The Application Value Of Contrast-Enhanced Ultrasonography In Microwave Ablation Treatment Of Hepatocellular Carcinoma

ObjectiveUltrasound guided microwave ablation therapy is an important treatment for hepatocellular carcinoma. This study aims to investigate the diagnostic value of contrast-enhanced ultrasonography in detecting the number, size, location and qualitative understanding of the hepatocellular carcinoma lesion before therapy, as well as the evaluation of its therapeutic efficiency. Materials and MethodsA total of 59 cases suspected primary hepatocellular carcinoma patients were enrolled in the study. Patients were recruited consecutively between Jan 2012 and Dec 2014. All patients received ultrasound-guided microwave ablation therapy and detection(males 50, females 9, age from 29 to 86 years old, mean age was 57.3 ± 13.9 years). Among them, 51 patients had history of hepatitis B, 3 patients had history of hepatitis C, 42 patients had liver cirrhosis and 55 patients had increased AFP value. The diameter of their tumors ranged from 10 to 66 mm. All cases were confirmed as primary hepatic carcinoma by imaging examinations(ultrasonography, CT or MRI), serum AFP detection or fine needle aspiration biopsy. All candidates had undergone routine ultrasound examination, contrast- enhanced ultrasonography and contrast-enhanced CT scan a week before operation. The number of lesions, size, location, surrounding structure and distribution of nourishing blood vessels were then recorded. 62 lesions were detected through contrast-enhanced ultrasonography and contrast-enhanced CT. All the patients received the microwave ablation therapy. And after a month, the routine ultrasound, contrast-enhanced ultrasonography and CT were conducted again to evaluate the therapeutic efficiency of percutaneous microwave ablation.After microwave treatment, if the internal and surrounding parts of the ablation lesion were not enhanced all the time, the lesion would be diagnosed completely inactivated. When the peripheral area of ablation lesions appeared nodular enhancement in arterial phase and contrast agent disappeared rapidly in portal venous phase,the residual tumor or local recurrence would be established. If lesion in the three periods of contrast-enhanced CT was not enhanced, it was regarded as complete inactivated. The results were then compared with each other statistically.Once the internal of the lesion is enhanced, it is regarded as a residue. When contrast-enhanced ultrasonography diagnosis consistent with contrast-enhanced CT, the results are the final diagosis. If the two results are different, we should puncture lesions guided by imaging methods. The pathological results is the final results. Results 1. An Preoperative Evaluation of Conventional Ultrasound, Contrast-enhanced Ultrasonography and Contrast-enhanced CTAmong the 62 lesions,54 displayed a typical enhancement at arterial phase and contrast washout at portal vein phase in contrast-enhanced ultrasonography. As for the rest of the lesions,5 showed high enhancement in arterial phase, and the other 3 showed irregular ring-shaped enhancement.However, in portal phase, they all faded fast and showed low enhancement.In this research, 56 lesions were detected through routine ultrasound examination. 62 and 61 lesions were explored by contrast-enhanced ultrasonography and CT. Compared with contrast-enhanced ultrasonography, conventional ultrasound had significant difference(χ2=6.305,P=0.012),whereas contrast-enhanced ultrasonography and contrast enhanced CT had no significant difference(χ2=1.008,P=0.315).In conventional ultrasound, the range of the lesion size was 10 mm~60 mm, and the average size was 29.5 mm. The value of contrast enhanced ultrasound was 12mm~57 mm, with an average size of 31.6 mm. The contrast-enhanced CT was measured from 12 mm to 59 mm, with an average size of 30 mm. In contrast to the size of the lesion, there was a statistically significant difference between conventional ultrasound and contrast-enhanced ultrasonography(t =-2.518,P =0.035 < 0.05), but there was no significant difference between contrast-enhanced ultrasonography and CT(t =0.132,P=0.896>0.05) According to conventional ultrasound, the detection rate of the main nourishing artery of tumorwas 33.9%(21/62). However, the corresponding number in contrast-enhanced ultrasonography was 62.9%(39/62) and in contrast-enhanced CT, 50%(31/62). There was a statistically significant difference between conventional ultrasound and contrast-enhanced ultrasonography(χ2=10.463,P=0.001). In other words, the detection rate of contrast-enhanced ultrasonography was significantly higher than color Doppler ultrasound. 2. An Evaluation of the One-month-postoperative –curative-effect of Conventional Ultrasound, Contrast-enhanced Ultrasonography and Contrast-enhanced CTAccording to the principle of final diagnosis as the gold, 55 cases of tumor became completely inactivated, and 7 cases turned to be local residual or recurrent. Through conventional ultrasound, 58 cases were diagnosed as complete inactivation and4 cases as residual because of the visible color flow signal in the edge of lesion. The results of Contrast-enhanced ultrasound suggested that 50 cases could be completely inactivated, and the other 12 cases may survive or recur because the lesion edge was enhanced locally in arterial phase and faded in portal venous phase e. The results of Contrast-enhanced CT showed 52 cases were completely inactivated, and 10 cases showed arterial enhancement in the edge, suggesting the tumor recurrence or residual. Contrast-enhanced ultrasonography and CT in evaluating therapeutic efficiency of ultrasound guided microwave ablation showed no significant difference(P > 0.05). 3. Conventional ultrasound, contrast-enhanced ultrasonography and contrast-enhanced CT in the detection of intrahepatic recurrence and metastasis after microwave ablation. an Detection of Intrahepatic Recurrence and Metastasis after Microwave Ablation of Conventional Ultrasound, Contrast-enhanced Ultrasonography and Contrast-enhanced CTColor Doppler revealed 6 cases cantrast- enhanced CT found 10 cases and contrast-enhanced ultrasonography found 13 cases. Detected rate of color Doppler ultrasound and contrast-enhanced ultrasound had significant difference(χ2=9.579,P=0.002). There was no significant difference between the contrast-enhanced CT and contrast-enhanced ultrasonography(χ2=3.391,P=0.066). Conclusion 1. Contrast-enhanced ultrasonography is helpful in the qualitative diagnosis of primary hepatocellular carcinoma before. We can use it to detect the lesion location, size and number accurately, making effective treatment to improve ablation curative effect. 2. Contrast-enhanced ultrasonography showed an important clinical value in evaluating curative effect of microwave ablation therapy and diagnosing the recurrence and metastasis lesion. Therefore, it can be used as a reliable imaging diagnosis of hepatocellular carcinoma and a follow-up study method.