实时灰阶超声造影在肝恶性肿瘤射频或微波消融治疗中的作用

The Application of Real-time Gray Scale Contrast Ultrasonography in Percutaneous Radio Frequency Ablation or Microwave Ablation of Liver Tumor

目的探讨实时灰阶超声造影技术(CEUS)在肝脏恶性肿瘤射频消融(RFA)或微波消融(MW)治疗中的应用价值。方法 92例140个肝脏恶性肿瘤接受了RFA或MW治疗,于治疗前后采用CEUS对部分病灶进行检查。结果消融治疗前:有73例109个病灶行CEUS,其中106(97.2%)个病灶CEUS可清晰显示边界;CEUS测量病灶平均最大直径、面积与常规超声比较,差异有统计学意义(P<0.05);消融过程中:1枚常规超声未能显示的病灶在CEUS引导下完成RFA治疗;5枚病灶消融后即刻CEUS证实完全灭活。消融治疗后,有19例31个病灶行CEUS检查,肿瘤灭活诊断准确率为96.8%,与CECT检查结果一致,CEUS诊断准确率明显高于常规超声的58.1%,两者差异有统计学意义。结论 CEUS在肝癌消融治疗前、治疗过程中和治疗后均具有重要的临床价值。

Objective To investigate the clinical value of real time gray-scale contrast ultrasonog- raphy（CEUS） in the treatment of liver tumors with percutaneous radio frequency ablation （RFA） or microwave ablation （MW）. Methods 92 patients with 140 liver tumors were treated with RF or MW,of which part some underwent CEUS before and after treatment and the use- fulness of CEUS was evaluated before,during and after RF or MW respectively. Results Before ablation ： 73 patients with 109 liver tumors underwent CEUS,the boundary of 97.2% （106/109） lesions could be demarcated on CEUS. The size and area of the lesions measured was larger on CEUS than on conventional ultrasound （P〈O. 05）. During ablation：One HCC lesion which could not be displayed on conventional ultrasound was treated with RFA by CEUS guidance. Com- plete treatment was proved on immediate CEUS after ablation in 5 patients with 5 lesions. After ablation ：19 patients with 31 lesions were observed with CEUS after RFA or MW,with an accu- racy of 96.8% （30/31） ,being similar to the CECT and was significantly superior to the conven- tional ultrasound whose accuracy was only 58.1% （18/31）. Conclusion Being useful and effec- tive, CEUS is clinically valuable before, during and after RFA or MW.