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Wiewiora M, Jopek J, Świętochowska E, Grynkiewicz M, Piecuch J. Evaluations of the combined use of blood- and tissue-based protein biomarkers for pancreatic cancer. Clin Hemorheol Microcirc 2024; 86:383-393. [PMID: 37955083 DOI: 10.3233/ch-231987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with a low 5-year survival rate. Biomarkers may be of value for the early diagnosis of pancreatic cancer. This study assessed blood- and tumour tissue-based biomarkers associated with pancreatic cancer. METHODS We studied 61 patients who underwent pancreatic resection. Of these 61 patients, 46 patients had PDAC, and 15 patients had inflammatory tumours. Blood and tumour tissue levels of VEGF, hypoxia-inducible factor 1α (HIF-1α) and glucose transporter 1 (GLUT1) were measured. RESULTS Blood concentrations of VEGF (p < 0.000001) and HIF-1α (p = 0.000002) were significantly higher in the PDAC group than in the inflammatory tumour group. Tumour tissue concentrations of VEGF (p < 0.000001), HIF-1α (p = 0.000005) and GLUT1 (0.000002) were also significantly higher in the PDAC group. Univariate analyses revealed that age, BMI, and blood levels of CA19-9, VEGF, and HIF-1α were potential predictors of PDAC. Potential predictors of PDAC in tumour tissue were VEGF, HIF-1α and GLUT1. Multivariate analyses found that VEGF was the most powerful independent predictor of PDAC in blood (OR = 1.016; 95% CI: 1.007-1.025; 0.001) and tumour tissue (OR = 1.02; 95% CI: 1.008-1.032, p = 0.001). The cut-off point for blood VEGF was 134.56 pg/ml, with a sensitivity of 97.8%, specificity of 86.7%, PPV of 95.7%, and NPV of 92.9%. The cut-off point for tissue tumour VEGF in PDAC was 208.59 pg/mg, with a sensitivity, specificity, PPV and NPV of 97.7%, 92.9%, 97.7%, and 92.9%, respectively. CONCLUSIONS There are significant differences in blood-based biomarkers for differentiating between PDAC and inflammatory tumours of the pancreas. VEGF was an independent predictor of PDAC independent of its addition to the routinely used tumour marker CA19-9 antigen.
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Affiliation(s)
- Maciej Wiewiora
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Janusz Jopek
- Department of General and Bariatric Surgery and Emergency Medicine in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Elżbieta Świętochowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Michael Grynkiewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Student Scientific Society, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Jerzy Piecuch
- Department of General and Bariatric Surgery and Emergency Medicine in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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Li H, He H, Tang J, Luo T, Yang G, Huang L, Dong X, Liu Z. A new sonoablation using acoustic droplet vaporization and focused ultrasound: A feasibility study. Med Phys 2023; 50:6663-6672. [PMID: 37731063 DOI: 10.1002/mp.16742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histotripsy and boiling histotripsy are two methods of mechanical ablation that use high-pressure focused ultrasound (FUS). PURPOSE Here, a new bubble sonoablation technique was investigated using low-pressure FUS in combination with local injection of perfluoropentane (PFP) in rabbit liver. METHODS Fifteen healthy New Zealand white rabbits were treated with FUS alone, FUS + PFP or PFP alone. FUS was performed using a single-element focused transducer (frequency 596 kHz, 0.27 ms pulses, 0.54% duty cycle, and peak negative pressure 2.0 MPa). Ten minutes before FUS treatment, the PFP droplet was locally injected into the rabbit liver, where the ultrasound was focused. Contrast-enhanced ultrasound (CEUS) of the liver was performed, and the temperature at the liver surface in the targeted liver region was recorded during treatment. The livers were collected for pathological examination. Statistical significance was set at p < 0.05. Paired t-tests were used to compare the pre- and post-treatment values. One-way analysis of variance was performed to compare multiple groups, and the least significant difference method was used for further comparisons between the two groups. RESULTS Analysis of CEUS data showed that the values of area under the curve (AUC) were significantly different in the PFP + FUS group pre- (10453.644 ± 1182.93) and post-treatment (4058.098 ± 2720.41), and the AUC values of PFP + FUS post-treatment (4058.098 ± 2720.41) were also significantly lower than those of the FUS (9946.694 ± 1071.54) and the PFP (10364.794 ± 2181.53) groups. The peak intensity values also showed the same results, the value of peak intensity of PFP+FUS post-treatment was 82.958 ± 13.99, whereas there was no difference between FUS (106.61 ± 7.61) and PFP (104.136 ± 10.55). Hematoxylin and eosin (H&E) staining revealed that the pathological damage ratings of the PFP + FUS, PFP, and FUS groups were grade 3, grade 1, and grade 0, respectively. Specifically, the area of liver necrosis in the PFP + FUS group (0.99 ± 0.29 cm2 ) was 198 times higher than that in the PFP group (0.005 ± 0.008 cm2 ), whereas no necrosis was observed in the livers treated with FUS alone. Simultaneously, the number of vacuoles in the liver of the PFP + FUS group (35.50 ± 23.31) was approximately five times that of the PFP group (7.00 ± 12.88), whereas no vacuoles were found in the liver treated with FUS alone. CONCLUSION PFP droplets combined with FUS can destroy liver tissue and cause tissue necrosis in the droplet injection area, without affecting the structure of surrounding tissue.
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Affiliation(s)
- Hui Li
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huan He
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jiawei Tang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Tingting Luo
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Guoliang Yang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Leidan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaoxiao Dong
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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Dong Y, Chen S, Möller K, Qiu YJ, Lu XY, Zhang Q, Dietrich CF, Wang WP. Applications of Dynamic Contrast-Enhanced Ultrasound in Differential Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma in Non-cirrhotic Liver. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1780-1788. [PMID: 37156676 DOI: 10.1016/j.ultrasmedbio.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of the work described here was to investigate the value of dynamic contrast enhanced ultrasound (DCE-US) and quantitative analysis in pre-operative differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) in non-cirrhotic liver. METHODS In this retrospective study, patients with histopathologically proven ICC and HCC lesions in non-cirrhotic liver were included. All patients underwent contrast-enhanced ultrasound (CEUS) examinations with an Acuson Sequoia unit (Siemens Healthineers, Mountain View, CA, USA) unit or LOGIQ E20 (GE Healthcare, Milwaukee, WI, USA) within 1 wk before surgery. SonoVue (Bracco, Milan, Italy) was used as the contrast agent. B-mode ultrasound (BMUS) features and CEUS enhancement patterns were analyzed. DCE-US analysis was performed by VueBox software (Bracco). Two regions of interest (ROIs) were set in the center of the focal liver lesions and their surrounding liver parenchyma. Time-intensity curves (TICs) were generated, and quantitative perfusion parameters were obtained and compared between the ICC and HCC groups using the Student t-test or Mann-Whitney U-test. RESULTS From November 2020 to February 2022, patients with histopathologically confirmed ICC (n = 30) and HCC (n = 24) lesions in non-cirrhotic liver were included. During the arterial phase (AP) of CEUS, ICC lesions exhibited heterogeneous hyperenhancement (13/30, 43.3%), heterogeneous hypo-enhancement (2/30, 6.7 %) and rim-like hyperenhancement (15/30, 50.0%), whereas all HCC lesions exhibited heterogeneous hyperenhancement (24/24, 100.0%) (p < 0.05). Subsequently, most of the ICC lesions exhibited AP wash-out (83.3%, 25/30), whereas a few cases exhibited wash-out in the portal venous phase (PVP) (15.7%, 5/30). In contrast, HCC lesions exhibited AP wash-out (41.7%, 10/24), PVP wash-out (41.7%, 10/24) and a small part of late phase wash-out (16.7%, 4/24) (p < 0.05). Compared with those of HCC lesions, TICs of ICCs revealed earlier and lower enhancement during the AP, faster decline during the PVP and reduced area under the curve. The combined area under the receiver operating characteristic curve (AUROC) of all significant parameters was 0.946, with 86.7% sensitivity, 95.8% specificity and 90.7% accuracy in differential diagnosis between ICC and HCC lesions in non-cirrhotic liver, which improved the diagnostic efficacy of CEUS (58.3% sensitivity, 90.0% specificity and 75.9% accuracy). CONCLUSION ICC and HCC lesions in non-cirrhotic liver might exhibit some overlap of CEUS features in diagnosis. DCE-US with quantitative analysis would be helpful in pre-operative differential diagnosis.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sheng Chen
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiu-Yun Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Medical Imaging, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Paratore M, Garcovich M, Ainora ME, Riccardi L, Gasbarrini A, Zocco MA. Dynamic contrast enhanced ultrasound in gastrointestinal diseases: A current trend or an indispensable tool? World J Gastroenterol 2023; 29:4021-4035. [PMID: 37476588 PMCID: PMC10354578 DOI: 10.3748/wjg.v29.i25.4021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Contrast enhanced ultrasound (CEUS) has been widely implemented in clinical practice because of the enormous quantity of information it provides, along with its low cost, reproducibility, minimal invasiveness, and safety of the second-generation ultrasound contrast agents. To overcome the limitation of CEUS given by the subjective evaluation of the contrast enhancement behaviour, quantitative analysis of contrast kinetics with generation of time-intensity curves has been introduced in recent years. The quantification of perfusion parameters [named as dynamic-CEUS (D-CEUS)] has several applications in gastrointestinal neoplastic and inflammatory disorders. However, the limited availability of large studies and the heterogeneity of the technologies employed have precluded the standardisation of D-CEUS, which potentially represents a valuable tool for clinical practice in management of gastrointestinal diseases. In this article, we reviewed the evidence exploring the application of D-CEUS in gastrointestinal diseases, with a special focus on liver, pancreas, and inflammatory bowel diseases.
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Affiliation(s)
- Mattia Paratore
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Matteo Garcovich
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Maria Elena Ainora
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Laura Riccardi
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Maria Assunta Zocco
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
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Zhang Q, Qiu YJ, Yang DH, Lu XY, Chen S, Dong Y, Wang WP. Differential diagnosis between pancreatic solid pseudopapillary tumors and pancreatic neuroendocrine tumors based on contrast enhanced ultrasound imaging features. Clin Hemorheol Microcirc 2023; 85:421-431. [PMID: 37718786 DOI: 10.3233/ch-231932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
PURPOSES To evaluate the application of contrast enhanced ultrasound (CEUS) in preoperatively differential diagnosis between pancreatic solid pseudopapillary tumors (SPTs) and pancreatic neuroendocrine tumors (pNETs). PATIENTS AND METHODS This retrospective study was approved by Institutional Review Board. Patients with surgical resection and histopathological diagnosis as SPTs and pNETs were included. All patients underwent B mode ultrasound (BMUS) and CEUS examinations within one week before surgical operation. On BMUS, the size, location, echogenicity, calcification, and margin of lesions were observed and recorded. On CEUS imaging, enhancement patterns, and enhancement degrees were recorded and analyzed. An independent t-test or Mann-Whitney U test was used for comparison between continuous variables. Chi-square test was used to compare the CEUS patterns. RESULTS From February 2017 to Dec 2022, patients diagnosed as SPTs (n = 39) and pNETs (n = 48) were retrospectively included. On BMUS, anechoic cystic changes (19/39, 48.72%) and hyperechoic calcification (14/39, 35.90%) are more commonly detected in SPTs (P = 0.000). On CEUS imaging, the majority of SPTs (27/39, 69.23%) showed hypo-enhancement in the arterial phase, while most of the pNETs (36/48, 75.00%) showed hyper- or iso-enhancement in the arterial phase (P = 0.000). In the venous phase, most of the SPTs (32/39, 82.05%) showed hypo-enhancement, while over half of pNETs (29/48, 60.42%) showed hyper- or iso-enhancement compared to pancreatic parenchyma (P = 0.001). CONCLUSIONS CEUS is a valuable and non-invasive imaging method to make preoperatively differential diagnoses between SPTs and pNETs.
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Affiliation(s)
- Qi Zhang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Jie Qiu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dao-Hui Yang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen, China
| | - Xiu-Yun Lu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng Chen
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Li N, Hu Z, Liu Y, Ding J, Han P, Jing X, Kan Y. Dynamic contrast-enhanced ultrasound characteristics of renal tumors: VueBox™ quantitative analysis. Clin Hemorheol Microcirc 2023; 85:341-354. [PMID: 37742629 DOI: 10.3233/ch-231750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND VueBoxtrademark has been used for contrast analysis in DCE-US-based quantitative research. OBJECTIVE Aim of this study was to use the enhancement-mode and VueBoxtrademark parameters to further evaluate the differential diagnostic value of DCE-US for renal tumors. METHODS 24 patients with renal tumors, including 7 benign and 17 malignant, were retrospectively analyzed.The DCE-US enhancement-mode and VueBoxtrademark parameters correlated with the histological analyses of tumors were obtained and analyzed. RESULTS The benign and malignant renal tumors showed significant differences in enhancement degree (P = 0.017) and presence of a pseudocapsule (P = 0.009) and in the VueBoxtrademark parameters FT (P = 0.045) and RT (P = 0.039). Receiver operating characteristic analysis for differential diagnosis of benign and malignant renal tumors showed that AUC for a combination of enhancement degree and presence of a pseudocapsule was greater (AUC = 0.815) than the values for either parameter of enhancement mode alone. Similarly, the AUC for a combination of RT and FT was greater (AUC = 0.798) than the values for RT or FT alone. A comprehensive index obtaining by combining the enhancement-mode and VueBoxtrademark parameters showed the largest AUC (AUC = 0.916) with relatively high accuracy (87.50%), sensitivity (76.50%), and specificity (85.70%). CONCLUSIONS DCE-US with enhancement mode and quantitative analysis can facilitate preoperative differential diagnosis of benign and malignant renal tumors.
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Affiliation(s)
- Ning Li
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Ziyue Hu
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yang Liu
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
| | - Jianmin Ding
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Pengcheng Han
- College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yanmin Kan
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
- Department of Ultrasound, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Early Assessment of Chemoradiotherapy Response for Locally Advanced Pancreatic Ductal Adenocarcinoma by Dynamic Contrast-Enhanced Ultrasound. Diagnostics (Basel) 2022; 12:diagnostics12112662. [PMID: 36359506 PMCID: PMC9689529 DOI: 10.3390/diagnostics12112662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Objective: To evaluate the value of dynamic contrast-enhanced ultrasound (DCE-US) and quantitative parameters in early prediction of tumor response to chemoradiotherapy (CRT) in patients with locally advanced pancreatic ductal adenocarcinoma (LAPC). Patients and Methods: In this prospective study, patients with biopsy-proved and histopathologically proved LAPC who underwent regular CRT were recruited. DCE-US evaluations were performed before and four months after CRT. SonoVue-enhanced contrast-enhanced ultrasound (CEUS) was performed by an ultrasound system (ACUSON Sequoia; Siemens Medical Solutions, USA) equipped with a 5C1 MHz convex array transducer. Time−intensity curves were created by VueBox software (Bracco, Italy), and various DCE-US quantitative parameters were obtained. Taking Response Evaluation Criteria in Solid Tumors (RECIST) based on computed tomography (CT) or magnetic resonance imaging (MRI) as the gold standard, DCE-US parameters were compared between the treatment responder group (RG) and non-responder group (NRG). The correlation between the DCE-US parameters and the serum carbohydrate antigen 19-9 (CA 19-9) level was also analyzed. Results: Finally, 21 LAPC patients (mean age 59.3 ± 7.2 years) were included. In comparing the RG (n = 18) and NRG (n = 3), no significant change could be found among the mean size of the lesions (31.2 ± 8.1 mm vs. 27.2 ± 8.3 mm, p = 0.135). In comparing the TICs between the two groups, the LAPC lesions in the RG took a longer time to reach peak enhancement and to wash out. Among all the DCE-US parameters, RT (rise time), WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve) and WiWoAUC (wash-in and wash-out area under the curve) decreased significantly after CRT in the RG (p < 0.05). The RT ratio, WiAUC ratio, WoAUC ratio and WiWoAUC ratio were closely correlated with the change in serum CA 19-9 level in the RG (p < 0.05). Conclusion: DCE-US might be a potential imaging method for non-invasive follow-up for early response in LAPC patients treated by CRT.
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