实时超声造影在肝癌射频消融治疗前的应用研究

Clinical application of real-time contrast-enhanced ultrasonography for liver cancer assessment before radiofrequency ablation

目的探讨肝癌射频消融(RFA)前实时超声造影对确定消融范围和选择治疗方案的应用价值。方法对RFA前239例肝癌患者315个病灶进行常规超声和低机械指数(MI<0.2)实时超声造影检查(造影剂为SonoVue),比较分析肝癌常规超声与超声造影的图像差异及其对确定消融范围和选择治疗方案的影响。结果192个病灶(60.9%)超声造影后肿瘤大小测值较造影前明显增大(P<0.01),其中163个病灶设计消融范围较超声造影前明显扩大,29例因肿瘤≥6cm而改为手术切除;125个病灶(39.7%)超声造影后肿瘤形态更加不规则(P<0.01),其中16例因显示形态不规则的肿瘤邻近重要结构而改为手术切除。结论与常规超声比较,RFA前超声造影可以更清晰、更准确地显示肝癌的大小、形态和浸润范围,为确定消融范围和选择治疗方案提供可靠的依据。

Objective to evaluate real - lime contrast- enhanced uhrasonography （CEUS） foe patients with hepatocellular carcinoma （HCC） in designing the ablation range and treatment protocol. Methods Three hundred and five lesions of 239 patients with HCC were examined by both conventional ultrasound and real - time CEUS （ SonoVue, MI 〈 0.2） before radiofrequency ablation （RFA）. Differences between conventional ultrasound and CEUS were compared and their influence on ablation range design and selection of treatment protocol was analyzed. Results One hundred ninety lesions （60.9%） were larger and 125 lesions showed a more irregular shape during the arterial phase of CEUS than in conventional ultrasound （ P 〈 0.01 ）. Ablation range was enlarged in 163 lesions after CELTS. Forty five lesions were transferred to surgical resection because the lesions were larger than 6.0 cm or near important structure after CELTS. Conchusion CEUS is more accurate in identifying the size, shape and invasive range of HCC before RFA, therefore shows clinical importance in ablation range design and selection of treatment protocol.