超声造影评价肝癌射频消融治疗近期疗效

Assessment of Short Term Therapeutic Response to Radiofrequency Ablation by Contrast Enhanced Ultrasound in Hepatocellular Carcinoma

目的探讨超声造影在原发性肝癌射频消融(radiofrequency ablation,RFA)治疗后近期疗效评价中的应用价值。方法选取我院原发性肝癌住院患者96例,共110个癌灶,RFA治疗前1周内行常规超声和超声造影检查,观察病灶数量、大小、边界、内部回声、造影剂灌注情况等,同时行增强CT扫描,然后在超声引导下行肝内肿瘤RFA治疗,1个月后行彩超、超声造影和增强CT扫描,以增强CT结果为标准,评估超声造影在肝癌RFA治疗后的近期疗效中的应用价值。结果RFA治疗前96例110个癌灶超声造影示动脉期均匀高增强83个,不均匀高增强27个;门脉期及延迟期低增强98个,等增强12个。RFA治疗后1个月超声造影示肿瘤无增强99个,边缘部分高增强11个;增强CT示肿瘤无强化96个,边缘不规则强化14个,两者比较差异无统计学意义(χ2=0.406,P>0.05)。对增强CT扫描边缘部分强化的14个癌灶再次行RFA治疗,1个月后超声造影及增强CT示肿瘤均无增强或强化。结论超声造影对评价肝癌RFA治疗的近期疗效有重要应用价值。

Objective To investigate the value of contrast enhanced ultrasound （CEUS） in evaluating the short term therapeutic response to radiofrequency ablation （RFA） of primary hepatocellular carcinoma. Methods One hundred and ten lesions were studied in 96 patients. Each patient underwent CEUS within a week before RFA, the number, size, border, inner echo and perfusion pattern of lesions were observed. One month after ultrasound- guided RFA, color Doppler flow imaging, CEUS and contrast enhanced computed tomography （CECT, reference standard） were performed to assess the therapeutic response. Results Before RFA, in 96 cases with 110 lesions, 83 lesions showed homogeneous hyper-enhancement and the other 27 heterogeneous hyper-enhancement in arterial phase, and 98 lesions were hypo-enhanced in portal venous phase and late phase and the other 12 iso-enhanced. One month after RFA, 99 of 110 lesions were found no-enhancement in entire CEUS procedure, while 11 lesions showed local enhancement on the edge of lesion. Ninety-six of 110 lesions showed no-enhancement and other 14 with irregular enhancement by CECT. There was no statistical significance between CEUS and CECT （χ^2= 0. 406, P〉0.05）. Fourteen lesions as tumor residual by CECT were underwent RFA again, and then 1 month after RFA no-enhancement was showed by both CECT and CEUS. Conclusion CEUS can play a role in assessing the short term therapeutic response to RFA of hepatocellular carcinoma.