CT/MR-US融合成像应用于肝肿瘤穿刺活检的价值初探

The value of CT/MR-US fusion imaging in the percutaneous biopsy for liver tumor

目的探讨CT/MR-US融合成像在经皮肝肿瘤穿刺活检中的应用价值。方法选取我院行CT/MR-US融合成像引导下穿刺活检的34例肝肿瘤患者的临床与影像学资料。其中有乙型肝炎病史患者22例,合并肝硬化患者19例。33例患者融合成像后同时进行了超声造影(Contrast enhanced ultrasound,CEUS)检查。分别评价了常规超声检查、CT/MR-US以及CT/MR-CEUS融合成像对病灶的显示情况,分析了穿刺病理及术后并发症。结果全组19例为单发病灶,15例为多发病灶,其中8例为肝段或肝叶弥漫型肝癌。病灶平均大小2.3 cm(范围0.8~9.1 cm)。28例(82.4%)常规超声检查显示不佳,CT/MR-US融合成像、CT/MR–CEUS融合成像对病灶的显示率分别为39.3%、88.9%。6例(17.6%)病灶通过融合成像进一步明确了病灶位置是否与MRI或CT一致。全组患者在确定靶目标位置后均进行了经皮超声引导下穿刺活检,无严重术后并发症。穿刺准确率为80.0%,阳性率为74.3%,包括肝细胞癌17例,肝内胆管细胞癌3例,肝转移癌3例,炎症1例,增生结节2例。假阴性率为20.0%。结论融合成像可改善肝肿瘤在超声影像的显示率,提高超声显示困难的肝脏病灶活检成功率。

Objective To explore the application value of CT/MR-US fusion imaging in percutaneous liver tumor biopsy.Methods The clinical and imaging data of 34 patients with liver tumor who undewent CT/MR-US fusion imaging-guided needle biopsy in our hospital were studied.22 patients had a history of hepatitis B and 19 patients had cirrhosis.Thirty-three patients underwent contrast enhanced ultrasound(CEUS)examination simultaneously after fusion imaging.The display performance of lesions on conventional ultrasound,CT/MR-US fusion imaging and CT/MR-CEUS fusion imaging were evaluated respectively,puncture pathology and postoperative complications were analyzed.Results Nineteen cases were single lesion and 15 cases were multiple lesions,among which 8 cases were hepatic segment or hepatic lobe diffuse carcinoma.The mean lesion size was 2.3 cm(range 0.8~9.1 cm).Among the 28 cases(82.4%)with poor conventional ultrasonography,the displaying rates of CT/MR-US fusion imaging and CT/MR-CEUS fusion imaging were 39.3%and 88.9%,respectively.In 6 cases(17.6%),fusion imaging was performed to further confirm whether the location of the lesions were consistent with that on MRI or CT.All patients underwent ultrasound-guided percutaneous puncture biopsy after the target location were determined by fusion imaging,and serious postoperative complications were not found.The localization accuracy was 80%and the positive rate was 74.3%,including 17 cases of hepatocellular carcinoma,3 cases of Intrahepatic cholangiocarcinoma,3 cases of hepatic metastatic carcinoma,1 case of inflammation and 2 cases of hyperplastic nodules.The false negative rate was 20%.Conclusion Fusion imaging can improve the display rate of liver tumor on ultrasonography and improve the success rate of biopsy on ultrasound-undetectable lesions.