超声造影对高强度聚焦超声治疗肝脏转移瘤疗效的评价作用

Treatment Effect Evaluation of High Intensity Focused Ultrasound on Hepatic Metastasis by Contrast-enhanced Ultrasound

目的探讨超声造影评价高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗肝脏转移瘤的临床应用价值。方法将18例肝转移瘤病例(共24个病灶)分别行高强度聚焦超声治疗。治疗前后行超声造影检查,通过病灶血流信号变化判断消融效果。所有病例随访1年,每月行肝脏彩超一次,并计算半年、1年生存率。结果超声造影能清楚显示肿瘤大小及内部血流信号。治疗前所有病灶动脉期呈不同程度增强。治疗后15个(62.5%)病灶动脉期呈无增强区域,随访中仅2个病灶(8.3%)出现局部肿瘤进展;9个病灶(37.5%)动脉期见异常增强信号,均在随访的不同阶段出现局部肿瘤进展。本组患者的半年生存率为100%,1年生存率为80%。结论超声造影能准确显示HIFU治疗肝脏转移瘤的消融范围及程度,可作为评价治疗效果及指导进一步治疗的可靠方法。

Objective To assess the value of contrast-enhanced ultrasound in evaluating the therapeutic efficacy of high intensity focused ultrasound （HIFU） on hepatic metastasis. Methods A total of 18 patients with 24 tumors were treated by HIFU. Contrast-enhanced ultrasound examination was performed before and after treatment. All patients were followed up for one year and received hepatic ultrasound examination every month after HIFU treatment. The half-year and one-year survival rates were calculated. Results The contrast-enhanced ultrasound method could show the size of the tumor and the blood flow signal clearly. Before treatment, the intensity of all 24 tumors in arterial period was stronger after the administration of Sonovue. During the follow-up, 15 tumors （62.5%） showed no signal of contrast agent, and only 2 （8.3%） of these 15 tumors showed local tumor progression. The remaining 9 tumors （37.5%） showed signal of partial contrast agent and tumor progression. The half-year and one-year survival rates were 100% and 80% respectively. Conclusion Contrast-enhanced ultrasound can display the ablation area and degree of hepatic metastasis correctly. It is a reliable method for the evaluation of therapeutic efficacy of HIFU treatment and for the direction of further therapy.