The value of contrast-enhanced ultrasound quantitative parameters in the prognosis prediction of hepatocellular carcinoma after thermal ablation: a retrospective cohort study

Abstract

Background:The postoperative recurrence rate is the main factor affecting the prognosis of hepatocellular carcinoma (HCC) patients, this study sought to investigate the value of contrast-enhanced ultrasound (CEUS) quantitative parameters in predicting the recurrence and the survival of HCC patients after thermal ablation. Methods:The data of 97 patients with pathologically diagnosed HCC who underwent thermal ablation were retrospectively included in this study. The patients had an average age of 46.6 years (range, 23-79 years), and 79 were male and 18 were female. CEUS follow-up was performed at 1-and 3-month after thermal ablation, then at 6-month intervals thereafter for 5 years. CEUS was performed before thermal ablation, and the results were analyzed quantitatively using CEUS perfusion software (VueBox ® , Bracco, Italy). The ratios of the CEUS quantitative parameters between the HCC lesions and reference liver parenchyma were calculated. The parameters included the average contrast signal intensity (MeanLin), peak enhancement (PE), rising time (RT), fall time (FT), time to peak (TTP), mean transit time (mTT), perfusion index (PI), Wash-in Area Under the Curve (WiAUC), Wash-in Rate (WiR), Wash-in Perfusion Index (WiPI), Wash-out Area Under the Curve (WoAUC), Wash-out Rate (WoR), and WiAUC + WoAUC (WiWoAUC). The correlations between the preoperative CEUS quantitative parameter ratios, the blood laboratory indexes, postoperative recurrence, and survival were analyzed using log-rank tests and a Cox regression model. Results:The average follow-up duration period was 79 months (range, 5-145 months). The average recurrence time after ablation was 1-127 months, and the median disease-free survival time was 21 months.The 1-, 3-and 5-year survival rates were 96.9%, 92.3%, and 80.6%, respectively. The log-rank tests showed that tumor size, prothrombin time, and WiAUC, WoAUC, and WiWoAUC ratios were predictors of survival, and aspartate aminotransferase was a predictor of recurrence. The Cox regression analysis showed that tumor size [odds ratio (OR): 6.421; 95% CI: 1.434-28.761] and alanine transaminase (OR: 0.88; 95% CI: 0.010-0.742) were predictors of a poor prognosis.Conclusions: CEUS quantitative parameters before thermal ablation and blood laboratory indexes provide potential clinical value for predicting the postoperative recurrence and survival of HCC patients.

Ultrasound Patterns of Hepatocellular Carcinoma and Their Prognostic Impact: A Retrospective Study

“…Other studies have evaluated the prognostic impact of CEUS quantitative parameters on survival outcomes, showing that some variables, such as rise time and time to peak, were associated with worse OS and RFS [18,19]. However, the application of these parameters in clinical practice is limited, since they cannot be interpreted in real time but require post-examination analysis.…”

“…However, to our knowledge, few studies have investigated the predictive role of US imaging features for HCC prognosis; rather, studies have mainly focused on the dynamic and quantitative parameters assessed by CEUS [18][19][20]. To date, no data are available on the correlation between HCC morphological features at US and tumor prognosis.…”

Dynamic contrast enhanced ultrasound in gastrointestinal diseases: A current trend or an indispensable tool?

“…In HCC patients undergoing microwave ablation, TTP evaluated before the procedure was confirmed as an independent predictor of OS[ 20 ]. Similarly, the WiAUC, the WoAUC and the WiWoAUC ratio between HCC lesion and surrounding liver parenchyma evaluated before thermal ablation were significantly associated with survival[ 30 ]. As a consequence, quantitative perfusion evaluation might provide additional information useful to plan treatment procedures.…”