超声超微细彩色血管成像技术评价经肝动脉化疗栓塞治疗的原发性肝癌患者肿瘤血供效能初步应用研究

doi:10.3969/j.issn.1672-5069.2018.04.006

摘要/Abstract

摘要： 目的探讨应用超声超微细彩色血管成像（SMI）技术评价经导管肝动脉化疗栓塞术（TACE）治疗的原发性肝癌（PLC）患者病灶血供情况。方法 2014年1月~2015年12月在我院接受TACE治疗的PLC患者45例（56个病灶）,术后1个月,接受增强CT、超微细彩色血流成像（SMI）和彩色多普勒血流成像（CDFI）检查。以增强CT作为对照,绘制受试者工作特征曲线（ROC曲线）,并计算曲线下面积（AUC）,比较同一病灶的血供情况。结果增强CT评估病灶血供的能力优于CDFI（x²=38.205,P<0.001）或SMI（x²=12.010,P=0.001）;以增强CT为标准,SMI评估病灶血供的能力优于CDFI（x²=9.583,P=0.002）;进一步对不同方法诊断病灶血供的效能显示,SMI检查的ROC曲线下面积大于CDFI（P=0.031）,SMI判断病灶血供的灵敏度、准确度和阴性预测值分别为62.4%、58.9%和31.5%,均优于CDFI的30.4%、28.4%和21.1%（x²=20.612,P<0.001;x²=10.251,P=0.001;x²=2.956,P=0.041）;SMI可以清晰地显示直径<2.0 cm的病灶内部血流,但是CDFI未显示血流信号,SMI评估病灶血供的能力优于CDFI（x²=5.758,P=0.016）;对于直径≥2 cm的病灶,SMI和CDFI均可显示病灶血流,但是SMI评估病灶血供的能力优于CDFI（x²=6.560,P=0.010）。结论 SMI技术是一种新型血流成像技术,能较好地检测病灶的血供情况,为临床评价PLC患者在TACE术后疗效提供了一种新的方法。

关键词: 原发性肝癌, 肝动脉化疗栓塞术, 超微细彩色血管成像, 彩色多普勒血流成像

Abstract: Objective To investigate the application of superb micro-vascular imaging （SMI） in the evaluation of blood suply in intrahepaitc lesions in patients with primary liver cancer（PLC） underwent transcatheter arterial chemoembolization （TACE）. Methods 45 patients with PLC were recruited in our hospital between January 2014 and December 2015. All patients received TACE, and 1 month later,they received computer tomography （CT）,SMI and color doppler flowimaging（CDFI）. The blood supply of lesions was compared with the contrast of enhanced CT scan. Results A total of 56 focci was found in the 45 patients with PLC,including 35 with single and 10 with multiple （21 foci）. The ability of enhanced CT scan in assessing lesion blood supply was better than CDFI （x²=38.205,P<0.001） or SMI （x²=12.010,P=0.001）;SMI assessment of blood supply was better than CDFI （x²=9.583,P=0.002）; furthermore,the diagnostic efficacy in assessing the blood supply by the area under the ROC curve with the CT scan as the golden criteria showed that the SMI was better than CDFI （P=0.031）,the sensitivity,accuracy and negative predictive value by SMI were 62.4%,58.9% and 31.5%,much better than by CDFI （30.4%,28.4% and 21.1%,x²=20.612,P<0.001, x²=10.251,P=0.001,x²=2.956,P=0.041）;SMI clearly showed the blood suply in lesions with diameters less than 2.0cm, while CDFI showed no blood flow signal in the same lesions（x²=5.758,P=0.016）,and SMI and CDFI both showed the blood flow in lesions greater than 2 cm,still the SMI assessment was better than CDFI（x²=6.560,P=0.010）. Conclusion SMI technology is a new approach of blood flow imaging, which can be used to detect the blood supply of tumor foci, which might provide a new method for the clinical evaluation of the curative effect of liver cancer after TACE.

Key words: Hepatoma, Transcatheter arterial chemoembolization, Superb micro-vascular imaging, Color doppler flow imaging

杨志军, 赵丽娟. 超声超微细彩色血管成像技术评价经肝动脉化疗栓塞治疗的原发性肝癌患者肿瘤血供效能初步应用研究[J]. 实用肝脏病杂志, 2018, 21(4): 509-512.

Yang Zhijun, Zhao Lijuan. Application of superb micro-vascular imaging in the evaluation of blood suply in intrahepaitc lesions in patients with primary liver cancer underwent TACE[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(4): 509-512.

参考文献

[1] Pinato DJ,Howell J,Ramaswami R,et al.Review article: delivering precision oncology in intermediate-stage liver cancer.Aliment Pharmacol Ther,2017,45(12):1514-1523.
[2] Li J,Zhang F,Yang J,et al.Combination of individualized local control and target-specific agent to improve unresectable liver cancer managements:a matched case-control study.Target Oncol,2015,10(2):287-295.
[3] 周晓琳. TACE术治疗原发性肝癌患者临床路径分析. 实用肝脏病杂志,2012,15(6):580-581.
[4] Edeline J,Boucher E,Rolland Y,et al.Comparison of tumor response by response evaluation criteria in solid tumors (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer,2017,118(1):147-156.
[5] Jiang T,Zhu AX,Sahani DV.Established and novel imaging biomarkers for assessing response to therapy in hepatocellular carcinoma. J Hepatol,2013,58(1):169-177.
[6] Jia Z,Diao XH,Jin JM,et al.Superb microvascular imaging—A new vascular detecting ultrasonographic technique for avascular breast masses:A preliminary study. Eur J Radiol,2016,85(5):915-921.
[7] Hans P.American association for the study of liver diseases. Hepatology,2010,18(7):1-5.
[8] Yamada T,Makita F,Takehara K,et al.Evaluation of the therapeutic effect of TAE on primary liver cancer. Cancer Chemother Pharmacol,1994,33(1):55-59.
[9] Huppert P,Wenzel T,Wietholtz H. transcatheter arterial chem-oembolization(TACE) of colorectal cancer liver metastases by irinotecan-eluting microspheres in a salvage patient population. Cardiovasc Intervent Radiol,2014,37(1):154-164.
[10] Au J,Frenette C.Development of tivantinib as treatment for hepatocellular carcinoma. J Clin Transl Hepatol,2013,1(1):75-78.
[11] Patidar KR,Kang L,Siddiqui MS,et al.The utility of fractional excretion of urea for the differential diagnosis of acute kidney injury in decompensated cirrhotics on diuretic therapy. Gastroenterology,2017,152(5):1149.
[12] Minami Y,Kudo M.Therapeutic response assessment of transcatheter arterial chemoembolization for hepatocellular carcinoma:ultrasonography,CT and MR imaging. Oncology,2013,84(1):58-63.
[13] Wang Y,Liao J,Qi W,et al.Predictive value of conventional ultrasound and contrast-enhanced ultrasound in early recurrence of hepatocellular carcinoma after surgical resection. Ultrasound Med Biol,2016,42(5):1042-1048.
[14] Tai CJ,Huang MT,Wu CH,et al.Contrast-enhanced ultrasound and computed tomography assessment of hepatocellular carcinoma after transcatheter arterial chemo-embolization:A systematic review. J Gastrointestin Liver Dis,2017,25(4):499-507.
[15] Ma S,Liu J,Zhang Y,et al.Application of color Doppler ultrasound combined with Doppler imaging artifacts in the diagnosis and estimate of congenital hypertrophic pyloric stenosis. Sci Rep,2017,7(1):9527.
[16] Lecler A,Boucenna M,Lafitte F,et al.Usefulness of colour Doppler flow imaging in the management of lacrimal gland lesions. Eur Radiol,2016,27(2):1-11.
[17] 罗福成. 原发性肝癌血供的彩色多普勒超声检查研究进展. 实用肝脏病杂志,2005,8(6):372-375.
[18] 刘水清,马一博,韩宗宏, 等. 超微细血流成像技术评价原发性肝癌介入治疗疗效的价值. 中华肝脏病杂志,2017,25(7):328-331.
[19] Cantisani V,David E,Ferrari D,et al.Color Doppler ultrasound with superb microvascular imaging compared to contrast-enhanced ultrasound and computed tomography angiography to identify and classify endoleaks in patients undergoing EVAR. Ann Vasc Surg,2017,40:136-145.
[20] Sato T,Terasawa Y,Mitsumura H,et al.Utility of superb micro-vascular imaging(SMI) for evaluating morphological change after carotid artery stenting. Neurosonology,2017,30(2): 35-37.