Application Of Liver CEUS In PRETEXT Staging Diagnosis Of Hepatoblastoma In Children

Purpose:To analyze the image features of contrast-enhanced ultrasound(CEUS)in children with hepatoblastoma,and evaluate the reliability and accuracy of CEUS in the PRETEXT staging of hepatoblastoma and the risk stratification of hepatoblastoma.Methods: This is an observational study.The analysis of the children with hepatoblastoma from August 2016 to August 2020 was carried out.The clinical manifestations,age,alpha fetoprotein(AFP)values and other general information were collected,and the children who met the inclusion criteria were included as the research objects.All the patients were confirmed as hepatoblastoma by pathological diagnosis,and CEUS and enhanced CT(CECT)were performed.The contrast enhanced ultrasound was performed by GE logic E9 ultrasonic diagnostic instrument(GE Healthcare,Milwaukee,WIS),and Sono Vue(Bracco,Plan-Les-Ouates,Switzerland)was injected 0.03ml/kg intravenously.The PRETEXT staging was evaluated by using CEUS images.All cases were performed respectively by Tru-cut 18 g needle and liver tumor and partial hepatectomy.The resected specimens were present for pathological examination.According to CEUS and CECT diagnosis of PRETEXT staging and pathological results,the risk stratification of 18 children were stratified according to the international experimental group of liver tumor(CHIC)and Children’s Oncology Group(COG)risk level,and the influence of CEUS—PRETEXT on risk stratification was evaluated.Result: 18 patients(mean age,12 months;age range,4 months to 7 years;10 boys)followed the inclusion criteria and were further analyzed.The clinical manifestations were abdominal mass in 9 cases,abdominal distension in 5 cases,abdominal pain in 3 cases and fever in 3 cases.The AFP increased.CEUS images diagnosed 18 cases of hepatoblastoma with PRETEXT,there were 3 cases in stage I,5 cases in stage II,6 cases in stage III,and4 cases in stage IV.One case was misdiagnosed as stage II,and CECT diagnosed as stage IV.The consistency between CEUS and CECT was excellent(kappa=0.925,P<0.001).In PRETEXT annotation factors diagnosis,CEUS missed diagnosis in 2 cases: CT showed tumor thrombus formation in the main portal vein and its left branch in 1 case,but CEUS did not.In one case,CECT showed that the main portal vein was surrounded by tumor,while CEUS only showed compression.There was no enhancement feature of bleeding and necrosis in the tumors.2 cases of tumor rupture were consistent with the results of CECT.CEUS images showed different enhancement patterns in three phases,with "highlow-low" enhancement pattern in arterial phase,portal venous phase and hepatic venous phase respectively.CEUS guided percutaneous biopsy of liver tumors was performed in 8cases,and showed tumor blood perfusion area and necrotic bleeding area in 7 cases,which improved the accuracy of pathological diagnosis.In CEUS diagnosis according to CHIC risk stratification,there were 3 cases in the extremely low-risk group(case 10,13,15);3cases in the low-risk group(case 4,11,17);12 cases in the medium-risk group(case 1,2,3,5,6,7,8,9,12,14,16,18);and 0 case in the high-risk group.Compared with CECT,15 cases were confirmed,3 cases were inconsistent and were underestimated,1 case of medium-risk was underestimated as low-risk,2 cases of high-risk were underestimated as medium-risk.CEUS and CECT had a good consistency in evaluating the CHIC and COG risk stratification of hepatoblastoma.Conclusion: CEUS has better contrast resolution in tumor hemorrhage and necrosis than the traditional gray-scale ultrasound.CEUS imaging has similar perfusion pattern with CECT.In PRETEXT staging diagnosis and positive determination of annotation factors,CEUS has good equivalence with CECT,and it is feasible to grade cancer risk.CEUS in children is helpful to show tissue perfusion and guide tumor biopsy for the pathological diagnosis.It was need for further study of the accuracy of CEUS in the evaluation of PRETEXT staging in hepatoblastoma.