超声评价微泡诱导超声空化联合血凝酶增强兔VX2肝癌微波热消融作用

Ultrasonic evaluation on effect of microbubble-enhanced cavitation combined with prothrombin on microwave ablation in rabbit VX2 liver tumors

目的采用二维灰阶超声、CDFI和CEUS评价微泡诱导超声空化联合血凝酶对兔VX2肝癌微波热消融的增强作用。方法将32只VX2肝癌荷瘤新西兰大白兔随机分为生理盐水组(空化假辐照+生理盐水)、血凝酶组(空化假辐照+生理盐水+血凝酶)、空化组(超声空化+微泡)和联合组(超声空化+微泡+血凝酶)4组,每组8只,分别给予相应空化治疗后行微波热消融治疗,并在治疗前后分别行二维灰阶超声、CDFI和CEUS检查,观察治疗前后超声表现,测量并比较肿瘤和消融区体积。结果治疗前4组间肿瘤体积差异无统计学意义(P>0.05),治疗后4组间消融区体积总体差异有统计学意义(P<0.001);两两比较,联合组消融区体积大于其他3组(P均<0.05),空化组消融区体积大于生理盐水组和血凝酶组(P均<0.05),生理盐水组与血凝酶组体积差异无统计学意义(P>0.05)。治疗前肿瘤均可见丰富血流信号;消融后联合组肿瘤实质内CEUS均未显示增强,生理盐水组、血凝酶组和空化组部分肿瘤实质消融区边缘可见少量残余活性组织,呈典型"快进快出"表现,与CDFI显示的点状血流信号相对应。结论微泡诱导超声空化联合血凝酶可增强兔VX2肝癌微波热消融效果。

Objective To investigate the enhanced effect of ultrasonic microbubbles combined with prothrombin on microwave ablation（MWA）of rabbit VX2 liver tumors with 2 Dgray-scale US,CDFI and CEUS.Methods Totally 32 rabbits with VX2 tumors were randomly divided into four groups（each n=8）,normal saline group（sham therapeutic ultrasound exposure with normal saline）,prothrombin group（sham therapeutic ultrasound exposure with normal saline and prothrombin）,cavitation group（therapeutic ultrasound with microbubble）and combined group（therapeutic ultrasound plus microbubble with prothrombin）.After corresponding treatment,the targeted liver tumors in all groups were ablated with microwave.2 Dgray-scale US,CDFI and CEUS were performed before and after treatment.The ultrasound images were observed,and tumor and coagulated volumes were measured and compared.Results There was no significant difference of tumor volume among 4 groups before treatment（P〉0.05）,while there was statistical difference of coagulated volumes after treatment（P〈0.001）.The coagulated volume in the combined group was larger than that in the other 3 groups（all P 〈0.05）,in cavitation group was also larger than that in prothrombin and normal saline groups（all P〈0.05）,and no significant difference was found between normal saline group and prothrombin group（P〉0.05）.Before treatment,CDFI and CEUS showed abundant blood flow signals in rabbit VX2 liver tumors.After treatment,CEUS demonstrated no enhancement in combined group,while in the other 3 groups,residual active tissue was found in periphery regions,typical ＂ fast-forward＂ performances were observed,which corresponded to the point blood signal shown with CDFI.Conclusion Ultrasonic microbubble-enhanced cavitation combined with prothrombin can significantly improve the effect of MWA on rabbit VX2 liver tumors.