Value of gastric contrast-enhanced ultrasound combined with intravenous contrast-en-hanced ultrasound in evaluating the invasion and angiogenesis of gastric cancer
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摘要:
目的 分析胃超声造影联合经静脉超声造影评估胃癌侵袭及新生血管的价值。 方法 选取医院2020年1月~2021年12月收治的82例胃癌患者，所有患者均在手术治疗前1周内完成胃超声造影联合经静脉超声造影(双重超声造影)检查，取术中病理组织，免疫组化法检测肿瘤微血管密度。以手术病理检查结果作为“金标准”，分析双重超声造影在评估胃癌T分期中的价值，Pearson相关分析胃癌病变区与正常胃壁时间-强度曲线参数与微血管密度之间的关系。 结果 手术病理检查证实82例胃癌患者中T1、T2、T3及T4a、T4b期分别有23例、26例、18例、9例及6例。以手术病理检查结果作为“金标准”，双重超声造影在术前诊断胃癌T分期中的总准确率为78.05%。胃癌病变组织超声造影参数基础强度、达峰时间以及灌注时间水平均低于正常胃壁组织，峰值强度及增强强度水平均高于正常胃壁组织，差异有统计学意义(P < 0.05)。两组达到时间水平的差异无统计学意义(P > 0.05)。相关性分析显示，胃癌组织内微血管密度表达量与超声造影参数基础强度、达峰时间以及灌注时间均呈负相关关系(P < 0.05)，与峰值强度及增强强度均呈正相关关系(P < 0.05)。 结论 双重超声造影在胃癌术前分期中具有良好应用价值，其时间-强度曲线参数在提示肿瘤内部新生血管中也具有一定的价值，有望成为胃癌术前病前判断的有效参考。 Abstract:Objective To investigate the value of gastric contrast-enhanced ultrasound combined with intravenous contrast-enhanced ultrasound in evaluating the invasion and angiogenesis of gastric cancer. Methods Eighty-two patients with gastric cancer admitted to the hospital from January 2020 to Decembe 2021 were enrolled. All patients received gastric with intravenous contrast-enhanced ultrasound (double contrast-enhanced ultrasound) examinations one week before operation. The pathological tissues were collected during surgery, tumor microvessel density was detected by immunohistochemistry. Taking the pathological examination results as "gold standard", the value of double contrast-enhanced ultrasound in evaluating the T-stage of gastric cancer was analyzed. The relationship between time intensity curve parameters and microvessel density of gastric cancer lesions and normal gastric wall tissues was discussed by Pearson correlation analysis. Results Surgical pathological examination confirmed that 82 gastric cancer patients included 23 patients at stage T1, 26 at stage T2, 18 at stage T3, 9 at stage T4a and 6 at stage T4b. Taking the results of surgical pathological examination as the "gold standard", the total accuracy of dual-contrast ultrasound in the preoperative diagnosis of T-stage of gastric cancer was 78.05%. The baseline intensity, time to peak and infusion time of gastric cancer lesions were significantly lower than those of normal gastric wall tissues, while the peak intensity and enhanced intensity were significantly higher than those of normal gastric wall tissues (P < 0.05). No significant difference was found in arrival time between two tissues (P > 0.05). Correlation analysis showed that microvessel density in gastric cancer tissue was negatively correlated with the ultrasound contrast parameters baseline intensity, time to peak and infusion time (P < 0.05), and positively correlated with peak intensity and enhanced intensity (P < 0.05). Conclusion Double contrast-enhanced ultrasound has a good application value in the preoperative staging of gastric cancer. Its time intensity curve parameters are also of certain value in the indication of tumor angiogenesis, which is expected to be an effective tool in the preoperative assessment of gastric cancer. -
图 1 正常胃壁组织及胃癌组织双重超声造影表现分析
Figure 1. Images of double contrast-enhanced ultrasound of gastric cancer lesions and normal gastric wall tissues. A: Normal gastric wall tissues; B: Gastric cancer lesions.
表 1 双重超声造影在术前诊断胃癌T分期中的价值
Table 1. Value of double contrast-enhanced ultrasound in evaluat-ing the T-stage of gastric cancer
Surgical staging Cases (n) Gastric contrast-enhanced ultrasound combined with intravenous contrast-enhanced ultrasound [n(%)] T1 23 19(82.61) T2~3 44 32(72.73) T4a 9 7(77.78) T4b 6 6(100.00) Total 82 64(78.05) 
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表 2 胃癌病变组织与正常胃壁组织超声造影参数比较
Table 2. Comparison of contrast-enhanced ultrasound parameters between gastric cancer lesions and normal gastric wall tissues (n=82, Mean±SD)
Different tissues BI(dB) TTP(s) PI(dB) AT(s) EI(dB) Infusion time (s) Gastric cancer lesions 2.16±0.36 17.63±2.41 28.41±4.15 7.83±1.86 26.74±3.36 10.31±2.13 Normal gastric wall tissues 4.97±1.06 20.65±3.33 23.69±4.43 7.92±1.94 18.85±3.47 12.15±2.28 t 22.730 6.653 7.041 0.303 14.792 5.340 P < 0.001 < 0.001 < 0.001 0.762 < 0.001 < 0.001 BI: Baseline intensity; TTP: Time to peak; PI: Peak intensity; AT: Arrival time; EI: Enhanced intensity.
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表 3 超声造影参数与MVD表达的相关性分析
Table 3. Correlation analysis between contrast- enhanced ultra-sound parameters and MVD
Parameters MVD r P BI -0.268 0.030 TTP -0.374 0.007 PI 0.685 ＜0.001 AT 0.074 0.814 EI 0.873 ＜0.001 Infusion time -0.243 0.034 MVD：Microvessel density
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