融合成像超声造影术中即时评估肝癌射频消融疗效

Evaluation of hepatocellular carcinoma ablation using image fusion assisted contrast-enhanced ultrasound

目的探讨融合成像超声造影（CEUS）在肝癌射频消融（RFA）术中即时评估消融疗效的临床价值。方法行肝癌RFA治疗的患者90例，在RFA后分别行融合成像CEUS和常规CEUS评价消融效果，同时定义每组中二维超声显示欠佳、直径〉5cm及穿刺入径困难的病灶为困难病灶，以消融术后1个月的CT／MRI结果为金标准，比较两组病例及其中困难病例的完全消融率。结果融合成像CEUS组及常规CEUS组分别有48及68个病灶，困难病例分别有19及18个，两组病例的病灶大小、困难病灶比例、联合行经动脉化疗栓塞或经皮无水酒精注射治疗的比例差异无统计学意义（P=0．052，P=0．136，P=0．185，P=1．000）。术后随访提示融合成像CEUS组及常规CEUS组完全消融率分别为100％（48／48）和92．6％（63／68），两者比较差异无统计学意义（P=0．145）。两组中困难病例的完全消融率分别为100％（19／19）及72．2％（13／18），两组比较差异有统计学意义（P=0．020）。结论融合成像CEUS能在术中即时评价消融疗效，尤其能提高困难病例的完全消融率，可作为常规CEUS的补充方法。

Objective To evaluate the clinical value of intraoperative image fusion assisted contrast- enhanced ultrasound （CEUS） in real-time assessing the curative effect on radiofrequency ablation of hepatocellular carcinoma（HCC）. Methods From November 2010 to August 2011, the patients with HCC which would accept radiofrequency ablation （RFA） in our hospital were divided into image fusion assisted CEUS group and conventional CEUS group. The HCC lesion in each group was named as difficult lesion if it was invisible in B-mode ultrasound,larger than 50 mm in diameter or the puncuture route was affected by lung,ribs or blood vessels. Ten minutes after RFA, two groups of patients were performed intraoperative image fusion assisted CEUS examination and conventional CEUS examination respectively. All the patients received CT/MRI one month after ablation to decide whether the HCC had been completely ablated. Difference of complete ablation rate of HCC was compared between the two groups as well as between the difficult lesions in each group. Results Forty-eight lesions in 39 patients were enrolled in image fusion assisted CEUS group including 19 difficult lesions. Sixty-eight lesions in 53 patients were enrolled in conventional CEUS group including 18 difficult lesions. No statistical difference was found between the two groups in lesion size, proportion of difficult lesions, proportion of lesions received TACE or RFA plus PEIT （ P = 0. 052, P = 0. 136, P = 0. 185, P = 1. 000）. Postoperation following-up results demonstrated that complete ablation rate of HCC in navigation assisted CEUS group（100% ,48/48） was not statistically higher than that in conventional CEUS group（92.6% ,63/68） （ P = 0. 145）. But the difficult lesions in navigation assisted CEUS group （100%, 19/19） had statistically higher complete ablation rate than that in conventional CEUS group （72.2%, 13/18） （ P = 0. 020）. Conclusions Intraoperative navigation assisted CEUS could real-time assess the curative effect on RFA of HCC, especially in the difficult lesions, and could be used asthe beneficial supplement of the conventional CEUS.