Quantitative perfusion analysis of contrast-enhanced ultrasound for the preoperative prediction of microvascular invasion: an experimental study in rabbit VX2 liver tumors
Year: 2026
Type: article
Abstract: Background: Microvascular invasion (MVI) is a critical risk factor for postoperative recurrence and metastasis in hepatocellular carcinoma (HCC); however, reliable noninvasive preoperative prediction remains challenging. This study aimed to investigate the value of contrast-enhanced ultrasound (CEUS) in evaluating MVI in rabbit VX2 liver tumors. Methods: Twenty healthy New Zealand rabbits were selected and used to establish VX2 liver tumor models. After 2 weeks, all models underwent conventional ultrasonography and CEUS with SonoVue (Bracco). We plotted time-intensity curves (TICs) to derive quantitative parameters, including mean intensity of the TIC (mTIC), peak intensity (PI), arrival time (AT), rise time (RT), time to peak (TTP), flow-out time (FT), and mean transit time (mTT). Based on histological diagnosis, tumors were classified into MVI and non-MVI groups. We compared the two groups in terms of the differences between VX2 tumors and the surrounding hepatic parenchyma. Results: (I) Histological examination confirmed that 39 VX2 liver tumor models were successfully established in rabbits, with a tumor inoculation success rate of 97.50%. Among these, MVI was identified in 21 VX2 tumors. (II) Compared to tumors in the non-MVI group, those in the MVI group exhibited a larger diameter (P=0.01). Quantitative CEUS analysis revealed that the MVI group, compared to a non-MVI group, had a higher mTIC and PI (P=0.02 and P<0.001, respectively) and a shorter AT and TTP (both P values =0.03). (III) The RT of VX2 tumors was shorter than that of the surrounding liver parenchyma in both the MVI and non-MVI groups (P=0.002 and P=0.047, respectively). In the MVI group, the AT and TTP of the tumors were shorter (P=0.049 and P<0.001, respectively) while the PI was higher compared to the adjacent parenchyma (P=0.01). (IV) Receiver operating characteristic analysis showed that the PI achieved the highest diagnostic performance, with an area under the curve of 0.79 [95% confidence interval (CI): 0.65-0.93]. Conclusions: Quantitative CEUS parameters provide crucial information for evaluating MVI in VX2 liver tumors. These findings constitute experimental evidence that supports the clinical assessment of tumor aggressiveness.
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223200983