超声造影时间-强度曲线在肝癌射频消融的应用研究

Application study of contrast-enhanced ultrasound time-intensity curve in hepatocellular carcinoma radiofrequency ablation

目的探讨超声造影时间-强度曲线在肝癌射频消融治疗效果的应用价值。方法对76例肝癌患者共118个肿瘤病灶行超声引导下射频消融治疗,消融术后1个月使用声学定量分析软件对残余消融灶行动态分析,并与同期增强磁共振成像(MRI)检查结果进行比较,以病理为金标准,对肿瘤残余消融病灶良恶性进行统计对比分析。结果肝脏射频消融治疗后超声造影疗效的准确性为82.2%,增强MRI为83.9%;超声造影与增强MRI间比较差异无统计学意义(P>0.05),其检查结果一致性较高;消融术后良性残留消融灶与恶性残留灶血流灌注特点不同,时间强度曲线示峰值强度(IMAX)良性残留消融灶小于恶性残留灶(P<0.01),峰值强度上升时间(RT)及达峰时间(TTP)良性残留消融灶长于恶性残留灶(P<0.01);超声造影与增强MRI判断残余病灶良恶性比较差异无统计学意义(P>0.05)。结论超声造影结合时间强度曲线可以动态、直观、定量地反映灭活灶及良恶性残留灶与周围肝实质血流灌注的差异。

Objective To investigate the application value of contrast-enhanced ultrasound（CEUS） time-intensity curve in the radiofrequency ablation treatment of hepatocellular carcinoma. Methods Seventy-six patients with hepatocellular carcinoma （118 tumor lesions） conducted the ultrasound-guided radiofrequency ablation therapy. The acoustic quantitative analysis software was employed to dynamically analyze the residual ablation lesions, which were compared with the examination results of synchro- nous enhanced MRI, with the pathology as the gold standard, the benign and malignant tumor residual ablation lesions were per- formed the statistically comparative analysis. Results The accuracy of CEUS effect atter liver radiofrequency ablation therapy was 82.2 %,which of enhanced MRI was 83.9 %;the difference between CEUS and enhanced MRI had no statistical significance（P〈 0. 05） ,their examination results had higher consistency; the benign residual ablation lesions after radiofrequency ablation had blood perfusion characteristics different from malignant residual lesions,the time-intensity curve showed that IMAX benign residual le- sions were smaller than malignant residual lesions（P〈0.01）. The benign residual lesions of RT and TTP were longer than the ma- lignant residual lesions（P〈0.01）;diagnosing benign and malignant had no statistical difference between CEUS and enhanced MRI （P〉0.05）. Conclusion CEUS combined with the time-intensity curve can dynamically, intuitively and quantitatively reflect the blood perfusion differences among inactivated focus,benign and malignant residual lesions,and the surrounding liver parenchyma.