| Objective: The aim of our study was to evaluate the value of dynamic three-dimensional contrast-enhanced ultrasonography(3D-CEUS) in the HCC artery blood flow distribution. To explore the value of image fusion guided CEUS in detecting liver nodules with abnormal blood supply missed by ultrasonography(US) and CEUS. To evaluate the the value of clinical application of dynamic 3D-CEUS in the assessment of local response to chemical or heat ablation therapy for HCC and compared with2D-CEUS.Methods:The 3D-CEUS examination results of 52 cases of HCC patients were analyzed retrospectively and compared with2D-CEUS results to evaluate two methods difference in the detection rate of nutrient artery of tumor and the display quality of nutrient artery.In 35 patients with HBV cirrhosis, forty-two liver nodules with abnormal blood supply which were missed by US and CEUS but detected by contrast-enhanced CT/MRI were analyzed retrospectively. Image fusion guided CEUS was performed after ultrasound and contrast enhanced CT/MRI images were fused. We analyzed the fusion time, technical success rate, nodule detection rate and diagnosis accuracy rate. Thermal or chemical ablation were performed in 75 patients(89 lesions) with HCC. One month after treatment, 3D-CEUS was usedto evaluate the localresponse to ablation therapy.Thediagnostic efficacy of 3D-CEUS was evaluated by comparing with CECT/CEMRI as referencestandards. Eighty-five patients with 106 HCCs confirmed by pathology treated by means of radiofrequency ablation(33 cases with 43 HCCs), microwave ablation(35 cases with 44 HCCs),and ethanol ablation(17 cases with 19 HCCs)?Follow-up examination including 2D-CEUS?3D-CEUS and CECTwere performed at 1,3,6 and 12 months. With CECT as the reference standard, the diagnostic ability of 2D-CEUS and 3D-CEUS in detecting recurrence during follow-up was evaluated.Results:In all 52 cases, the detection rate of nutrient artery of tumor was 67.3%(35/52) by 2D-CEUS and 100%(52/52) by 3D-CEUS, the detection rate of 3D-CEUS was higher than that of 2D-CEUS(P<0.05). The display quality of nutrient artery of3D-CEUS was better than that of 2D-CEUS(P<0.05). Image fusion was underwent successfully in all 35 patients, the technical success rate was 100%. Average fusion time was 4.1±1.8 min. Forty liver nodules with abnormal blood supply were detected by image fusion guided CEUS, and the detection rate was 95.2%(40/42). The diagnosis accuracy rate of image fusion guided CEUS was 97.5%(39/40), and two nodules misdiagnosed by contrast-enhanced CT were diagnosed correctly by image fusion guided CEUS. Complete ablation was diagnosed in lesions of 82.0%(73/89) by 3D-CEUS and 80.9%(72/89) lesions by CECT/CE-MRI. According to CECT, the complete ablation rates and local recurrence rates were 84%(89/106) and 16%(17/106),respectively.With CECT as the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 3D-CEUS and 2D-CEUS in detecting recurrence after LAT was 82.4%(14/17)and 88.2%(15/17),98.9%(88/89) and 98.9%(88/89), 93.3%(14/15) and 93.8%(15/16),96.7%(88/91)and 97.8%(88/90),96.2%(102/106) and 97.2%(103/106),respectively.Thediagnostic results between 3D-CEUS and 2D-CEUS showed no statistically significant difference(?2 =0.14,P=1.00)but a high degree of consistency(Kappa=0.74,P=0.00).Conclusions:The dynamic 3D-CEUS can efficiently evaluate the HCC artery blood flow distribution, and provide abundant information for the diagnosis and treatment of HCC. It is used as a useful complement to 2D-CEUS. Image fusion guided CEUS had a high detection rate and diagnosis accuracy rate for liver nodules with abnormal blood supply missed by US and CEUS. 3D-CEUS was feasible and useful in the assessment of therapeutic response of HCC treated with LAT, provided similar diagnostic performance as 2D-CEUS.3D-CEUS could be an effective initial screening test. |
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