虚拟导航三维超声造影评估肝癌消融安全边界的初步研究

Virtual navigation assisted 3-D contrast-enhanced ultrasound in evaluating ablative margin after radiofrequency ablation

目的探讨虚拟导航三维超声造影（VNA-3D-CEUS）评估肝癌消融范围和安全边界的可行性及其临床应用价值。方法采用VNA-3D-CEUS对51例肝癌患者共61个病灶进行消融范围及安全边界测量评估。以增强MRI为金标准，先评价VNA-3D-CEUS判断消融是否完全的准确性，再按消融灶在三维空间上与原病灶的关系，将病灶分为3组：A组，肿瘤消融完全，且能达到5mm安全边界；B组，肿瘤消融完全，但未能达到5mm安全边界；C组，肿瘤消融不完全。通过随访观察消融是否达到安全边界与肿瘤局部进展的关系。结果VNA-3D-CEUS的操作成功率为78．7％（48／61），判断肿瘤是否消融完全的符合率为100％（40／40）；A组和B组肿瘤局部进展分别为0／26和2／13，组间差异有统计学意义（P=0．032）；肿瘤局部进展与消融是否达到安全边界之间存在显著相关性（r=-1．000，P〈0．001）。结论VNA-3D-CEUS有望成为客观、全面、准确评估肝癌消融范围及安全边界的新方法。

Objective To evaluate the value of virtual navigation assisted 3-D contrast-enhanced ultrasound （VNA-3D-CEUS） in depicting ablative area and ablative margin after hepatocellular carcinoma radiofrequency ablation. Methods Sixty-one lesions in 51 patients were evaluated ablative area and ablative margin using VNA-3D-CEUS. The results were divided into three groups （A） tumor was completely ablated and 5 mm ablative margin was achieved （B） tumor was completely ablated but 5 mm ablative margin was not achieved （C） tumor was not completely ablated. The technical successful rate of VNA-3D- CEUS,as well as the coincidence rate of complete ablation with contrast-enhanced MRI,was evaluated. The relation between local tumor progression and ablative margin was observed through follow-up. Results The technical successful rate of VNA-3D-CEUS was 78.7% （48/61）. Coincidence rate of complete ablation with contrast-enhanced MRI was 100% （40/40）. The local tumor progressions of group A and group B were 0/26 and 2/13. There was significant difference between A and B group（ P = 0. 032）. Significant correlation between local tumor progression and ablative margin was found （ r = - 1. 000, P 〈0. 001）. Conclusions VNA-3D-CEUS could be a new method in accurately evaluating the ablative area and ablative margin after hepatocellular carcinoma ablation.