超声造影在肝细胞肝癌射频治疗中的应用

目的探讨超声造影（CEUS）在肝细胞肝癌（HCC）射频消融（RFA）治疗中的应用价值。方法对接受RFA治疗的84例HCC患者共105个病灶,于治疗前、后行CEUS检查,与常规超声、增强CT比较,分析CEUS在治疗前、治疗后、随访中的作用。结果 RFA治疗前：CEUS清晰显示95.24%（100/105）病灶的边界,优于常规超声47.62%（50/105）];CEUS测量病灶平均最大直径、面积较常规超声测值大,差异有统计学意义（P〈0.01）;CEUS对荷瘤动脉血管的显示率为60.95%（64/105）,高于彩色多普勒（25.71%）和增强CT（42.86%）。RFA治疗后：CEUS与增强CT评价疗效符合率为96.15%;3个病灶CEUS发现残留,CEUS引导下完成补充治疗。随访：CEUS评价RFA治疗后病灶残留或复发的敏感度、特异度和准确率分别为84.62%、95.40%和94.00%,与同期增强CT比较,差异无统计学意义（P〉0.05）。结论 RFA治疗HCC中,CEUS可有效辅助,具有重要价值。

Application of contrast enhanced ultrasound in treatment of hepatocellular carcinoma with radiofrequency ablation

Objective To explore the clinical value of contrast enhanced ultrasound (CEUS) in treatment of hepatocellular carcinoma (HCC) with radiofrequency ablation (RFA). Methods Eighty-four patients with 105 lesions underwent CEUS before and after RFA .The results of CEUS were compared with those of conventional ultrasound and contrast enhanced CT, and the usefulness of CEUS was analyzed before and after RFA and during follow-up, respectively. Results Before RFA: The boundary of 95.24% (100/105) lesions could be demarcated at CEUS, whereas the boundary of 47.62% (50/105) lesions could be demarcated at conventional ultrasound. The size of the lesions measured at CEUS was larger than at conventional ultrasound (P<0.01). Bearing HCC blood vessels were detected with CEUS in 60.95% (64/105) lesions,and it was higher than conventional ultrasond (25.71%) and contrast enhanced CT (42.86%). After RFA: The diagnostic agreement between immediate CEUS and contrast enhanced CT was achieved in 96.15%. Residual viable tumors were visible at immediate CEUS after RFA in 3 lesions, and additional treatment with RFA was accomplished by CEUS guidance. During following-up, the sensitivity, specificity and accuracy in evaluating therapeutic effect was 84.62%, 95.40% and 94.00% with CEUS, respectively. There was no significant difference of the sensitivity, specificity or accuracy in evaluating therapeutic effect between CEUS and at the same time contrast enhanced CT (P>0.05). Conclusion CEUS can be used to assist to treatment of HCC with RFA.