Original ResearchQuantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound

- First quantitative study explores contrast-enhanced ultrasound (CEUS) in microcirculation blood perfusion in hepatocellular carcinoma.
- Perfusion parameters of CEUS quantitatively assess interventional therapeutic effect.
- Curative effects in 3-15 d after surgery were better.
- The microvessel density count under a light microscope at 50× magnification, peak intensity, increased signal intensity, area under the curve and blood flow of well-differentiated tumour greatly increased.
- Preoperative perfusion parameters were positively correlated with microvessel density, interleukin 8 and vascular endothelial growth factor.

To conduct a quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolisation (TACE) using contrast-enhanced ultrasound (CEUS). From 2013 June to 2105 October, a total of 106 HCC patients undergoing TACE were recruited. CEUS was performed before and after TACE to determine time-intensity curve (TIC) and perfusion quantitative parameters of the HCC lesions and surrounding liver parenchyma. Quantitative perfusion parameters were obtained using the region of interest method. The microcirculation blood perfusion was measured with a blood analysis system and microcirculation microscope. Tumour microvessel density (MVD) was detected by CD34 immunohistochemistry. Compared with surrounding liver parenchyma, the HCC lesions had earlier arrive time (AT), time to initial peak (TTP) and acceleration time, and faster slope of rise time (a3), but no differences were observed in mean transit time (MTT), slope of decrease to half of peak (a2), peak intensity (PI), increased signal intensity (ISI), area under the curve (AUC) and blood flow (BF). There were significant differences in PI, a3, ISI, AUC and BF in HCC lesions between before and after TACE. The high blood viscosity, low blood viscosity, plasma viscosity and integral viscosity in HCC lesions increased after TACE, but the velocity of nailfold microcirculation decreased after TACE. The MVD of well-differentiated HCC lesions was higher than that of poor-differentiated HCC lesions under a light microscope at 50× magnification. However, no significant differences were found in MVD between well-differentiated and poor-differentiated HCC lesions under a light microscope at 100× and 200× magnifications. The PI, ISI, AUC and BF of poor-differentiated HCC lesions were significant lower than those of well-differentiated HCC lesions, but there were no differences in AT, TTP, ACU, MTT, a2 and a3. In conclusion, these results indicate that quantitative CEUS perfusion parameters could be useful tools for assessing the efficacy of TACE for HCC.