30例肝转移性神经内分泌肿瘤超声造影表现及微波消融治疗效果分析

Contrast-enhanced ultrasound feature and short-term efficacy of microwave ablation in patients with neuroendocrine tumor liver metastases:An analysis of 30 cases

目的观察肝转移性神经内分泌肿瘤超声造影(CEUS)表现特征,并观察在超声引导下微波消融(MWA)的治疗效果。方法2017年1月~2022年1月空军军医大学第一附属医院收治的肝转移性NET患者30例,其中原发病灶来自结肠21例(70.0%)、胰腺7例(23.3%)和胃2例(6.7%)。均接受CEUS检查和在超声引导下行MWA治疗,随访。结果30例肝转移性NET病灶CEUS检查开始增强时间(AT)、达峰时间(TTP)和消退时间(RT)分别为(17.2±3.5)s、(22.3±4.5)s和(40.9±13.1)s,病灶整体增强24例(80.0%),向心性增强6例(20.0%);病灶增强峰值表现为均匀增强、不均匀增强和环形增强分别为18例(60.0%)、8例(26.7%)和4例(13.3%);门静脉期呈轻度消退和明显消退分为为10例(33.3%)和20例(66.7%);病灶CEUS增强-消退模式包括快进快出、同进快出和慢进快出分别为15例(50.0%)、9例(30.0%)和6例(20.0%);在MWA治疗后,30例肝转移性NET病灶近期获得CR、PR、PD和SD分别为21例(70.0%)、4例(13.3%)、2例(6.7%)和3例(10.0%)。结论大多肝转移性NET来自胃肠道,在CEUS下呈整体增强或均匀增强,门静脉期则明显消退,以快进快出增强模式为主,难以与肝细胞癌鉴别。局部介入治疗后,可获得短期疗效。

Objective The aim of this study was to observe the contrast-enhanced ultrasound(CEUS)feature and shortterm efficacy of microwave ablation(MWA)in patients with liver metastatic neuroendocrine tumors(LMNET).Methods 30 patients with LMNET arose from gastrointestinal tract were admitted to the First Affiliated Hospital,Air Force Military Medical University between January 2017 and January 2022,and all underwent CEUS check-up and MWA under US guidance.Results The arrival time,time to peak and resolution time by CEUS in the 30 patients with LMNET were(17.2±3.5)s,(22.3±4.5)s and(40.9±13.1)s,and the enhancement modes included global enhancement in 24 cases(80.0%)and centripetal enhancement in 6 cases(20.0%);at peak enhancement,the lesions showed uniform,heterogeneous and circular enhancement in 18 cases(60.0%),in 8 cases(26.7%)and 4 cases(13.3%);at portal vein phase,the lesions showed mild and obvious subsides in 10 cases(33.3%)and in 20 cases(66.7%);the CEUS enhancement patterns of the lesions included fast-in and fast-out,average-in and fast-out,slow-in and fast-out in 15 cases(50.0%),in 9 cases(30.0%)and 6 cases(20.0%);after intervention of MWA,the complete remission,partial remission,stable disease and progressive disease were obtained in 21 cases(70.0%),4 cases(13.3%),3 cases(10.0%)and 2 cases(6.7%).Conclusion The most LMNET arise from the gut,and the CEUS scan showoverall and uniform enhancement,with obvious subside at portal vein phase.The short-term efficacy by MWA ispromising.