| Popis: |
New treatments such as anti-angiogenic therapy, chemoembolisation, radio-embolisation cause tumour stabilisation which may render conventional size based imaging invalid for monitoring early response to therapy. The aim of this thesis was to develop an alternative index which can predict response for patients with liver tumours earlier, at 2 weeks, than the contemporary gold standard response evaluation criteria at 3 months. This technique was based on the use of microbubble ultrasound as an alternative method for detection of hepatic arterialisation. In this thesis, I evaluated the microbubble ultrasound derived liver blood flow parameters to reflect global liver blood flow in phantom as well as in patients. I also evaluated the impact of several variable factors affecting the liver blood flow and studied the potential role of the blood flow parameters and proposed an alternative index -the contrast enhanced hepatic perfusion index (CE-HPI) - in prediction of early response to treatment for liver tumours. We showed the ability of this technique to reflect global liver blood flow parameters in vitro as well as in patients. Subsequently the index was applied to determine the response assessment in patients receiving treatments. The results from these experiments present the first demonstration in humans that microbubble ultrasound derived liver blood flow parameters including CE-HPI can be helpful in early identification of non-responders. I propose that the microbubble ultrasound technique developed in this thesis can be used to further probe and investigate response assessment in randomized and multicentre studies. |
