摘要
目的评价造影增强超声(CEUS)对判断肝恶性肿瘤射频消融疗效的应用价值。方法53例肝恶性肿瘤共71个病灶经射频消融治疗后行CEUS检查,其中原发性肝癌44例59个病灶、转移癌9例12个病灶。全部病灶采用超声造影剂SonoVue团注法行CEUS检查,并与同期常规超声及彩色超声、增强CT检查结果比较。超声仪为TechnosDU8并使用CnTI实时超声造影匹配成像技术。结果CEUS观察71个病灶中,54个(76.1%)病灶在造影各时相均未强化,提示肿瘤完全灭活;13个(18.3%)病灶边缘局部动脉期增强,判断有肿瘤残存;4个(5.6%)病灶判断不清。最终诊断依据两种以上影像学检查并结合肿瘤标志物水平、穿刺活检、3个月以上随访进行综合判断。以最终诊断为金标准,CEUS诊断准确性91.5%(65/71),增强CT为93.9%(62/66),常规超声及彩色超声为67.6%(48/71)。CEUS与增强CT在评价肿瘤复发或残留方面的灵敏性、特异性、准确性差异均无显著性意义。结论CEUS可较准确地判断射频消融后肿瘤灭活程度,是评价射频消融疗效的有效方法,可成为肝癌局部治疗随访的重要手段,有较高临床应用价值。
Objective To investigate the role of contrast enhanced ultrasonography （CEUS） in evaluating therapeutic response of hepatic malignancies treated with radiofrequency ablation（RFA）. Methods A total of 53 patients with 71 lesions were enrolled. Among them, 44 patients had 59 primary hepatocellular carcinoma and 9 patients had 12 hepatic metastases. All cases underwent CEUS with contrast agent（SonoVue） after RFA treatment, and CEUS results were compared with routine ultrasonography and contrast enhanced CT results, the latter two means performing at the same time. The final diagnosis was achieved synthetically by more than two kinds of imaging examinations （such as CT, MR）, the level of tumor marker, biopsy and more than 3 months＇ follow-up. Technos DU8 and Contrast Tuned Imaging （CnTI） technique were adopted. Results After RFA, 54 of the 71 lesions（76. 1%） were found no enhancement in entire CEUS procedure, which indicated complete necrosis. Thirteen lesions（18.3 %） were showed local enhancement at tumor margin in arterial phase and diagnosed as tumor residual, 4 lesions （5.6%） were presented no typical enhancement and diagnosed as suspected tumor residue. According to the final diagnosis, the accuracy was 91.5%（65/71） for CEUS, 93.9%（62/66） for CT and 67.6%（48/71） for routine ultrasonography respectively. There was no significant difference in sensitivity, speciality and accuracy between CEUS and contrast enhanced CT. Conclusions CEUS can accurately differentiate tumor necrosis and viable tissue after RFA, and evaluate therapeutic efficacy of RFA. It will become a sensitive tool to follow-up hepatic malignancies after local treatment and play an important role in clinic.
出处
《中华超声影像学杂志》
CSCD
2005年第9期655-658,共4页
Chinese Journal of Ultrasonography
基金
北京市重大项目培育专项基金(Z0005190040431)
首都医学发展科研基金项目(ZD199909)
