能量多普勒声学造影评价微波凝固治疗VX_2肝癌疗效的实验研究

The experimental study in assessing the therapeutic effect of microwave coagulated VX_2 tumor with contrast enhanced power Doppler

目的 探讨能量多普勒声学造影对兔VX2 肝癌微波凝固治疗的疗效评价 ,及其对残存瘤组织检查的敏感性与特异性。方法 应用UMC 1型微波治疗仪 ,频率 2 45 0MHz ,16G防粘植入性天线 ,芯线裸露长度为 9mm ,对 10只兔VX2 肿瘤行开腹微波辐射治疗 ,60W× 12 0s。治疗前后均行能量多普勒声学造影 ,灌注 延迟法观察肿瘤结节内血流变化。结果 微波治疗后造影检查 ,6例VX2 肿瘤仅于静脉相观察到稀疏的点状血流 ,2周后病理证实为完全坏死。 4例首次治疗后肿瘤内可见持续血流增强 ,对该区二次微波治疗后 ,3例结节内未见血流 ,1例静脉相边缘有持续血流显示 ,2周后再次行造影检查 ,可见中心及周边血流明显增多 ,病理证实为不完全坏死。结论 能量多普勒声学造影能早期评估微波凝固治疗VX2 肿瘤的疗效 ,并能指导再次治疗的目标区域 。

Objective To evaluate the sensitivity and specificity of contrast enhanced power Doppler ultrasonography in the detection of untreated tumor after microwave coagulation of hepatic VX 2 carcinoma.Methods The Ultrasound Microwave Coagulation 1(UMC 1)equipment was utilized at 2 450 MHz in frequency.The monopolar needle electrode of 9 mm length was inserted directly into the tumor at laparotomy in 10 VX 2 bearing rabbits.The energy output was 60 W×120 s per bout.Pre and post coagulation contrast enhanced imaging was performed by perfusion delayed methods.Results Contrast enhanced ultrasound was applied 10～15 minutes after coagulation.Punctate intratumoral enhanced signal was observed in 6 VX 2 tumors.These tumors were complete necrosis in pathology in 2 weeks.After first therapy persistent intratumoral color enhancement was detected in 4 VX 2 tumors.These 4 tumors were retreated with microwave by targeting the areas of color enhancement.Complete necrosis was seen after the second therapy in 3 of 4 lesions.But persistent enhanced signal of venous phase was seen on the margin of 1 VX 2 tumor and there was distinctly increased color enhancement in the tumor in 2 weeks,correponding to the pathology was incomplete necrosis.Conclusions Contrast enhanced power Doppler ultrasound shows promise in assessing the therapeutic effect of microwave on VX 2 tumor and in guiding additional treatment in cases of incomplete tissue coagulation.Residual unablated tumor can be seen as persistent color enhancement by using power Doppler with microbubble contrast after microwave tissue coagulation.