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联合应用经导管碘油化疗栓塞与高强度聚焦超声治疗原发性肝癌对灭活肿瘤血供作用的影像学研究 总被引:2,自引:0,他引:2
目的:从影像学角度观察经导管碘油化疗栓塞(TOCE)联合高强度聚焦超声(HIFU)治疗肝细胞癌是否对肿瘤血供灭活有协同作用。方法:比较40例接受TOCE联合HIFU治疗的病例与同期40例接受单纯TOCE治疗的患者治疗前后数字减影血管造影表现,以及治疗当时与下次复查前采集的腹部平片结果。结果:联舍治疗组肿瘤血管消失及减少比率高于单纯化疗栓塞组。而病灶内碘油清除程度低于单纯化疗栓塞组。结论:TOCE联合HIFU治疗肝细胞癌对肿瘤血供灭活有协同作用,是可以提高肿瘤坏死效果的有效的非手术治疗手段组合。 相似文献
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目的:探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)配合B超引导下经皮肝穿刺注射无水乙醇(percutaneous ethanol injection,PEI)治疗原发性肝癌的疗效及其影响因素。方法:原发性肝癌22例,采用FEP-BYO2型高能聚焦超声肿瘤治疗机,点累积方式分次治疗,靶区完全覆盖肿瘤;1周后行PEI治疗。观察治疗前后临床症状、影像学、肿瘤标记物改变,追踪观察生存期,分析影响疗效的因素。结果:治疗后患者临床症状改善、治疗区域病灶回声增强、血供减少或消失。18例(81.8%)病灶体积缩小,12例(75.0%)AFP阳生患者AFP浓度下降,1/2、1、2年生存率分别为90.9%、85.8%、71.5%。疗效与肿瘤分型、病灶大小、个数、肝功状态等因素有一定关系。结论:HIFU联合PEI治疗可以缩小瘤体,延长生存期,是治疗原发性肝癌的一种新的有效的微创性综合治疗方法。 相似文献
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目的观察经肝动脉化疗栓塞术(TACE)、经门静脉化疗栓塞术(PVE)联合高强度聚焦超声(HIFU)治疗原发性肝癌合并门静脉癌栓的临床疗效。方法分析2011年1月至2012年2月收治的原发性肝癌合并门静脉癌栓患者85例,TACE、PVE联合HIFU治疗47例为观察组,TACE、PVE治疗38例为对照组,TACE治疗后2周行PVE,PVE后10 d左右行HIFU治疗。结果观察组的近期有效率为89.4%(42/47),对照组为39.5%(15/38),两组比较差异有统计学意义(P<0.05)。观察组6个月、1年、2年的生存率为87.2%(41/47)、66.0%(31/47)、27.7%(13/47),中位生存期15.4个月,对照组上述时间点生存率分别为55.3%(21/38)、39.5%(15/38)和10.5%(4/38),中位生存期10.3个月,两组比较差异有统计学意义(P<0.05)。结论 TACE、PVE联合HIFU治疗原发性肝癌门静脉癌栓可显著提高疗效,延长生存时间,是一种较为安全、有效的治疗方法。 相似文献
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肝节段动脉栓塞治疗原发性肝癌 总被引:49,自引:2,他引:47
目的:研究以无水乙醇碘油乳剂作栓塞剂,行肝节段动脉栓塞术治疗原发性肝癌。材料和方法:观察4例无水乙醇碘油乳剂选择性栓塞正常狗肝动脉前后的门脉血流动力学改变。采用同一栓塞剂,行肝节段动脉栓塞术治疗原发性肝癌患者34例。依肿瘤的类型、血供特点分别采用3种不同的栓塞技术:同轴导管法、直接法或药物辅助法。结果:实验性肝动脉栓塞后,门脉造影表现出局部门脉分支的阻塞性改变。镜下见肝实质内栓塞剂沉积区域的门脉分支内有滴状的无水乙醇碘油乳剂。临床治疗34例后均无严重并发症出现,随访3~18个月,24例非手术患者中有6例出现局部复发,目前尚存活21例;10例患者接受二期手术,术后病检4例肿瘤完全坏死,其余6例包括子灶、包膜浸润癌灶均可见明显坏死,均未发现弥漫性肝损害。结论:行肝节段动脉栓塞术,能使肿瘤所在部位达到动门脉双重栓塞,且并发症少,对于病灶局限的原发性肝癌是一种很好的治疗手段。 相似文献
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目的 评价高强度聚焦超声(HIFU)补救性治疗经选择性肝动脉化疗栓塞(TACE)失败的晚期肝细胞肝癌(HCC)患者的有效性和安全性.方法 回顾性分析44例应用HIFU治疗的经TACE治疗失败的晚期HCC患者临床资料.结果 患者总生存时间为12.8个月(95%CI:10.4 ~ 15.0),1年生存率为46.7%,2年生存率为11.4%.单因素分析显示,肿瘤分期(P=0.001)、肿瘤大小(P< 0.001)、门静脉癌栓(P=0.030)、AFP水平(P=0.001)和消融效果(P< 0.001)为预后的影响因素.多因素分析显示肿瘤大小(P=0.002)及临床分期(P=0.010)是影响患者总生存时间的独立预测因素.3/4级不良反应包括发热(4.5%)贫血(4.5%)、腹部不适(4.5%)、皮肤烧伤(9.1%)、乏力(4.5%)、出血(2.3%)等,未出现严重并发症.结论 对于TACE治疗失败的HCC患者,应用HIFU可有效降低肿瘤负荷,延长生存时间. 相似文献
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肝动脉化疗,栓塞治疗原发性肝癌的临床观察 总被引:8,自引:0,他引:8
目的:研究原发性肝癌肝动脉化疗、栓塞的疗效及其影响因素。材料与方法:L回顾性分析188例肝癌肝动脉化疗、栓塞的临床随访资料。结果:总疗效为症状缓解占59.6%,肿瘤缩小占55%,AFP下降占37.8%,半年及1、2、3年生存率分别为75.4%、46%、23.5%、14.7%,平均生存期12.2月,最长已存活50月,获二步手术切除18例,对比分析了7个影响疗效的有关因素。结论:无或轻度肝硬化、早中期 相似文献
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Zhu H Zhou K Zhang L Jin C Peng S Yang W Li K Su H Chen W Bai J Wu F Wang Z 《European journal of radiology》2009,72(1):160-166
Objective
It has long been known that high intensity focused ultrasound (HIFU) can kill tissue through coagulative necrosis. However, it is only in recent years that practical clinical applications are becoming possible. Since the ribs have strong reflections to ultrasonic beams, they may affect the deposition of ultrasound energy, decreasing the efficacy of HIFU treatment and increasing the chance of adverse events when the intra-abdominal tumours concealed by ribs are treated. The aim of this study was to evaluate the influence of partial rib resection on the efficacy and safety of HIFU treatment.Methods
This prospective study was approved by the ethics committee at Chongqing University of Medical Sciences. An informed consent form was obtained from each patient and family member. A total of 16 patients with hepatocellular carcinoma (HCC), consisting of 13 males and 3 females, were studied. All patients had the successful HIFU treatment. To create a better acoustic pathway for HIFU treatment, all of the 16 patients had the ribs that shield the tumour mass to be removed. Magnetic resonance imaging (MRI) was used to evaluate the efficacy of HIFU treatment.Results
Sixteen cases had 23 nodules, including 12 cases with a single nodule, 1 case with 2 nodules, 3 cases with 3 nodules. The mean diameter of tumours was 7.0 ± 2.1 cm (5-10 cm). According to TNM classification, 9 patients were diagnosed as stage II, 4 patients were stage III, and 3 patients were stage IV. Follow-up imaging showed an absence of tumour blood supply and shrinkage of all treated lesions. The survival rates at 1, 2, 3, 4, and 5 years were 100%, 83.3%, 69.4%, 55.6%, and 55.6%, respectively. No serious complications were observed in the patients treated with HIFU.Conclusion
Partial rib resection can create a better acoustic pathway of HIFU therapy. Even though it is an invasive treatment, this measure offers patients an improved prospect of complete tumour ablation when no other treatment is available. 相似文献12.
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High intensity focused ultrasound (HIFU) has been introduced to treat cancers. However, this therapy is a time-consuming procedure;
destructing a deeper volume is also difficult as ultrasonic energy attenuates exponentially with increasing depth in tissues.
The aim of the present study was to investigate the effects of introducing microbubbles on liver HIFU ablation. Seventeen
goats were divided into groups A (n=8) and B (n=9). The livers in both groups were ablated using HIFU (1.0 MHz, 22,593 W/cm2) performed in the manner of a clinical regime using a clinical device. A microbubble agent was bolus-injected intravenously
before HIFU exposure in group B. All animals in group A and seven goats in group B were euthanased to evaluate the ablation
efficiency 24 h after HIFU. The necrosis rate (mm3/s), which was the volume of necrosis tissue per second of HIFU exposure, was used to judge the ablation efficiency. Pathological
examinations were performed to determine whether there were residual intact tissues within the exposed volume. The other two
goats in group B were used to determine the delayed pathological changes 7 days after ultrasonic ablation. The necrosis rate
(mm3/s) was increased in group B (14.4647±4.1960 versus 33.5302±12.4484, P=0.0059). Pathological examinations confirmed that there were no residual unaffected tissue focuses within the exposed volume.
Two remarkable changes occurred in the other two goats in group B 7 days after HIFU: there were ghost-cell islands at the
periphery of the ablated tissues, and surrounding adjacent tissues outside the reactive zone necrotized. These findings showed
that microbubbles could be used to assist liver HIFU ablation.
T. Yu and X. Fan contributed equally to this paper. 相似文献
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Yuanyuan Zhang Jiannong ZhaoDajing Guo Weijia ZhongLifen Ran 《European journal of radiology》2011,79(3):347-352
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To explore the significance of contrast-enhanced MRI (CE-MRI) and diffusion-weighted imaging (DWI) in evaluating the short-term response of high intensity focused ultrasound (HIFU) ablation for primary hepatic carcinoma (PHC).Methods
Thirty-nine lesions in the livers of 27 patients were performed HIFU ablation. Conventional MRI sequences, CE-MRI and DWI were performed 1 week before HIFU and 1 week, 3 months after the therapy, respectively. The short-term responses of HIFU for all lesions were evaluated with MRI.Results
28 of the 39 lesions (28/39, 71.8%) showed complete necrosis with no enhancement 1 week and 3 months after HIFU. The apparent diffusion coefficient (ADC) values 1 week and 3 months after HIFU were significantly higher than those 1 week before treatment (p < 0.05). The tumor recurrence was detected in 7 of the 39 lesions (7/39, 17.9%) which had no significant enhancement 1 week after HIFU. On the 3 months follow-up, focal nodules were found on the inner aspects of the treated areas. The ADC values had no significant difference between 1 week before and after treatment (p > 0.05), however, they were significantly higher 3 months after HIFU (p < 0.05). The tumor residuals were detected in 4 of the 39 lesions (4/39, 10.3%) showing enhancement 1 week after treatment and increased size 3 months after HIFU. The ADC values had no significant difference among 1 week before HIFU, 1 week and 3 months after treatment (p > 0.05).Conclusion
CE-MRI and DWI can be employed to evaluate the short-term response of HIFU ablation for PHC and to guide the patient management. 相似文献15.
Kazushi Numata Hiroyuki Fukuda Ryu Itou Masaaki Kondou Eii Karasawa 《European journal of radiology》2010,75(2):e67
Objective
We performed contrast-enhanced three-dimensional sonography (CE 3D US) with a perflubutane-based contrast agent to immediately evaluate the completeness of ablation of small hepatocellular carcinoma (HCC) lesions by extracorporeal high-intensity focused ultrasound (HIFU).Subjects and methods
Twenty-one HCC lesions were treated by a single ultrasound-guided HIFU ablation session, and CE 3D US was performed before, immediately after, and 1 week, and 1 month after HIFU, and contrast-enhanced CT (CE CT) or contrast-enhanced MRI (CE MRI) was performed before HIFU, 1 week and 1 month after HIFU, and during the follow-up period.Results
Immediately and 1 month after HIFU, 17 lesions were evaluated as adequately ablated by CE 3D US, and the other 4 lesions as residual tumors. One month after HIFU, 18 were evaluated as adequately ablated by CE CT or CE MRI, and the other 3 as residual tumors. The evaluation by CE 3D US immediately after HIFU and by CE CT or CE MRI 1 month after HIFU was concordant with 20 lesions. The kappa value for agreement between the findings of CE 3D US and other modalities by two blinded observers was 0.83. When the 1-month CE CT or CE MRI findings were used as the reference standard, the sensitivity, specificity, and accuracy of CE 3D US immediately after HIFU for the diagnosis of the adequate ablation were 100%, 75%, and 95%, respectively.Conclusion
CE 3D US appears to be a useful method for immediate evaluation of therapeutic efficacy of HIFU ablation of HCC lesions. 相似文献16.
经肝动脉化疗栓塞治疗肝癌的疗效分析 总被引:1,自引:1,他引:0
目的 探讨经肝动脉化疗栓塞(TACE)、单纯灌注化疗(TAI)治疗原发性肝癌的疗效。材料与方法对32例原发性肝癌中25例行TACE治疗,7例行TAI治疗。结果通过TACE治疗的病例半年、1年、2年生存率分别为70%、56%、32.2%,TAI治疗的病例提高了生存质量。结论TACE治疗原发性肝癌能提高患的生存质量。延长生存时间。TAI治疗仅能提高生存质量。 相似文献
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目的:对原发性肝癌伴腺功能亢进(脾亢)患者行部分脾栓塞,使其血细胞恢复正常,以便能进一步行肝动脉化疗。方法:对46例不能行手术切除,且血细胞明显低于正常的肝癌伴脾亢的患者行部分脾栓塞,栓塞面积控制在50%-70%,栓塞前后测定血细胞数量,并作方差分析和t检验。结果:脾栓术后24h、48h、72h、1周、2周、4周的血白细胞和血小板均较栓塞前明显升高(P<0.05或P<0.01)。结论:部分脾栓塞能治疗脾功能亢进,提高血细胞数量,使肝癌伴脾亢患者的肝动脉化疗能正常进行。 相似文献
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High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins 总被引:3,自引:0,他引:3
Hepatocellular carcinoma (HCC) is an especially frequent malignancy in China. Radiofrequency ablation, percutaneous ethanol
injection, transarterial chemoembolization, cryoablation, microwave coagulation, and laser-induced interstitial thermotherapy
all offer potential local tumor control and occasionally achieve long-term disease-free survival. High-intensity focused ultrasound
(HIFU), as a noninvasive therapy, can be applied to treat tumors that are difficult to treat with other techniques. The preliminary
results of HIFU in clinical studies are encouraging. The aims of this investigation were to assess the efficacy of the system
in obtaining necrosis of the target tissue and to determine whether HIFU ablation is hazardous to adjacent major blood vessels.
Over 7 years, thirty-nine patients with HCC were enrolled in this investigation. The inferior vena cava (IVC), main hepatic
vein branches, and the portal vein and its main branches were evaluated. The distance between tumor and main blood vessel
was less than 1 cm in all these enrolled patients. Contrast-enhanced MRI was used to evaluate the perfusion of tumors and
major blood vessels. We conducted HIFU ablation for the treatment of 39 patients with 42 tumors, with each tumor measuring
7.4 ± 4.3 (1.5–22) cm in its greatest dimension. Among the 39 patients, 23 were males and 16 females. The average age was
53.2 years (range 25–77 years). Thirty-seven patients had a solitary lesion, one had two lesions, and the remaining one had
three lesions. Nineteen lesions were located in the right lobe of liver, 18 in the left lobe, and 5 in both right and left
lobes. Among the 42 tumors, 25 were adjacent to 1 blood vessel, 12 adjacent to 2 main vessels, 2 adjacent to 3 main vessels,
and 1 adjacent to 4 main vessels. Twenty-one of the 42 tumors were completely ablated, while the rest of the tumors were ablated
by more than 50% of lesion volume after one session of HIFU. No major blood vessel injury was observed in any subject after
23.8 ± 17.2 months follow-up. HIFU can achieve complete tumor necrosis even when the lesion is located adjacent to the major
hepatic blood vessels. Short-term and long-term follow-up results show that HIFU can be safely used to ablate the tumors adjacent
to major vessels.
Lian Zhang and Hui Zhu contributed equally to this research, which was supported by the National Natural Science Foundation
of China (grant no. 30171060). 相似文献
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Maythem Saeed Roland Krug Loi Do Steven W Hetts Mark W Wilson 《World journal of radiology》2016,8(3):298-307
AIM: To use magnetic resonance-guided high intensity focused ultrasound (MRg-HIFU), magnetic resonance imaging (MRI) and histopathology for noninvasively ablating, quantifying and characterizing ablated renal tissue.METHODS: Six anesthetized/mechanically-ventilated pigs underwent single/double renal sonication (n = 24) using a 3T-MRg-HIFU (1.1 MHz frequency and 3000J-4400J energies). T2-weighted fast spin echo (T2-W), perfusion saturation recovery gradient echo and contrast enhanced (CE) T1-weighted (T1-W) sequences were used for treatment planning, temperature monitoring, lesion visualization, characterization and quantification, respectively. Histopathology was conducted in excised kidneys to quantify and characterize cellular and vascular changes. Paired Student’s t-test was used and a P-value < 0.05 was considered statistically significant.RESULTS: Ablated renal parenchyma could not be differentiated from normal parenchyma on T2-W or non-CE T1-W sequences. Ablated renal lesions were visible as hypoenhanced regions on perfusion and CE T1-W MRI sequences, suggesting perfusion deficits and necrosis. Volumes of ablated parenchyma on CE T1-W images in vivo (0.12-0.36 cm3 for single sonication 3000J, 0.50-0.84 cm3, for double 3000J, 0.75-0.78 cm3 for single 4400J and 0.12-2.65 cm3 for double 4400J) and at postmortem (0.23-0.52 cm3, 0.25-0.82 cm3, 0.45-0.68 cm3 and 0.29-1.80 cm3, respectively) were comparable. The ablated volumes on 3000J and 4400J double sonication were significantly larger than single (P < 0.01), thus, the volume and depth of ablated tissue depends on the applied energy and number of sonication. Macroscopic and microscopic examinations confirmed the locations and presence of coagulation necrosis, vascular damage and interstitial hemorrhage, respectively.CONCLUSION: Contrast enhanced MRI provides assessment of MRg-HIFU renal ablation. Histopathology demonstrated coagulation necrosis, vascular damage and confirmed the volume of damage seen on MRI. 相似文献