Application of quantitative contrast-enhanced ultrasound perfusion analysis in preoperative evaluation of differentiation of hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-3232.2019.04.017

Abstract

Abstract:

Objective

To explore the feasibility and application value of quantitative contrast-enhanced ultrasound perfusion (Q-CEUS) in the preoperative evaluation of differentiation degree of hepatocellular carcinoma (HCC).

Methods

Clinical data of 91 patients with HCC undergoing contrast-enhanced ultrasound in the First Affiliated Hospital of Sun Yat-sen University from January 2015 to June 2016 were retrospectively analyzed. Among them, 78 patients were male and 13 were female, with an average age of (52±12) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Q-CEUS analysis was performed in all patients. Related data such as the rise time (RT) of peak intensity and time to peak (TTP) were recorded. The relationship among RT, TTP and the differentiation of HCC was analyzed by one-way ANOVA. The diagnostic value of perfusion parameters on the HCC differentiation was evaluated by receiver operating characteristic (ROC) curve.

Results

In total,22, 53 and 16 patients were respectively diagnosed with highly-, moderately- and lowly-differentiated HCC. Q-CEUS analysis indicated that RT and TTP in the tumor and tip-enhanced region (TER) were significantly correlated with the HCC differentiation, they decreased along with the decrease of differentiation degree (F=21.374, 10.575 and 14.629, 17.432; P<0.05). The RT and TTP in the tumor and TER significantly differed between the highly- and moderately-differentiated groups (HSD-t=13.317, 13.136 and 15.003, 14.473; P<0.05), and between the highly- and lowly-differentiated groups (HSD-t=11.425, 10.754 and 12.741, 12.145; P<0.05). The area under the ROC curve of RT and TTP in the tumor was respectively 0.835 and 0.696 for diagnosing highly-differentiated HCC, and was respectively 0.805 and 0.783 in TER. The area under the ROC curve of RT in the tumor was significantly larger than that of TTP (Z=2.855, P<0.05).

Conclusions

Q-CEUS parameters, such as RT and TTP, can be used in the differential diagnosis of highly-differentiated HCC with moderate diagnostic value. The diagnostic value of RT is better than that of TTP.

Key words: Carcinoma, hepatocellular, Ultrasonography, interventional, Preoperative evaluation

Manxia Lin, Xiaoer Zhang, Zebin Chen, Xiaoyan Xie, Ming Kuang. Application of quantitative contrast-enhanced ultrasound perfusion analysis in preoperative evaluation of differentiation of hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(04): 353-357.

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References 17

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分化程度	例数	性别（例，男/女）	年龄（岁，±s）	肝炎背景（例）			肿瘤直径（cm，±s）
分化程度	例数	性别（例，男/女）	年龄（岁，±s）	无	乙肝	丙肝	肿瘤直径（cm，±s）
高分化	22	20/2	58±12	2	19	1	2.7±1.1
中分化	53	45/8	50±12	1	51	1	3.6±1.0
低分化	16	13/3	49±12	0	16	0	4.1±0.8

分化程度	例数	性别（例，男/女）	年龄（岁，±s）	肝炎背景（例）			肿瘤直径（cm，±s）
分化程度	例数	性别（例，男/女）	年龄（岁，±s）	无	乙肝	丙肝	肿瘤直径（cm，±s）
高分化	22	20/2	58±12	2	19	1	2.7±1.1
中分化	53	45/8	50±12	1	51	1	3.6±1.0
低分化	16	13/3	49±12	0	16	0	4.1±0.8

分化程度	肿瘤				瘤内最高增强区
分化程度	Imax（%，±s）	RT（s，±s）	TTP（s，±s）	mTT [s，M(Q_R)]	Imax（%，±s）	RT（s，±s）	TTP（s，±s）	mTT[s，M(Q_R)]
高分化	483±241	17.3±3.6	18.7±6.1	83（13～314）	807±463	16.8±4.0	19.5±5.9	71（12～270）
中分化	232±30	13.3±2.9	15.0±3.5	51（19～302）	299±34	13.1±3.7	14.5±3.6	42（15～302）
低分化	215±46	11.4±1.4	12.7±2.1	50（18～251）	300±58	10.8±1.9	12.1±2.5	42（20～251）
统计值	F=1.612	F=21.374	F=10.575	Z=3.611	F=1.838	F=14.629	F=17.432	Z=3.184
P值	0.205	0.000	0.000	0.164	0.165	0.000	0.000	0.204

分化程度	肿瘤				瘤内最高增强区
分化程度	Imax（%，±s）	RT（s，±s）	TTP（s，±s）	mTT [s，M(Q_R)]	Imax（%，±s）	RT（s，±s）	TTP（s，±s）	mTT[s，M(Q_R)]
高分化	483±241	17.3±3.6	18.7±6.1	83（13～314）	807±463	16.8±4.0	19.5±5.9	71（12～270）
中分化	232±30	13.3±2.9	15.0±3.5	51（19～302）	299±34	13.1±3.7	14.5±3.6	42（15～302）
低分化	215±46	11.4±1.4	12.7±2.1	50（18～251）	300±58	10.8±1.9	12.1±2.5	42（20～251）
统计值	F=1.612	F=21.374	F=10.575	Z=3.611	F=1.838	F=14.629	F=17.432	Z=3.184
P值	0.205	0.000	0.000	0.164	0.165	0.000	0.000	0.204

项目		曲线下面积	诊断界值	敏感度	特异度	阳性预测值	阴性预测值
肿瘤		?	?	?	?	?	?
?	RT	0.835	14.6	0.82（0.60～0.95）	0.86（0.75～0.93）	0.64（0.44～0.81）	0.94（0.85～0.98）
?	TTP	0.696	18.0	0.50（0.28～0.72）	0.93（0.84～0.98）	0.69（0.41～0.89）	0.85（0.75～0.92）
瘤内最高增强区		?	?	?	?	?	?
?	RT	0.805	11.8	1.00（0.85～1.00）	0.51（0.38～0.63）	0.39（0.27～0.54）	1.00（0.90～1.00）
?	TTP	0.783	17.6	0.59（0.36～0.79）	0.88（0.78～0.95）	0.62（0.39～0.82）	0.87（0.77～0.94）

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