本研究的目的是定义一种全面且可重复的超声造影（CEUS）成像方案和分析方法，以定量评估病变血流。易于重复的 CEUS 评估对于纵向治疗监测至关重要。这里描述的量化方法旨在为未来的临床研究提供一个结构。这项回顾性分析研究包括 80 名患者的肝脏 CEUS 研究，其中 40 名患者含有病变（原发性肝细胞癌，n = 28）。每个患者至少注射 2 次微泡造影剂，每次注射采集 60 秒的连续循环，以便评估可重复性。每次推注时，输送 1.2 mL 造影剂，同时进行连续、静态扫描。自动呼吸门控和运动补偿算法处理呼吸运动。在病变和肝实质周围绘制大小相似的感兴趣区域，并生成具有线性化图像数据的时间强度曲线（TIC）。四个推注传输参数：上升时间 (RT)、平均传输时间 (MTT)、峰强度 (PI) 和曲线下面积 (AUC) 直接从实际 TIC 数据或从拟合的对数正态分布曲线中提取TIC。每个参数的注射间重复性通过变异系数进行评估。计算所有拟合对数正态分布曲线决定系数 (R2) 值的 95% 置信区间，作为数据质量指标。在从进样对获得的值之间以及拟合对数正态分布曲线和 TIC 计算方法直接提取之间进行单样本 t 检验，以确定进样和测量精度分别没有显着差异。 平均进样间变异系数对于感兴趣的病变和实质区域，拟合曲线和直接计算 RT 和 MTT 小于 21%，而 PI 和 AUC 小于 40%。所有拟合对数正态曲线的 R2 值的 95% 置信区间为 [0.95, 0.96]。注射间值差异的 1 样本 t 检验显示没有显着差异，表明重复推注的顺序与所得参数之间没有关系。拟合对数正态分布曲线的值与 TIC 计算直接提取的值之间的 1 样本 t 检验发现，除了病变和实质 PI 以及病变 MTT 之外，所有灌注相关参数均无统计学显着差异 (α = 0.05)。本研究中概述和验证的方案和分析方法提供了对病变血流的易于重复的定量评估，以及 CEUS 数据中的推注传输参数，这是以前无法获得的。凭借铰接臂理想的探头稳定性和自动呼吸门控算法等重要功能，我们能够实现血流参数的注射重复性，这些参数可与目前临床 2D CEUS 扫描建立的水平相当或超过。在根据拟合曲线或直接根据数据进行的计算之间获得了相似的值和注射重复性。这不仅证明了该协议以最小噪声生成 TIC 的强度，而且还表明可以避免曲线拟合以获得更标准化的方法。利用本研究中定义的成像方案和分析方法，我们的目标是通过该方法潜在地帮助临床医生评估纵向研究中 CEUS 治疗监测的真实灌注变化。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

The aim of this study is to define a comprehensive and repeatable contrast-enhanced ultrasound (CEUS) imaging protocol and analysis method to quantitatively assess lesional blood flow. Easily repeatable CEUS evaluations are essential for longitudinal treatment monitoring. The quantification method described here aims to provide a structure for future clinical studies.This retrospective analysis study included liver CEUS studies in 80 patients, 40 of which contained lesions (primarily hepatocellular carcinoma, n = 28). Each patient was given at least 2 injections of a microbubble contrast agent, and 60-second continuous loops were acquired for each injection to enable evaluation of repeatability. For each bolus injection, 1.2 mL of contrast was delivered, whereas continuous, stationary scanning was performed. Automated respiratory gating and motion compensation algorithms dealt with breathing motion. Similar in size regions of interest were drawn around the lesion and liver parenchyma, and time-intensity curves (TICs) with linearized image data were generated. Four bolus transit parameters, rise time (RT), mean transit time (MTT), peak intensity (PI), and area under the curve (AUC), were extracted either directly from the actual TIC data or from a lognormal distribution curve fitted to the TIC. Interinjection repeatability for each parameter was evaluated with coefficient of variation. A 95% confidence interval was calculated for all fitted lognormal distribution curve coefficient of determination (R2) values, which serves as a data quality metric. One-sample t tests were performed between values obtained from injection pairs and between the fitted lognormal distribution curve and direct extraction from the TIC calculation methods to establish there were no significant differences between injections and measurement precision, respectively.Average interinjection coefficient of variation with both the fitted curve and direct calculation of RT and MTT was less than 21%, whereas PI and AUC were less than 40% for lesion and parenchyma regions of interest. The 95% confidence interval for the R2 value of all fitted lognormal curves was [0.95, 0.96]. The 1-sample t test for interinjection value difference showed no significant differences, indicating there was no relationship between the order of the repeated bolus injections and the resulting parameters. The 1-sample t test between the values from the fitted lognormal distribution curve and the direct extraction from the TIC calculation found no statistically significant differences (α = 0.05) for all perfusion-related parameters except lesion and parenchyma PI and lesion MTT.The scanning protocol and analysis method outlined and validated in this study provide easily repeatable quantitative evaluations of lesional blood flow with bolus transit parameters in CEUS data that were not available before. With vital features such as probe stabilization ideally performed with an articulated arm and an automated respiratory gating algorithm, we were able to achieve interinjection repeatability of blood flow parameters that are comparable or surpass levels currently established for clinical 2D CEUS scans. Similar values and interinjection repeatability were achieved between calculations from a fitted curve or directly from the data. This demonstrated not only the strength of the protocol to generate TICs with minimal noise, but also suggests that curve fitting might be avoided for a more standardized approach. Utilizing the imaging protocol and analysis method defined in this study, we aim for this methodology to potentially assist clinicians to assess true perfusion changes for treatment monitoring with CEUS in longitudinal studies.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.