| Objective: To investigate the correlation between quantitative parameters of blood perfusion with contrast-enhanced ultrasound (CEUS) and tumor mirovessel density (MVD) in hepatocellular carcinoma (HCC) with a second-generation contrast agent (SonoVue). Pulse-inversion harmonic (PIH) imaging, contrast-enhanced power Doppler and acoustic quantitative software were used in the study. The aim was to evaluate the clinical value of CEUS in the quantitative assessment of blood perfusion in HCC with those parameters. And try to supply basis for clinical diagnosis, choosing the therapy plan and assessing prognosis.Methods: Thirty-four patients with HCC underwent CEUS examination with a second generation contrast agent (SonoVue) before operation. All patients were fasting for eight to twelve hours before examination. At first, 2D gray-scale sonography was used to depict the position, size, quantity and inner echo of the lesions. The area of necrosis in the lesion was defined. The features of blood supply intratumor were displayed with color Doppler flow imaging (CDFI) and power Doppler imaging (PDI), then transformed the sequences to the state of CEUS after the best section was selected. At the same time,a 2.4 ml intravenous bolus injection of SonoVue was used, and followed by a flush of 5ml of saline (shook 5s before injection, then injected quickly within 3s). PIH technique and CE-PD technique were performed in the examination. We observed dynamic enhancement course of liver lesions and saved the whole procedure to hard disk of machine. Acoustic densitometry technique was used to analyze the imaging and delineate Time-intensity curve (TIC) after CEUS. According to TIC, the acoustic quantified parameters were obtained and absolute enhanced intensity (AEI) was calculated. Mean flow density (MFD) of enhanced images on the peak intensity time were obtained by computer. The satisfactory images selected in CD-PD model were graded into 0～III, based on the numbers of color vessels within the lesion. Mean color vessel density (MCVD) of the satisfactory images was obtained by computer. Compared the parameters above to microvessel density (MVD) counted with immunohistochemistry after operation and studied the correlation.Results: 1 34 lesions showed typical enhancement pattern of"quick enhancement quick washing-out". The peak intensity time of 34 cases were all in arterial phase (according to the phase criterion defined by EFSUMB in Guidelines for the use of contrast agents in ultrasound. The AEI of 34 cases was (7.44±3.56)dB. The MFD calculated on the peak intensity time was 0.79±0.16.2 The images of 34 cases were graded into 0～III , according to its number of blood signals in CE-PD model. There were 3 cases in grade I, 12 cases in grade II and 19 cases in grade III. The MCVD of 34 cases in CE-PD model was (0.17±0.09).3 The output of immunohistochemistry after operation was sacrificed. The CD34 expressed positively in HCC tissues, while expressed negatively or faintly in normal hepatic tissues or cirrhotic tissues. The MVD counted after operation was 62.59±23.96.4 The MFD of 34 lesions before operation was positively correlated to the MVD of pathologic section after operation (r=0.85 P<0.01). We did not find significant correlation between AEI and MVD(r=0.20 P<0.05).5 The MCVD of 34 cases in CE-PD model before operation was positively correlated to MVD of pathologic section after operation (r=0.56 P<0.05).6 The MVD of pathologic section after operation was significant different within groups (F=8.06 P<0.05). The results of multiple comparisons showed that the MVD of grade III was significant different to that of grade I and grade II. There was no significant difference of MVD between group I and grade II. We did not find linear tendency among three groups.Conclusion: 1 The quantity, structure and distribution of tumor vessels in HCC were the pathologic basis for CEUS to quantify tumor blood perfusion.2 CD34 expressed positively in HCC tissues, while expressed negatively or faintly in normal hepatic tissues or cirrhotic tissues. It can stain neoangiogenesis in HCC specifically and sensitively, and the MVD derived from it is an accurate index in quantification of tumor microvascularity.3 CEUS could depict the quantity and distribution of tumor blood perfusion sensitively and the parameters derived from it could exactly reflect tumor angiogenesis, which could provide more information for clinical diagnosis, assessing prognosis and evaluating antiangiogenic therapy.
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