The Clinical Study Of Using Of Contrast-enhanced Ultrasound (CEUS) In Evaluating The Therapeutic Effect Of TACE For Primary Liver Cancer

Background/Aims:At present,we usually use Contrast-enhanced MRI(CEMRI)or Contrast-enhanced computed tomography(CECT)to evaluate the therapeutic effect of transarterial chemoembolization(TACE)for primary liver cancer(PLC).However,dense lipiodol depositions after TACE therapy can mask the enhancement of viable PLC tissue in CECT;Contrast-enhanced MRI(CEMRI)has high diagnostic accuracy,but is limited by its long appointment time and high cost;Contrast-enhanced ultrasound(CEUS)could be effective in detecting small areas of viability and patency in vessels,and it has been included in PLC diagnosis and treatment norms of China.We investigated the application value of CEUS,CECT and CEMRI in evaluating the efficacy of TACE for PLC.Method:The study was divided into two parts.Part ? was retrospective study:Forty-three patients with HCC who received TACE were enrolled in the study from January 2013 to January 2018,.All patients were examined by CEUS and CECT after TACE.With the results of digital subtraction angiography(DSA),Liver biopsy(LB)or the results of follow-up as the gold-standard,the detection results were compared.Part ? was a prospective study design.Twenty subjects of HCC underwent CEUS and CEMRI examinations 4 weeks after TACE.Second TACE would be performed or liver biopsy before other trentments when any one of the two tests was positive;when both tests were negative,they would be re-evaluated at 12th week.The final assessment criteria were DSA,LB or follow-up results.The detection results were compared between CEUS and CEMRI.Result:In the first part of the study,assessment of 43 TACE-treated target lesions were eventually confirmed by DSA or follow-up results,with 37 positive and 6 negative lessions respectively.In the 37 positive lesions,35 were detected by CEUS,and 26 were detected by CECT.Five of six negative lesions were detected by CEUS and CECT were 5.The sensitivity and accuracy of CEUS and enhanced CT in the diagnosis of positive lesions after interventional therapy were 94.6%(35/37),93%(40/43),and 70.3%(26/37),72.1%(31/43),respectively,with statistically significant difference(p<0.05).Among the 20 subjects of HCC that were included in the prospective study,13 and 7 were ultimately diagnosed as positive and negative.Of the 13 positive lesions,12 were detected by CEUS and 10 by CEMRI.With the results of digital subtraction angiography(DSA),Liver biopsy(LB)or the results of clinical follow-up as the gold-standard,the sensitivity and accuracy rate were 92.3%(12/13),76.9(10/13)and95.0%(19/20),85.0%(17/20),repectively.Th-e consistency of CEUS and final diagnosis was better(Kappa>0.85),while The consistency of CEMRI and final diagnosis was poor(Kappa<0.7).Conclusion:CEUS is a reliable method for evaluating the therapeutic effect of TACE for HCC;CEUS may partially replace CECT/CEMRI in early assessment of TACE.