超声造影技术在肝癌介入治疗术后随访中的作用评价

The value of contrast-enhanced ultrasound in the follow-up of liver cancer patients after interventional therapy

目的探讨超声造影技术在肝癌介入治疗术后随访中的作用。方法回顾性分析2013年6月至2016年6月于本院行肝癌介入治疗的113例肝癌患者的临床资料。其中,48例患者采用经导管肝动脉化疗栓塞术治疗,35例患者接受射频消融治疗,30例患者接受经导管肝动脉化疗栓塞术、射频消融及粒子植入治疗。所有患者均随访6个月,分别行常规超声、超声造影及增强CT检查以判断肿瘤状态,并对疗效进行评估。结果随访3个月检查结果显示,113例肿瘤病灶中103例仍有残存病灶,10例病灶完全坏死。103例残存病灶中,超声造影技术和增强CT检查各检出97例和85例,10例完全坏死病灶二者均检出,超声造影技术对病灶复发检查的灵敏度和准确度均显著高于增强CT检查(P<0.05),二者特异度比较无显著差异(P>0.05)。随访6个月检查结果显示,113例患者超声造影技术检查结果整体有效率为64.6%,增强CT检查结果整体有效率为62.8%,二者无显著差异(χ~2=0.077,P=0.782)。超声造影技术检出的完全缓解病例数显著少于增强CT检查(P<0.05),部分缓解病例数显著多于增强CT检查(P<0.05)。两种检查结果不同者共41例,占总病例数的36.3%,Kappa=0.485(χ~2=20.762,P=0.000),两种检查方法存在弱一致性。治疗前后超声造影技术和增强CT检查对病灶直径的测量结果无显著差异(P>0.05),常规超声检查对病灶直径的测量结果显著小于超声造影技术和增强CT检查(P<0.05)。结论与增强CT检查相比,超声造影技术能够显著提高肿瘤残存病灶的检出率,评估疾病进展程度,是客观评价肝癌介入治疗效果的有效方法。

Objective To study the value of contrast-enhanced ultrasound in the follow-up of liver cancer patients after interventional therapy.Method 113 cases of liver cancer patients who were diagnosed and treated in our hospital from June 2013 to June 2016 were included in this study to retrospectively analysed their clinical data. 48 patients were treated with transarterial chemoembolization, 35 patients were treated with radio frequency ablation, and 30 patients were treated with combined therapy including transarterial chemoembolization, radio frequency ablation and radioactive seed. All patients were followed-up for 6 months by examined with ultrasonic testing, contrast-enhanced ultrasound and contrast-enhanced computer tomography to evaluate the tumor status. Modified response evaluation criteria in solid tumor was used to estimate the therapeutic effect.Result Followed-up for 3 months, there were 103 residual tumors and 10 necrotic tumors in 113 lesions. Contrast-enhanced ultrasound detected 97 lesions and contrast-enhanced computer tomography detected 85 lesions in 103 residual tumors, 10 necrotic tumors were detected by both contrast-enhanced ultrasound and contrast-enhanced computer tomography. The sensitivity and accuracy of contrast-enhanced ultrasound were significantly higher than those of contrast-enhanced computer tomography （P〈0.05）, the specificity of the two methods showed no significant difference （P〉0.05）. Followed-up for 6 months, the overall response rate was 64.6% determined by contrast-enhanced ultrasound and 62.8% determined by contrast-enhanced computer tomography, which had no significant difference （χ^2=0.077, P=0.782）. However, the number of complete response determined by contrast-enhanced ultrasound was significantly less than that determined by contrast-enhanced computer tomography （P〈0.05）, the number of partial response determined by contrast-enhanced ultrasound was significantly more than that determined by contrast-enhanced computer tomography （P〈0.05）. There were 41 different cases in the two kinds of inspection which accounted for 36.3% of the total number of cases,Kappa=0.485 （χ^2=20.762,P=0.000）,there was a weak consistency between the two methods of inspection. Before and after treatment, contrast-enhanced ultrasound and contrast-enhanced computer tomography showed no significant difference in the diameter of the lesions （P〉0.05）, and the the diameter of the lesions determined by of conventional ultrasound was significantly smaller than those of contrast-enhanced ultrasound and contrast-enhanced computer tomography （P〈0.05）.Conclusion Contrast-enhanced ultrasound is an effective means to objectively evaluate the effect of interventional therapy for liver cancer, and it can improve the detection rate of tumor residual lesions and evaluate the degree of disease progression, which is an important method for follow-up of interventional therapy for liver cancer.