摘要
目的探讨射频消融（RFA）治疗前超声造影（CEUS）对制定消融范围及治疗策略的应用价值，并与RFA前未应用CEUS的治疗组比较疗效。方法161例原发性肝癌符合经皮RFA入选条件患者进行超声引导RFA治疗。其中，77例RFA前采用SonoVue行CEUS检查（CEUS组），84例RFA前未行CEUS检查（非CEUS组）。两组病例的临床资料无明显差异。肿瘤平均直径CEUS组（3．6±1．2）cm，非CEUS组（3．5±1．1）cm。治疗后采用常规超声、增强CT及（或）超声造影等影像检查进行规律性随访，至少随访6个月CT判断肿瘤灭活程度。结果CEUS组77例105灶行RFA治疗，造影动脉期显示59灶（56．2％）肿瘤范围较造影前增大，其中42灶（71．2％）造影前肿瘤边界不清；49灶（46．7％）肿瘤形态较常规超声更不规则，其中39灶（79．6％）为造影前边界不清。造影组〉3．5cm肿瘤52灶，37灶（71．1％）在动脉期显示主荷瘤血管。10例CEUS新发现≤2．0cm病灶16个，其中3例为肝硬化随访病例，均进行RFA治疗。两组平均治疗次数为1．2次和1．5次。RFA后随访6～36个月，CEUS组完全灭活率高于非CEUS组（95．4％对87．8％，P=0．042）。CEUS组生存期高于非CEUS组[（34．2±1．2）月对（30．2±1．6）月，P=0．0283。结论RFA前CEUS可清晰显示肿瘤浸润范围，灵敏发现卫星灶及其他区域微小病灶，确认荷瘤血管，为准确制定消融方案，施行治疗策略，整体覆盖灭活肿瘤提供了可靠的依据，从而有效地提高RFA对肝癌的治疗水平。
Objective To evaluate the clinical value of contrast enhanced ultrasound （CEUS） for patients with hepatocellular carcinoma in identifying the ablation range and designing the treatment protocol before radiofrequency ablation （RFA） treatment and to compare the efficacy of RFA after CEUS with the efficacy of RFA after fundamental uhrasonography （US） without contrast. Methods One hundred sixty-one patients with hepatocellular carcinoma （HCC） were suitable for percutaneous RFA and underwent US-guided RFA treatment. CEUS was performed for 77 patients pre-treatment （CEUS group） and fundamental US without contrast enhancement was performed for the remaining 84 patients pre-treatment （non-CEUS group）. There were no significant differences in clinical data between the two groups; the average diameters of the lesions in CEUS group and non-CEUS group were （3.6 ± 1.2） cm and （3.5 ± 1.1 ） cm, respectively. Regular follow-up after treatment was performed using fundamental US and contrast-enhanced computed tomography （CECT） or CEUS （or both）. No residue or local recurrence on CECT at least 6 months after treatment was classified as complete ablation. Results In the CEUS group,77 cases with 105 lesions were treated with RFA. There were 59 lesions （56.2%） that were larger during the arterial phase and 49 lesions （46.7%） that had a more irregular shape during the arterial phase than in fundamental US. Feeding vessels were detected with CEUS in 37 of 52 lesions larger than 3.5 cm （71.1%）. CEUS showed 16 small lesions （≤2.0 cm） in 10 cases,5 of which had 5 hepatic distant recurrences after RFA which coexisted with liver cirrhosis. Another 5 cases had 11 satellite lesions around the main tumor. The average number of RFA sessions in the CEUS group and non-CEUS group were 1.2 and 1.5 respectively. During the 6 to 3 6 months of follow - up , the complete ablation rate in the CEUS group was significantly higher than that in the non-CEUS group （95.4% vs 87.8%, P = 0. 042）. The average survival time in the CEUS group was longer than that of non CEUS group [（34.2 ± 1.2） months vs （30.2 ± 1.6） months, P = 0. 028]. Conclusions CEUS is used to accurately identify the tumor invasive range and sensitively detect minute or satellite lesions and the feeding vessel of the tumor. CEUS provides important information and evidence for planning the RFA protocol and may improve the efficacy of RFA treatment of liver tumors.
出处
《中华超声影像学杂志》
CSCD
2006年第3期193-197,共5页
Chinese Journal of Ultrasonography
基金
北京市重大项目培育专项基金资助(Z0005190040431)
北京大学医学部"十五""211工程"重点学科建设项目经费资助(523)
关键词
超声检查
造影剂
癌
肝细胞
导管消融术
Ultrasonography
Contrast media
Carcinoma, hepatocellular
Catheter ablation
