The Value Of Contrast Enhanced Ultrasound In The Evaluation Of Curative Effect After Local Thermal Ablation Of Liver Cancer And The Analysis Of Local Tumor Progression Factors

1 Objective:To compare the value of contrast-enhanced ultrasound(CEUS)and contrast-enhanced magnetic resonance imaging(CEMRI)or contrast-enhanced computed tomography(CECT)in evaluating the efficacy of local thermal ablation of liver cancer,and to analyze the possible influencing factors of local tumor progression after thermal ablation.Improve the diagnostic level of the efficacy after thermal ablation.2 Methods:2.1 The value of contrast-enhanced ultrasound in the evaluation of curative effect after local thermal ablation of liver cancerA total of 363 lesions(including 118 patients of 165 primary hepatic carcinoma lesions and 138 patients of 198 metastatic hepatic carcinoma lesions)in 256 patients with liver cancer who underwent ultrasound-guided thermal ablation in our hospital from June 2019 to May 2022 were collected.A total of 114 lesions(including 35 patients of38 primary hepatic carcinoma lesions and 57 patients of 76 metastatic hepatic carcinoma lesions)in 92 patients with complete follow-up data were selected as the research objects,and CEUS and CEMRI or CECT were used for follow-up after operation.Taking the final judgment as the standard,the diagnostic efficacy of CEUS and CEMRI/CECT in efficacy evaluation was compared.2.2 The value of contrast-enhanced ultrasound in the analysis of local tumor progression factors after thermal ablation of liver cancerTo further analyze the possible factors influencing the occurrence of local tumor progression after thermal ablation of hepatocellular carcinoma in the subjects selected for the first part of the study,including the location of the lesion,the adjacent part of the lesion(including whether it is adjacent to the blood vessel,diaphragm top,liver surface or important organs),pathological type,intraoperative auxiliary imaging technology,conventional ultrasound lesion boundary,conventional ultrasound lesion morphology,lesion maximum diameter and CEUS enhancement level of each phase of the lesion.3 Results:3.1 The value of contrast-enhanced ultrasound in the evaluation of curative effect after local thermal ablation of liver cancerA total of 114 lesions in 92 patients with liver cancer were followed up for 3 to 18 months,with an average of 13.8±5.0 months.The final judgment was that 93 lesions(33 primary and 60 metastatic liver cancer lesions)were completely ablated,1metastatic liver cancer lesion had residual tumor,and 20 lesions(5 primary and 15 metastatic liver cancer lesions)had local tumor progression.The local tumor progression rate was 17.5%,and the average progression time was 8 months.CEUS showed complete ablation in 95 lesions(32 primary and 63 metastatic liver cancer lesions),residual tumor in 3 lesions(2 primary and 1 metastatic liver cancer lesions),and local tumor progression in 16 lesions(4 primary and 12 metastatic liver cancer lesions).According to CEMRI / CECT,91 lesions were completely ablated(30 primary and 61 metastatic liver cancer lesions),3 residual tumors(2 primary and 1 metastatic liver cancer lesions),and 20 local tumor progression(6 primary and 14 metastatic liver cancer lesions).The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy of CEUS were 81.0 %,97.9 %,89.5 %,95.8 %and 94.7 %,respectively.The sensitivity,specificity,PPV,NPV and accuracy of CEMRI/ CECT were 95.2 %,96.8 %,87.0 %,98.9 % and 96.5 %,respectively.Mc Nemar test showed that there was no significant difference in the evaluation of ablation efficacy between CEUS,CEMRI / CECT and the final judgment(P = 0.688,0.625),and there was no significant difference between the two methods(P = 0.125).3.2 The value of contrast-enhanced ultrasound in the analysis of local tumor progression factors after thermal ablation of liver cancerUnivariate analysis of local tumor progression after thermal ablation showed that the lesion boundary and morphology of conventional ultrasound and the maximum diameter of lesions had statistically significant effects on local tumor progression(P =0.039,0.033,0.006).Multivariate analysis showed that the maximum diameter of lesions was an independent risk factor for local tumor progression after thermal ablation(P = 0.005).4 Conclusions:1.CEUS has high diagnostic efficiency in evaluating the efficacy of local thermal ablation of liver cancer,which is equivalent to CEMRI or CECT,and can be used as an effective follow-up method.2.The maximum diameter of lesions was an independent risk factor for local tumor progression after thermal ablation.As the maximum diameter of the lesion increases,the risk of local tumor progression increases.