目的 通过比较腹部恶性肿瘤在高强度聚焦超声（high-intensity focused ultrasound，HIFU）治疗前后的动态超声造影（dynamic contrast enhanced ultrasound，DCEUS）定量分析曲线及灌注参数，探讨DCEUS技术在HIFU治疗腹部恶性肿瘤疗效随访中的临床应用价值。方法 从2018年9月到2021年5月，前瞻性地纳入计划接受HIFU治疗的腹部恶性肿瘤患者，所有的病灶经穿刺或手术病理证实，且临床诊断为晚期恶性肿瘤。在HIFU开始治疗前1天及4周后分别进行超声造影（contrast enhanced ultrasound，CEUS）检查。Vuebox图像分析软件分析CEUS检查过程并生成时间-强度曲线（time intensity curve，TIC），并得到定量参数，包括峰值强度（peak enhancement，PE）、上升时间（rise time，RT）、达峰时间（time to peak，TTP）、平均渡越时间（mean transit time， mTT）及曲线下面积（area under curve，AUC）。比较HIFU治疗前后腹部恶性肿瘤病灶大小、CEUS增强-消退表现、TIC曲线、定量参数及肿瘤标志物的差异。结果 本研究最终纳入患者共19例。HIFU治疗前后，患者肿瘤标记物及病灶大小及CEUS表现均无明显变化。DCEUS分析结果显示，相较于HIFU治疗前，HIFU治疗后肿瘤病灶的TIC曲线峰值强度降低、曲线下面积缩小。在所有DCEUS定量参数中，PE ［（32 920.63±24 822.71）a.uvs. （17 296.11±16 570.41） a.u，P=0.001］及AUC［（624 665.28±593 711.71） a.u vs. （309 148.00±366 938.07） a.u，P=0.002］均显著低于治疗前。结论 DCEUS可在评估HIFU治疗腹部恶性肿瘤疗效时监测病灶微循环血流灌注，定量参数PE及AUC是具有潜在意义的评估参数。
Abstract
Objective To evaluate the clinical value of dynamic contrast enhanced ultrasound (DCEUS) in monitoring therapeutic effect of high-intensity focused ultrasound (HIFU) in patients with solid abdominal malignant tumors by compare the quantitative ananlysis curve and perfusion parametters.Methods From Sep 2018 to May 2021,patients with histopathologically confirmed advanced abdominal malignant tumors and planned to receive HIFU treatment were prospectively included. Contrast enhanced ultrasound (CEUS) examinations were performed 1 day before and 4 weeks after the initiation of HIFU treatment.CEUS cines in DICOM form were converted into time intensity curves (TICs) using Vuebox software.Various quantitative CEUS parameters were generated after curve fitting,including peak enhancement (PE),rise time (RT),time to peak (TTP),mean transit time (mTT) and area under curve (AUC).Comparisons of sizes,CEUS enhancement patterns,shape of TICs,quantitative CEUS parameters and serum tumor marker levels were conducted before and after HIFU treatment.Results A total of 19 patients were prospectively enrolled (10 women,9 men;average age,58.84±10.08 years).While comparing before and after HIFU treatment,no significant difference was observed on mean size of lesions,CEUS features or serum tumor markers.After HIFU treatment,TICs showed decreased enhancement,and AUC decreased either.Among all CEUS quantitative parameters,significant decrease could be found in PE[(32 920.63±24 822.71) a.u vs. (17 296.11±16 570.41) a.u,P=0.001] and AUC[(624 665.28±593 711.71) a.u vs. (309 148.00±366 938.07) a.u,P=0.002].Conclusion DCEUS may be a potential imaging method in detecting microvascular change of HIFU in patients with abdominal solid malignant tumor lesions.PE and AUC might be useful DCEUS quantitative parameters.
关键词
动态超声造影(DCEUS) /
定量分析 /
腹部晚期恶性肿瘤 /
高强度聚焦超声(HIFU) /
疗效监测
{{custom_keyword}} /
Key words
dynamic contrast enhanced ultrasound(DCEUS) /
quantitative analysis /
advanced abdominal malignant tumor /
high-intensity focused ultrasound(HIFU) /
therapeutic response evaluation
{{custom_keyword}} /
中图分类号：
R445.1
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] KAMISAWA T,WOOD LD,ITOI T,et al.Pancreatic cancer[J].Lancet,2016,388(10039):73-85.
[2] SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2020[J].CA Cancer J Clin,2020,70(1):7-30.
[3] 陆云飞,徐伟,丁小波,等.高强度聚焦超声治疗腹盆腔恶性实体肿瘤的疗效观察[J].中国社区医师,2019,35(35):45-47.
[4] CHEUNG VYT.High-intensity focused ultrasound therapy[J].Best Pract Res Clin Obstet Gynaecol,2018,46:74-83.
[5] IZADIFAR Z,IZADIFAR Z,CHAPMAN D,et al.An introduction to high intensity focused ultrasound systematic review on principles,devices,and clinical applications[J].J Clin Med,2020,9(2):460.
[6] EISENHAUER EA,THERASSE P,BOGAERTS J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[7] STRUNK HM,HENSELER J,RAUCH M,et al.Clinical use of high-intensity focused ultrasound (HIFU) for tumor and pain reduction in advanced pancreatic cancer[J].Rofo,2016,188(7):662-670.
[8] MARINOVA M,RAUCH M,MUCKE M,et al.High-intensity focused ultrasound (HIFU) for pancreatic carcinoma:evaluation of feasibility,reduction of tumour volume and pain intensity[J].Eur Radiol,2016,26(11):4047-4056.
[9] DIETRICH CF,NOLSOE CP,BARR RG,et al.Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB,AFSUMB,AIUM,and FLAUS[J].Ultrasound Med Biol,2020,46(10):2579-2604.
[10] ZHANG Q,WU L,YANG D,et al.Clinical application of dynamic contrast enhanced ultrasound in monitoring the treatment response of chemoradiotherapy of pancreatic ductal adenocarcinoma[J].Clin Hemorheol Microcirc,2020,75(3):325-334.
[11] DALAH E,TAI A,OSHIMA K,et al.PET-based treatment response assessment for neoadjuvant chemoradiation in pancreatic adenocarcinoma:an exploratory study[J].Transl Oncol,2018,11(5):1104-1109.
[12] MARINOVA M,HUXOLD HC,HENSELER J,et al.Clinical effectiveness and potential survival benefit of US-guided high-intensity focused ultrasound therapy in patients with advanced-stage pancreatic cancer[J].Ultraschall Med,2019,40(5):625-637.
[13] WU F,CHEN W Z,BAI J,et al.Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound[J].Ultrasound Med Biol,2001,27(8):1099-1106.
[14] GUO X,ZHU H,ZHOU K,et al.Effects of high-intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer[J].Oncol Lett,2020,19(6):3839-3850.
[15] DAN Z,YI F,QI Z,et al.The value of dynamic contrast enhanced ultrasound (DCE-US) in monitoring treatment effect of high-intensity focused ultrasound (HIFU) in locally advanced pancreatic cancer (LAPC)[J].Clin Hemorheol Microcirc,2021,77(3):323-333.
[16] HUDSON JM,WILLIAMS R,TREMBLAY-DARVEAU C,et al.Dynamic contrast enhanced ultrasound for therapy monitoring[J].Eur J Radiol,2015,84(9):1650-1657.
[17] SIDHU PS,CANTISANI V,DIETRICH CF,et al.The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications:update 2017 (long version)[J].Ultraschall Med,2018,39(2):e2-e44.
[18] 曹佳颖,范培丽,董怡,等.二维与三维超声造影定量分析技术评估肝肿瘤的对比研究[J].中华超声影像学杂志,2018,27(5):397-400.
[19] DIETRICH CF,AVERKIOU MA,CORREAS JM,et al.An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion[J].Ultraschall Med,2012,33(4):344-351.
[20] WIESINGER I,BEYER LP,ZAUSIG N,et al.Evaluation of integrated color-coded perfusion analysis for contrast-enhanced ultrasound (CEUS) after percutaneous interventions for malignant liver lesions:first results[J].Clin Hemorheol Microcirc,2018,69(1-2):59-67.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
基金
国家自然科学基金(82071942);上海市浦江人才计划(D类)(2020PJD008);促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR4060,SHDC2020CR1031B);上海市科委医学引导类项目(18411967200);上海市卫健委面上项目(201940409)
{{custom_fund}}
PDF(1313 KB)
