhosis, Ki67 and expression of VEGF (5) Analyze the potenti al risk factors of recurrence after resection of HCC.(5)Compare the difference of the quantitative parameters of CEUS in patients presenting with tumor recurrence between surgical resection groupand ablation group.Results:(1)tTTP, tRT, tMTT, ENSR, WT were significantly different in high, moderate a nd low differentiation groups (P<0.05)(2) tTTP and tRT in HCC patients who have microthrombus were significantly 1 ower than that of patients who have no microthrombus, while tIMAX and ENS R were significantly higher than that of patients who have no microthrombus (P <0.05)(3) tTTP and tRT in patients with satellite focus were significantly lower than t hat of patients who have no satellite focus, while tIMAX and ENSRwere signifi cantly higher than that of patients who have no satellite focus (P<0.05)(4) tTTP and tRT were significantly higher in HCC patients with complete caps ule group than that of patients with incomplete capsule group (P<0.05)(5) pTTP, p-tMTT, pMTT, p-tTTP, p-tRT and pRT were significantly lower in HCC patients with severe liver cirrhosis than in patients with mild liver cirrhosis (P<0.05).(6) tTTP, tRT, tIMAX, tMTT and p-tTTP were negatively correlated to the expr ession of VEGF and Ki67 in HCC patients ,whereas ENSR was positively corre lated to the expression of VEGF (P<0.05)(7) tTTP, tRT, microthrombus, VEGF and Ki67 were significantly differente between recurrent group and non-recurrent groups after surgical resection (p<0.05)(8) tTTP, p-tTTP and tIMAX were not different between recurrent group after surgical resection and recurrent groups after ablation (p> 0.05)Conclusion:(1) The quantitative parameters of CEUS are closely related to the biological per formance of HCC. CEUS can partly manifest the tumor pathology and expressio n of VEGF and Ki67.(2) Microthrombus and tTTP were risk factors for recurrence after surgical resec tion in our study.(3) There was no significantly difference in the quantitative parameters of CEUS between recurrent group after surgical resection and recurrent groups after ablati on.(4) Analysis of quantitative parameters of CEUS can effectively evaluate the clini cal biological performance of HCC and predict the recurrence of HCC after sur gical resection. |
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