| Chapter One:Application of Contrast-Enhanced Ultrasonography in the Diagnosis of Metastatic Liver CancerObjective:The detection of metastatic liver cancer(MLC)by two-dimensional ultrasound,contrast-enhanced ultrasound(CEUS)and enhanced CT(CECT)was compared to explore the diagnostic value of CEUS for MLC.Methods:The two-dimensional ultrasound,CEUS and CECT detection of 96 pathologically confirmed MLC lesions in our hospital were retrospectively analyzed.The chi-square test and consistency test were used to analyze the differences in enhancement methods and intensities between CEUS and CECT in 96 metastatic lesions in 96 MLC patients.Result:(1)A total of 306 lesions were detected in 96 MLC patients by 2D ultrasound,CEUS and CECT imaging examinations.The detection rates of 2D ultrasound,CEUS and CECT were 78.8%(241/306),97.7%(299/306)and 96.4%(295/306),respectively.CEUS and CECT detected more lesions than two-dimensional ultrasound(P<0.001),and there was no significant difference between CEUS and CECT in lesions detection(P>0.05).(2)In 96 MLC patients,CEUS enhancement was observed in all 96 lesions at the arterial stage.CEUS showed that 93.8%(90/96)had rapid clearance from the center to the periphery at the arterial stage or portal vein stage,and 6.2%(6/96)had slow clearance from the center to the periphery at the delayed stage.(3)Enhancement mode of 96 lesions:CEUS showed 52.1%(50/96)overall enhancement,47.9%(46/96)annular enhancement,CECT showed 34.4%(33/96)overall enhancement and 65.6%(63/96)annular enhancement.There were some differences between the two imaging enhancement methods.The difference was statistically significant(P<0.05)and the consistency was good(k=0.609).In terms of enhanced intensity of 96 lesions:Arterial phase CEUS showed 89.6%(86/96)high enhancement,5.2%(5/96)equal enhancement,5.2%(5/96)low enhancement,CECT showed 85.4%(82/96)high enhancement,14.6%(14/96)low enhancement.There were some differences in arterial phase enhancement intensity between the two examination methods.The difference was statistically significant(P<0.001)and the consistency was good(k=0.450).In portal phase,CEUS showed 93.8%(90/96)low enhancement,6.2%(6/96)equal enhancement,CECT showed 44.8%(43/96)high enhancement,and 55.2%(53/96)low enhancement,with statistically significant differences(P<0.001)and poor consistency(k=0.007).CEUS and CECT showed low enhancement in 100%(96/96)of the delay period.Conclusion:CEUS and CECT detected more lesions than two-dimensional ultrasound,and there was no statistically significant difference in the detection of lesions between CEUS and CECT.MLC in CEUS showed rapid enhancement in arterial stage and rapid clearance in late arterial stage and portal vein stage.CEUS was more sensitive than CECT in the response of blood flow supply in different periods of MLC.Chapter Two:Application of Targeted Ultrasound Contrast Agent Sonazoid in the Evaluation of Chemotherapy Efficacy in Metastatic Liver CancerObjective: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,including contrast 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(ABI),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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