声触诊组织量化技术评价肝癌射频消融疗效的研究

Acoustic palpation tissue quantification technique in evaluating the curative effects of radiofrequency ablation on hepatocellular carcinoma

目的探讨声辐射力脉冲成像(ARFI)包括声触诊组织成像(VTI)和声触诊组织量化(VTQ)技术在评价肝细胞肝癌射频消融(RFA)范围及残留病灶中的应用价值。方法选择2015年6月至2017年8月收治的确诊肝细胞肝癌患者108例,病灶110个。所有患者在射频消融术前24 h之内和术后1个月分别接受二维超声、ARFI、超声造影(CEUS)检查。比较消融后二维超声、VTI和超声造影所测消融区大小。以超声造影为"金标准"判断VTI、VTQ技术评估RFA后残留病灶的敏感性、特异性、阳性预测值、阴性预测值、诊断效率。结果二维超声所测消融区大小与超声造影所显示大小差异有统计学意义(P <0. 05),VTI所测消融区大小与超声造影所显示大小差异无统计学意义(P> 0. 05)。行RFA的110个病灶中经CEUS发现残留病灶20个,VTI检出14个,VTQ检出17个。VTI诊断残留病灶的敏感性70%,特异性93. 3%,阳性预测值70%,阴性预测值93. 3%,诊断效率89. 1%; VTQ诊断残留病灶的敏感性85%、特异性95. 6%、阳性预测值为81%,阴性预测值为96. 6%,诊断效率为93. 6%。结论 VTI技术可准确反映消融区的大小,ARFI识别RFA后残留病灶具有重要价值。

Objective To investigate the application value of acoustic radiation force pulse imaging （ARFI）, including virtual touch tissue imaging （VTI） and virtual touch tissue quantification （VTQ）, in the evaluation of ablation scope and residual lesions after radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC）. Methods A total of 108 patients （involving 110 lesions） who were diagnosed as HCC in our hospital from June 2015 to August 2017 were enrolled in the study. All the patients underwent two-dimensional ultrasound （2DUS）, ARFI, and contrast-enhanced ultrasound （CEUS） within 24h before and 1 month after RFA. The size of the ablation zone measured by 2DUS, VTI and CEUS was compared after ablation. Ultrasound angiography was used as the ＂gold standard＂ to detect the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic efficiency of VTI and VTQ techniques in evaluation of residual lesions after RFA. Results There was significant difference in the size of the ablation zone measured by 2DUS and CEUS （P〈0.05）. However, no significant difference was found in the size of the ablation zone measured by VTI and CEUS （P〉0.05）. Among the 110 lesions treated by RFA, the number of residual lesions detected by CEUS, VTI, and VTQ was 20, 14 and 17, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic efficiency of VTI in the diagnosis of residual lesions was 70%, 93.3 %, 70%, 93.3%, and 89.1%, respectively, whereas those of VTQ in the diagnosis of residual lesions was 85%, 95.6 %, 81%, 96.6%, and 93.6%, respectively. Conclusion VTI technique can accurately reflect the size of the ablation zone, and ARFI is of significant value in identifying residual lesions after RFA.