超声造影在困难部位恶性肿瘤放射性粒子植入治疗中的应用价值

Application Value of Contrast-enhanced Ultrasound in Radioactive Seeds Implantation to Malignant Neoplasm in the Region of Difficulty

【目的】探讨超声造影（CEUS）在困难部位恶性肿瘤放射性粒子植入治疗中的应用价值。【方法】超声造影引导下对24例共31个困难部位（肿瘤边缘与胆囊、肝门部、胃肠、左右门静脉主干或三支肝静脉、下腔静脉距离不足0.5 cm）的恶性肿瘤行放射性碘粒子植入治疗术。分别于术前和术后1、3、6、12月进行增强CT及超声造影随访。根据RECIST判定标准评价局部疗效,根据超声造影早期增强程度评估病灶血供变化。【结果】平均随访时间11个月,范围1~46个月。增强CT显示术后1、3、6、12月总有效率分别为0%、7.7%、21.1%及54.6%。超声造影显示术后1、3、6、12月富血供病灶所占比例分别为89.7%、50.0%、36.8%及27.3%。无严重并发症及粒子植入相关死亡发生。【结论】超声造影在困难部位恶性肿瘤放射性粒子植入治疗中能安全有效地引导放射性粒子的植入,对肿瘤局部疗效的评判也具有一定的帮助。

【Objective】 To investigate the application value of contrast-enhanced ultrasound（CEUS） in evaluating radioactive seeds implantation to malignant neoplasm in the region of difficulty.【Methods】 CEUS-guided radioactive seeds implantations were performed in 31 malignant neoplasm in the region of difficulty of 24 cases（the distance from the malignant neoplasm margin to gallbladder,hepatic portal,gastrointestinal tract,the left and right main branch of portal vein,hepatic vein or inferior vena cava less than 0.5 cm）.The follow-up time was pre-therapy,1 month,3 months,6 months and 1 year after therapy.According to RECIST,the change of tumor size was evaluated by contrast-enhanced tomography（CECT）,and the change of tumor blood supply was evaluated by the early features of CEUS.【Results】 The median of follow-up time was 11 months;the range was 1-46 months.CECT showed the overall response rates were 0%,7.7%,21.1% and 54.6% in 1 month,3 months,6 months and 1 year after the implantation,respectively.CEUS showed the ratio of hypervascular lesions were 89.7%,50.0%,36.8% and 27.3% in 1 month,3 months,6months and 1 year after the implantation,respectively.Neither serious complication nor death related to implantation happened for all cases.【Conclusion】 In the procedure of radioactive seeds implantation to malignant neoplasm in the region of difficulty,CEUS could guide the implantation safely and effectively,and evaluate the local therapeutic effect of the implantation.