| 摘要: |
| 目的：探讨靶向超声造影剂Sonazoid在转移性肝癌(MLC)化学药物治疗疗效评估中的应有价值。方法：经临床确诊并拟行化学药物治疗的MLC患者30例。所有患者化疗前、化疗2个疗程后均行增强CT/增强MRI(CECT/CEMRI)及超声造影(CEUS)检查。多发病灶则选取最大的病灶进行CEUS观察。对化疗前病灶、正常肝组织CEUS时间强度曲线(TIC)各定量参数进行对比分析,分析的参数包括：始增时间(AT)、造影剂未到达时的基本强度(BI)、造影剂上升斜率(AS)、达峰时间(TTP)、峰值强度(PI)及3分钟曲线下面积(AUC)。化疗两个疗程后,CECT/CEMRI根据mRECIST标准进行疗效评估,将30例患者分为有效组与无效组。对比分析两组患者化疗前后各病灶TIC曲线定量参数。结果：(1)CECT/CEMRI疗效评估结果为有效组10例,无效组20例。CEUS与CECT/CEMRI评估MLC病灶增强范围最大径变化情况同步性高,达96.7%。(2)化疗前,30例MLC患者30个转移灶的TTP、PI、AUC的值低于正常肝组织,差异具有统计学意义(P＜0.05),BI、AT、AS与周围肝组织差异无统计学意义(P＞0.05),12例病灶中出现坏死,坏死区的TIC曲线呈一条平直直线。(3)无效组与有效组化疗前各参数差异无统计学意义(P＞0.05)。无效组化疗前后各参数变化差异无统计学意义(P＞0.05)；有效组化疗后BI、PI、AUC值较化疗前下降,差异具有统计学意义(P＜0.05),而AT、TTP、AS化疗前后变化差异无统计学意义(P＞0.05)。(4)有效组与无效组BI化疗前后差值(△BI)、PI化疗前后差值(△PI)及AUC化疗前后差值(△AUC)存在差异,差异具有统计学意义(P＜0.05),△BI、△PI及△AUC值评估化学疗效的ROC曲线的曲线下面积分别是0.795、0.785、0.920,最佳截断值分别是0.075dB、2.24dB、432.18dB×s,相对应的约登指数分别是0.550、0.600、0.800,灵敏度分别是90%、100%、100%,特异度分别是65%、60%、80%。结论：靶向CEUS可有效鉴别转移灶、正常肝组织及坏死区。CEUS可定量评估化疗过程中血管分布变化情况,定量参数BI、PI、AUC在MLC患者化学药物治疗疗效评估中具有重要意义。 |
| 关键词: 转移性肝癌 超声造影 定量评估 靶向超声造影剂 化学疗法 |
| DOI： |
| 投稿时间：2022-06-16修订日期：2022-07-10 |
| 基金项目:超声医学新技术的开展及临床应用(YY-1),医学影像四川省重点实验室开放课题基金(MIKLSP2021010),川北医学院附属医院第一批临床研究课题(2021LC004),川北医学院2021年度校级课题(CBY21-QA40) |
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| Application of Targeted Ultrasound Contrast Agent Sonazoid in the Evaluation of Chemotherapy Efficacy in Metastatic Liver Cancer |
| chenwen,yanghao,heping,tangxiaoqing,yangyou,liyang,Yujinghong |
| () |
| Abstract: |
| Objective: To evaluate the value of Sonazoid in chemotherapeutic therapy for metastatic liver cancer (MLC). Methods: There were 30 patients with MLC who were clinically confirmed and planned to receive chemotherapy. All patients underwent contrast-enhanced computer tomography (CECT) or contrast-enhanced magnetic resonance imaging (CEMRI) and contrast-enhanced ultrasound (CEUS) examinations before chemotherapy and after 2 courses of chemotherapy. For multiple lesions, the largest lesions were selected for CEUS observation. The quantitative parameters of CEUS time intensity curve (TIC) of lesions and normal liver tissue before chemotherapy were compared and analyzed, includingcontrast agent arrive time(AT), basic intensity before contrast agent arrival (BI), ascending slope of contrast agent (AS), peak time to peak (TTP), peak intensity (PI) and area under 3-minute curve (AUC). After two cycles of chemotherapy, CECT or CEMRI evaluated the efficacy according to mRECIST criteria, and 30 patients were divided into effective group and ineffective group. Quantitative parameters of TIC curve of each lesion before and after chemotherapy were compared and analyzed between the two groups. Result: (1) CECT or CEMRI efficacy evaluation results showed that there were 10 cases in the effective group and 20 cases in the ineffective group. CEUS and CECT or CEMRI showed a high degree of synchronicity in the maximum diameter change of MLC lesion enhancement area, up to 96.7%. (2) Before chemotherapy, TTP, PI and AUC values of 30 metastases in 30 MLC patients were lower than those in normal liver tissue, with statistically significant differences (P<0.05), while BI, AT and AS showed no statistically significant differences with surrounding liver tissue (P>0.05). Necrosis occurred in 12 lesions, and the TIC curve of necrotic lesions presented a straight line. (3) There was no significant difference in parameters before chemotherapy between the ineffective group and the effective group (P>0.05). There was no statistical significance in parameters of ineffective group before and after chemotherapy (P>0.05). BI, PI and AUC values of effective group decreased after chemotherapy compared with those before chemotherapy, with statistical significance (P<0.05), while AT, TTP and AS showed no statistical significance before and after chemotherapy (P>0.05). (4) The difference of BI before and after chemotherapy (△BI), PI before and after chemotherapy (△PI) and AUC before and after chemotherapy (△AUC) between the effective group and the ineffective group was statistically significant (P<0.05). △BI, △PI and △AUC values were 0.795, 0.785 and 0.920, respectively. The optimal cut-off values were 0.075dB, 2.24dB and 432.18dB×s, respectively. The corresponding Youden indices were 0.550, 0.600 and 0.800. The sensitivity was 90%, 100%, 100%, and the specificity was 65%, 60%, 80%. Conclusion: CEUS can effectively identify the metastases, normal liver tissue and necrotic areas. CEUS can quantitatively evaluate the changes of vascular distribution during chemotherapy, and the quantitative parameters BI, PI and AUC are of great significance in the evaluation of chemotherapy efficacy in MLC patients. |
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