超声造影在肝癌射频消融治疗中的作用

目的：探讨超声造影（CEUS）在肝癌冷循环射频消融（RFA）治疗中的应用价值。方法：选取肝癌患者20例25个病灶为观察对象,RFA治疗前行CEUS确定肿瘤的性质、数目和大小,治疗后1个月内和随访10个月后行CEUS与增强CT对比疗效评价。结果：治疗后1个月内CEUS复查,20个消融病灶各期均无异常增强区,提示肿瘤完全灭活;4个边缘局部有早期增强,提示肿瘤残留,增强区经增强CT及穿刺活组织检查证实为肿瘤残留,当即补充RFA治疗;1个CEUS图像模糊,未能作出诊断。随访10个月,1个消融病灶有残留复发,4例患者行CEUS发现新生病灶11个,直径0.6-3.8 cm,其中2例4个直径〈1.0 cm的病灶增强CT未能发现。结论：CEUS可以在RFA治疗前为治疗方案提供依据,在治疗后判断RFA疗效,是一种有效方法,并有助于发现微小新病灶。     

超声造影对小肝癌多电极冷循环射频消融的近期疗效评估

目的探讨应用CEUS评估多电极冷循环射频消融(RFA)治疗小肝癌后肿瘤灭活程度的价值。方法对49例小肝癌患者(63处病灶)RFA治疗前后分别进行常规超声、CEUS检查及增强CT检查,评估病灶完全消融及局部残留情况。结果 RFA治疗前,CEUS测量病灶最大径为(2.47±0.53)cm,常规超声测值为(2.12±0.57)cm,二者差异有统计学意义(t=-4.907,P0.05)。CEUS测量病灶面积为(6.50±1.26)cm2,常规超声测值为(5.43±1.06)cm2,差异有统计学意义(t=-6.867,P0.05)。CEUS与增强CT对病灶检出率差异无统计学意义(χ2=0.25,P0.05)。RFA治疗后,CEUS判断肿瘤完全灭活与局部残留情况与增强CT差异无统计学意义(χ2=0.50,P0.05)。结论 CEUS可用于评估小肝癌RFA治疗效果。     

超声造影量化分析评价经非手术联合介入治疗后原发性肝癌的残存血供

目的探讨CEUS量化分析评价肝细胞癌（HCC）非手术联合介入治疗后残存血供的应用价值。方法对30例HCC患者共33个病灶进行TACE及超声引导下无水乙醇消融（PEI）治疗;在低机械指数状态下进行实时CEUS,评价疗效;采用时间-强度量化分析软件检测治疗后残留灶内血流灌注信息。结果 CEUS时间-强度量化分析表明3个病灶治疗彻底,病灶直径均〈3 cm;30个残留灶增强时间和增强强度无明显变化（P〉0.05）,而治疗前后曲线下面积差异有统计学意义（P〈0.05）。随访期间CEUS时间-强度量化分析参数差异无统计学意义（P〉0.05）。结论 CEUS量化分析不仅能够准确显示HCC经TACE/PEI治疗后的坏死范围,且有助于客观评价残留肿瘤的血供。     

超声引导下射频消融治疗肝转移瘤的疗效观察

目的评价超声引导下射频消融（RFA）治疗结直肠癌肝转移瘤（MLC）的疗效。方法采用超声引导下RFA治疗结直肠癌MLC患者60例134个病灶,其中91个病灶≤3.0 cm,43个〉3.0 cm。术前39例血清癌胚抗原（CEA）增高,21例正常。采用CEUS检查结合增强CT、穿刺活检及CEA值的动态变化综合评价肿瘤治疗效果。结果术后3个月复查CEA,37例增高,23例正常。术后30 min CEUS检查显示127个射频消融病灶呈无灌注区,近期有效率达94.78%（127/134）。术后1个月CEUS检查显示8个病灶局部增强,考虑复发,经超声引导下穿刺活检及细胞学检查证实而行第2次治疗。术后1个月增强CT复查显示126个（126/134,94.03%）射频消融病灶呈无灌注区,为完全坏死的转移病灶;部分坏死病灶为8个,与CEUS结果一致。结论超声引导下RFA是治疗MLC的一种安全有效的局部微创治疗方法。     

超声造影量化分析评估肝细胞性肝癌TACE疗效的应用价值

目的观察肝细胞性肝癌(hepatocellular carcinoma,HCC)施行经皮肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)治疗后的超声造影(contrast-enhanced ultrasound,CEUS)表现,并探讨超声造影定量分析评价肝细胞性肝癌施行治疗后残留/复发灶的临床应用价值。方法对42例HCC患者共47个病灶行TACE治疗,在低机械指数状态下进行实时CEUS,并进行评价疗效;采用时间-强度量化分析软件检测治疗后残留病灶内血流灌注的信息。结果 HCC病人施行TACE治疗后,超声造影显示,8个病灶三期无增强,39个病灶局部有增强。以同期DSA结果为对照标准,超声造影诊断TACE治疗后残留/复发的灵敏度为97.4%,特异度为87.5%,准确度为95.7%。CEUS时间-强度量化分析表明,38个残留、复发灶治疗前后,增强强度与达峰时间差异有统计学意义(P0.05)。结论 CEUS可以作为HCC病人TACE治疗的疗效评估的可靠方法,时间-强度量化分析有助于客观评价残留/复发灶的血供。     

CEUS评价肝癌射频治疗后的局部进展:与初发肝癌的自身对比

目的探讨原发性肝细胞癌(HCC)射频消融(RFA)治疗后局部进展病灶的CEUS灌注特征,并与初发HCC的CEUS灌注模式进行自身对照比较。方法收集本院RFA治疗后,经随访发现局部进展病灶并于治疗前后均接受CEUS检查的HCC患者33例。比较初发病灶与RFA治疗后局部进展病灶CEUS灌注特征,包括增强时相、荷瘤血管、增强形态、增强边界、增强过程、廓清时相、内部坏死等。结果 RFA治疗后局部进展病灶100%(33/33)呈动脉期或门静脉期增强,96.97%(32/33)呈实质或延迟期廓清,与初发病灶差异无统计学意义(P0.05)。灌注特征比较:HCC初发病灶多见荷瘤血管(29/33,87.88%)、增强形态规整(27/33,81.82%)、边界清(26/33,78.79%);增强过程以周边至中心多见(18/33,54.55%),部分病灶出现内部坏死(9/33,27.27%)。RFA后局部进展病灶多见无荷瘤血管(20/33,60.61%)病灶、增强形态不规则(31/33,93.94%)、边界不清(27/33,81.82%);增强模式以整体增强多见(19/33,57.58%),内部坏死相对少见(2/33,6.06%)。结论 RFA后局部进展病灶造影灌注特征具有特殊表现,有助于其早期诊断及生物学行为检测。     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

超声造影监测原发性肝癌射频消融术的疗效

目的 观察对比剂超声造影（contrast-enhanced ultrasound,CEUS）成像技术对原发性肝癌的诊断价值,以及对肝癌射频消融术治疗效果的评价.方法 适合行射频消融治疗的46例原发性肝癌患者,观察射频消融术前普通超声、CT与CEUS的差别;同时以CT作为标准,对比射频消融术后行CEUS的价值.结果 CEUS与CT检查对原发性肝癌术前诊断价值基本相同,两者的阳性似然比分别为1.26和1.31,敏感度、特异度分别为97%、91%和23%、31%,而灰阶超声检查诊断原发性肝癌的阳性似然比为0.99,敏感度、特异度分别为76%和23%与前两者相比较稍差.射频消融术后CEUS对残存病灶诊断的敏感度和特异度分别为60%和90%,阳性似然比6.18,阴性似然比为0.44,与CT相比差异有统计学意义（P=0.012）.所有患者随访1～9个月,平均5个月,目前均存活;术后1个月射频消融灶周围肿瘤残留3例（6.5%）;术后3、6、9个月复发率分别为8.7%（4/46）、11%（5/46）、11%（5/46）.结论 CEUS与CT结合对诊断原发性肝癌和射频消融术后的复查具有实际应用价值.     

实时超声造影在肝癌介入术中的应用价值

目的 探讨实时超声造影在肝癌微创介入治疗中的应用价值.方法 63例肝癌患者在分别接受经肝动脉化疗栓塞术(TACE)、射频消融(RFA)和微波消融(MCT)治疗中及治疗后,采用实时超声造影对其中76个病灶检查,并与常规超声、CT、数字剪影血管造影(DSA)比较.结果 TACE组21个病灶治疗后1个月, 超声造影显示13个病灶有部分残留,与DSA结果 一致.RFA组和联合治疗组(TACE和RFA,TACE和MCT)共55个病灶在首次接受RFA及MCT治疗后即刻行彩色多普勒超声(CDFI)检查,检出6个病灶部分残留,而超声造影检出24个病灶部分残留.介入治疗后最后一次随访中,超声造影显示有20个病灶部分残留、55个病灶治疗完全、1个病灶判断不明确,与最终诊断比较,在诊断准确性上,超声造影明显优于CDFI(P=0.039),超声造影与增强CT比较,差异无统计学意义(P=0.930).结论 实时超声造影可以增加检测肝癌的血流信号强度,有助于确定介入治疗范围,尤其对于在介入治疗短期内需多次确定疗效者以及消融治疗中即刻评价疗效者,更具优势.     

肝脏恶性肿瘤射频消融术后即刻超声造影的临床价值

目的:探讨肝脏恶性肿瘤射频消融(RFA)后即刻超声造影(CEUS)的临床价值。方法:将中南大学湘雅医院收治的60例肝脏恶性肿瘤患者(76个病灶)随机分为试验组与对照组,每组30例(试验组41个病灶,对照组35个病灶)。两组均采用超声实时引导下经皮RFA治疗,试验组于RFA后即刻(5~10 min内)行CEUS,若发现肿瘤残存则行补充消融治疗,至造影检查无肿瘤残存时结束;对照组RFA后不做即刻CEUS。试验组患者术后36~48 h复查CEUS,所有患者术后1个月复查CEUS及增强CT或增强MRI、肝功能及肿瘤标志物。结果:试验组患者RFA术后即刻CEUS发现5例患者共5处病灶有残存,对残存肿瘤行补充治疗。两组患者1个月后复查,试验组发现1处病灶残存(1/41),对照组发现7处病灶残存(7/35),试验组与对照组的完全消融率差异有统计学意义(96.7%vs.80.0%,P0.05)。试验组患者RFA后即刻及36~48 h CEUS动脉期所测射频灶周围充血水肿带的宽度分别为(6.89±2.73)mm、(4.68±2.05)mm,差异有统计学意义(P0.05)。结论:肝脏恶性肿瘤RFA治疗后即刻CEUS能及时发现残存肿瘤并指导补充治疗,有效提高完全消融率。     

超声造影评价射频治疗肝细胞癌疗效

目的探讨超声造影在肝细胞癌射频治疗术后疗效评估中的临床应用价值。方法对21例因单发病灶肝细胞癌接受射频治疗后患者，应用超声对比剂SonoVue与低机械指数实时造影技术进行超声造影成像，观察病灶坏死范围，并结合增强CT、MRI与血清甲胎蛋白水平评定有无肿瘤复发或局部残留。结果21个病灶超声造影后，毁损灶最大平均直径约（4．7±0．3）cm。17例毁损灶较原病灶增大；8例原病灶旁或病灶周边有动脉期强化灶，提示肿瘤局部复发，1例复发灶位于肝脏膈顶部而未发现。结论超声造影可显示射频治疗后毁损灶的范围，对术后肿瘤消融不全或局部复发的诊断具有较高敏感性。     

TACE联合RFA与TACE联合冷循环微波刀治疗原发性肝癌的疗效比较

目的评价比较肝动脉化疗栓塞(TACE)联合射频消融(RFA)以及TACE联合冷循环微波刀治疗原发性肝细胞癌(HCC)的效果。方法 50例患者接受TACE联合RFA,60例患者接受TACE联合冷循环微波刀治疗术。术后4周复查动态增强CT,观察疗效。采用Tyko Radinics CooltipTM systerm进行RFA,ECO-100冷循环微波肿瘤治疗系统进行微波刀治疗。结果治疗后1个月,两组患者肿瘤一次消融率分别为70.00%和87.67%,TACE联合冷循环微波刀组肿瘤完全坏死率高于TACE联合RFA组(P0.05)。结论 TACE联合采用Tyko Radinics CooltipTM进行RFA以及TACE联合ECO-100冷循环微波肿瘤治疗系统进行微波刀治疗均为原发性肝细胞癌的有效治疗方法,后者是单纯TACE疗效不佳者的较理想选择。     

Contrast-enhanced ultrasound of hepatocellular carcinoma: correlation between enhancement pattern and cellular differentiation on histopathlogy

The aim of this study was to evaluate and correlate the enhancement pattern of hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS) and tumour cellular differentiation on histopathology. Patients underwent hepatic CEUS, performed with SonoVue and contrast pulse sequencing. The correlation between enhancement time and enhancement level of the lesions in different vascular phases and tumour cellular differentiation was determined. The tumours were graded according to the Edmondson grading system. Then, diagnosis was obtained by histopathological examination following surgery or percutaneous ultrasound-guided biopsy. 189 patients with HCC were examined with CEUS and histopathological examination between 2003 and 2009: 159 had a solitary lesion (85?%), 24 had 2 lesions (12?%) and 6 had multiple lesions (3?%). The final histological grading of the tumours was as follows: 22, 114, 49, 4 grade I?CIV, respectively. Significant differences were shown between the time that HCC become hypoenhancing or remained echogenic in late phase and tumour cellular differentiation (p?=?0.006, p?=?0.036). The timing of HCC becoming hypoenhancing was correlated with tumour cellular differentiation, with better differentiated HCCs washing out more slowly than poorly differentiated ones (p?=?0.164, p?=?0.113; p?=?0.186, p?=?0.070). The enhancement pattern of HCC by CEUS correlates with the cellular differentiation. In late phases, hyperechoic lesions are likely to be better differentiated, whereas hypoechoic lesion is more likely to be poorly differentiated.     

肝脏异型增生结节的常规超声及超声造影图像分析

目的探讨肝脏异型增生结节的常规超声和CEUS声像图特点及其诊断价值。方法回顾性分析经增强MRI和超声引导下穿刺活检病理证实的39例肝脏异型增生结节患者的常规超声以及CEUS表现。结果常规超声显示39例病灶的平均直径（1.8±1.0）cm;偏低回声占84.62%（33/39）,边界清晰占69.23%（27/39）,质地欠均匀者占64.10%（25/39）,94.87%（37/39）不伴声晕,94.87%（37/39）不伴后方回声增强。常规超声诊断为肝脏异型增生结节13例,诊断正确率33.33%（13/39）。CEUS示动脉期高增强占84.62%（33/39）,其中28例门脉期等增强,延迟期低增强（71.79%,28/39）;2例（5.13%,2/39）动脉期等增强;4例（10.26%,4/39）动脉期低增强。CEUS诊断为肝脏异型增生结节23例,诊断正确率58.97%（23/39）。结论常规超声异型增生结节多表现为边界清晰、质地欠均匀的偏低回声,且不伴声晕及后方回声增强;CEUS多以动脉期高增强、门脉期等增强、延迟期低增强表现为主,CEUS的诊断准确率明显高于常规超声。     

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??Objective:To evaluate the clinical merit of contrast??enhanced ultrasound (CEUS) in the diagnosis of Small hepatocellular carcinoma (HCC) in patients with posthepatitic cirrhosis. Methods:Small hepatocellular carcinoma were examined and observed by CEUS between March 2004 and October 2005,using ultrasound contrast agent??Sonovue.Contrast enhanced CT and or MRI were performed in all cases. Results:The accuracy of diagnosing Small HCC by CEUS were 88.2% (60/68),according to the hypo??enhancement in arterial phase,iso??enhancement or hyo??enhancement in portal phase,hypo??enhancement in delayed phase.The accuracy and false positive rate of diagnosing Small HCC by CEUS were 97.1% (66/68) and 2.9%(2/68) according to the hypo??enhancement in delayed phase. Conclusion:CEUS might increase the diagnosis of small HCC.     

超声观察犬急性肾损伤

目的评价常规超声及超声造影(CEUS)在急性肾损伤诊断中的价值。方法选择8条健康杂种犬的16只肾脏,全麻下制造不同程度的肾实质损伤模型,分别进行常规超声及CEUS检查,并将检查结果与大体标本及组织病理结果进行对照分析。结果肾挫伤及轻度肾裂伤组,常规超声显示率为10%(1/10),CEUS均不能显示;重度肾裂伤组,常规超声及CEUS显示率均为100%(6/6)。结论对于犬急性肾损伤,肾实质损伤程度是影响超声显像的主要因素,常规超声结合CEUS评价肾损伤的严重程度和血管损伤更加准确可靠。