Application Value In Early Diagnosis And Treatment Of Recurrence Liver Cancer After Treatment:CEUS Combined With US/Gd-EOB-DTPA MRI Fusion Imaging

Objective To investigate the clinical application value of contrast-enhanced ultrasound(CEUS)combined with fusion imaging technology of ultrasound and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid enhanced magnetic resonance imaging(Gd-EOB-DTPA MRI)in early diagnosis and treatment of recurrence hepatocellular carcinoma.MethodsFrom January 2015 to December 2016,34 patients with 76 suspicious recurrence lesions were found by Gd-EOB-DTPA MRI examination in our hospital enrolled in this prospective study,and those patients belongs to high-risk populations who had treatment history of hepatocellular carcinoma.All the patients underwent CEUS examination,the fusion imaging of US and Gd-EOB-DTPA MRI.Use Fisher's Exact Test to compare the detection rate of suspicious lesions in ultrasound image before and after fusion imaging,to compare the recurrence of patients with solitary suspicious lesion and multiple suspicious lesions,and to compare and analyze the enhancement mode of CEUS and Gd-EOB-DTPA MRI,and then to assess the value in guiding treatment.The cases were followed up by AFP and imaging examination.Results 76 suspicious lesions showed hypo-enhancement in the hepatobiliary phase of Gd-EOB-DTPA MRI.There were 61 lesions among the suspicious lesions showed hyper-enhancementin the arterialphase;the others didn't show hyper-enhancement in the arterial phase(4 lesions had hyper-enhancement in portal venous phase,11 lesions showed hypo-enhancement or no enhancement).Before fusion imaging,53%(40/76)of them could be seen and 47%(36/76)lesions were invisible in conventional US.The invisible lesions could be shown difficult lesions by fusion imaging of Gd-EOB-DTPA MRI and US/CEUS,and the success rate of fusion examination was 100%(76/76).The visible rate of lesions increased to 97%(74/76)in conventional US.The remaining invisible 2 lesions also can be detected by fusion imaging of Gd-EOB-DTPA MRI and CEUS.The detection rate was significantly increased,and the difference was statistically significant(P=0.000).CEUS showed 76 lesions(100%),43of the lesions showed hyper-enhancement in the arterial phase,noenhancement of 1 lesionand the other 27 lesions were iso-enhancement during the whole three phases.The enhancement mode of arterial phase and late phase in Gd-EOB-DTPA MRI were compared with that in CEUS,and all of the three phases had statistical differences(the P value were 0.002 and 0.000,respectively).The enhancement mode of portal venous phase in Gd-EOB-DTPA MRI was compared with that in CEUS,and there wasn't statistical difference(the P value was 0.074).A total of 34 patients with 76 lesions were followed up,including 45 lesions were treated with RFA,1 lesion underwent surgical resection,2 lesions were treated with PEI,6 lesions underwent comprehensive treatment of RFA combined with PEI,and the other 22 lesions didn't be treated.During the follow-up,22 patients had no definite recurrence after treatment,and the other 12 cases were found metastasis and recurrence lesions.The recurrence of patients with single suspicious recurrence lesion and patients with multiple lesions hasn't statistical difference(the P value was 0.282).ConclusionFusion imaging of US and Gd-EOB-DTPA MRI can improve the detection rate of suspicious lesions on US.CEUS combined with Gd-EOB-DTPAMRI play a guiding role in the selection of treatment strategy,can be more effective in the early diagnosis and treatment of recurrent hepatocellular carcinoma after treatment and improve the prognosis of patients.