| ObjectiveTo explore the value of contrast-enhanced ultrasound(CEUS)in sequential treatment of liver cancer by combination of transcatheterarterial chemoembolization(TACE)and percutaneous microwave coagulation therapy(PMCT),thus to provide CEUS imaging reference for clinical treatment of liver cancer.MethodsStage ?:There were a total of 188 lesions after TACE in the 163 selected from patients with liver cancer:The CEUS and color Doppler ultrasound examinations were analyzed and compared to investigate the effects of CEUS in efficacy evaluation after TACE in patients with liver cancer and selection of appropriate patients who were prepared to perform PMCT.Stage ?:There were a total of 155 lesions after TACE in the 135 selected patients with liver cancer who were suitable for PMCT.The real-time CEUS and contrast-enhanced computed tomography(CECT)or contrast-enhanced Magnetic resonance imaging(CE-MRI)examinations 1 week after surgery were analyzed and compared to investigate the effect of real-time CEUS in monitoring the residual lesions after the PMCT and guidance of additional therapy.Stage ?:There were 121 lesions after sequential therapy in the 109 selected patients.The reexamination CEUS after 1 month and CECT or CE-MRI in the same period were analyzed and compared to investigate the effect of CEUS in the liver cancer after combination of TACE and PMCT sequential therapy.Results1.Color Doppler ultrasound demonstrated that 73.8%(62/84)of the patients with blurred borderline lesions showed increased diameter lines in the CEUS.Color Doppler ultrasound also demonstrated that 81.7%(98/120)of patients with clear borderline lesions showed no increased diameter lines in the CEUS.The two groups were compared and the results showed that the difference was statistically significant(P<0.05).It can be considered that the constituent ratio of using color Doppler ultrasound to examine the clear or blurred boundary lesions is different from that using the CEUS to detect whether the inferior diameter line is increased or not In one case of single lesion,the CEUS showed a longest diameter>50mm after the increase in diameter.A total of 17 cases of small disseminated lesions with a diameter<10mm were found in the 6 patients.2.Comparison of the real-time CEUS and CECT or CE-MRI examination one week after surgery showed that the sensitivity,specificity and accuracy of real-time CEUS for diagnosing the residual lesions during PMCT were 80.0%(12/15),96.4%(135/140)and 94.8%(147/155),respectively.There was no statistical difference between real-time CEUS and CECT or CE-MRI one week after surgery in the diagnosis of residual lesions(P>0.05).3.The CEUS examination was performed on 121 lesions one month after the sequential treatment.111 lesions(92.7%,111/121)were not enhanced in the third phase of the ablation zone,which were considered for complete ablation.10 lesions(8.3%,10/121)were showed local enhancement in the early arterial phase,which were suggested for residual lesions.Compared with the results of CECT or CE-MRI examininations in the same period,the sensitivity,specificity and accuracy of CEUS reexamination after TACE combined PMCT sequential therapy were 81.8%(9/11),99.1%(109/110)and 97.5%(118/121),respectively.There was no statistical difference in the diagnostic result between reexamination of CEUS after one month and CECT or CE-MRI in the same period(P>0.05).Conclusions1.Compared with color Doppler ultrasound,the CEUS has higher diagnostic sensitivity.When the color Doppler ultrasound shows blurred boundaries,it is highly suggested the increased diameter lines.It is recommended to perform the CEUS to more accurately evaluate the efficacy of TACE and select patients more suitable for the PMCT.2.Compared with the CECT or CE-MRI one week after surgery,the diagnostic results of the real-time CEUS are highly correlated Also,it can additionally treat the residual lesions in the PMCT and judge whether the surgery is completed or not,thus effectively reducing the residual rate of the lesion.3.The diagnostic results of CEUS reexamination one month after surgery and CECT or CE-MRI are highly consistent.After sequential treatment in liver cancer,it has advantages of simple operation,rare energencies,and accurate assessment of efficacy.In summary,the CEUS has important clinical application value in TACE combined PMCT sequential treatment of liver cancer. |
PDF Full Text Request