超声造影在评价高强度聚焦超声治疗肿瘤疗效中的作用

[目的]了解超声造影在高强度聚焦超声(HIFU)治疗肿瘤临床疗效评价中的应用价值。[方法]选取高强度聚焦超声治疗的肿瘤患者42例(60个病灶)为观察对象。59个病灶HIFU治疗前后采用超声造影检查评价疗效,其中18例患者(23个病灶)与增强CT检查结果进行比较。[结果]HIFU治疗前,超声造影观察60个病灶,51个病灶表现为动脉期增强,8个病灶表现为静脉期增强,治疗后行超声造影检查,显示27个病灶各期均无异常增强区,提示肿瘤“完全灭活”;23个病灶治疗后边缘局部有增强,提示有肿瘤残存;9个病灶呈地图样充盈缺损,提示肿瘤大部分没有灭活。18例患者(23个病灶)超声造影结果与增强CT检查结果相近。[结论]超声造影是评价HIFU的一种有效方法,且能明确肿瘤残存部位引导补充治疗,有助于评价治疗后肿瘤灭活范围。     

高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤的初步研究

目的探讨高强度聚焦超声(High intensity focused ultrasound, HIFU)结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤的可行性。方法 选取大庆油田总医院超声科2010年8月—2011年4月收治入院的子宫肌瘤患者40例, 给予高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗, 通过治疗前后彩色多普勒超声、超声造影、增强MRI图像对比, 以及治疗后1个月、6个月随访超声造影及月经改变、腹痛、尿频等症状的缓解程度, 评价治疗效果。结果 高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗后, 彩色超声、超声造影、增强MRI均显示子宫肌瘤内无血流灌注, 治疗后一个月和治疗后六个月分别与治疗前体积比较以及治疗后一个月与治疗后六个月体积比较, 差异均有统计学意义(P＜0.01)。治疗后1个月、6个月随访超声造影, 肌瘤内仍无血流灌注, 肌瘤体积明显缩小(P＜0.01)。患者月经量较治疗前明显减少, 周期变化规律, 腹痛、尿频等症状明显缓解, 无一例患者出现严重并发症。结论 高强度聚焦超声结合超声引导下瘤内无水乙醇注射治疗子宫肌瘤是一种可行、有效的治疗方式。     

多普勒超声预测HIFU治疗子宫肌瘤早期疗效

目的:通过多普勒超声观察高强度聚焦超声(HIFU)治疗子宫肌瘤滋养血管血流动力学变化,探讨其在疗效评价方面的应用价值.方法:HIFU治疗子宫单发肌壁间肌瘤30例,分别于HIFU术前、术后即刻、1个月及3个月行超声检查,比较肌瘤周边滋养血管和子宫动脉PI及RI变化,并将术后3个月体积变化与其进行相关分析.结果:术后1月及3个月肌瘤体积分别由术前的(40.92±28.58)cm3降至(27.48±16.92)cm3(P＜0.001)和(15.57±17.72)cm3(P＜0.0001),肌瘤HIFU术后即刻周边滋养血管RI增高(P＜0.05),术后3个月滋养血管RI较1个月增高(P＜0.01),术后1个月周边滋养血管PI增高(P＜0.05),HIFU术后即刻较术前,术后3个月较1个月子宫动脉RI增高(P＜0.001),PI增高不明显(P＞0.05).子宫肌瘤HIFU术后1个月周边滋养血管RI增加率与术后3个月体积缩小率呈正相关(r=0.42),术后3个月周边滋养血管RI增加率与之呈正相关(r=0.33).结论:多普勒超声检测HIFU术后1月肌瘤周边滋养血管RI是预测早期疗效的有效手段.     

高强度聚焦超声治疗21例结直肠癌肝转移

[目的]探讨高强度聚焦超声（HIFU）治疗结直肠癌肝转移患者的有效性及安全性。[方法]21例结直肠癌肝转移患者37个病灶行HIFU治疗,观察患者的生命体征、肿瘤转归和毒副反应情况。[结果]随访观察37个肿瘤病灶中,22个病灶体积缩小50%,11个病灶体积保持稳定,1例4个病灶出现新转移灶而放弃治疗。平均随访17个月（5～36个月）,存活12例,中位生存时间为17个月,6、12、24、36个月生存率分别为94.74%、87.45%、61.84%和32.98%。8例患者皮肤出现条索状灼痕。[结论]HIFU是一种安全、有效的治疗结直肠癌肝转移的方法。     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的：探讨超声造影在评价微波凝固治疗肝细胞癌（HCC）的应用价值。方法：经静脉注射造影剂SonoVue后,对30例（男20例、女10例）HCC患者（共33个病灶）在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至2周采用超声造影检查评价疗效,并与同期增强CT检查结果进行比较,12个病灶治疗区取病理标本送检,21个病灶治疗区接受随访观察。结果：微波治疗后超声造影显示22个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及6个月以上的随访,证实微波治疗联合肝动脉栓塞化疗（TACE）,的2个HCC病灶,增强CT判断失误,增强CT诊断肿瘤灭活准确率为94%（31/33）;超声造影诊断肿瘤灭活准确率为97%（32/33）。统计结果显示,两者诊断肿瘤灭活差异无统计学意义（P〉0.05）。结论：超声造影不仅能评价HCC微波治疗的疗效,且能有效地评价TAE和微波凝固联合治疗HCC的疗效,因不受碘油干扰可优于增强CT。     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的:探讨超声造影在评价微波凝固治疗肝细胞癌(HCC)的应用价值.方法:经静脉注射造影剂 SonoVue 后,对 30例(男20例、女10例)HCC患者(共 33 个病灶)在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至 2 周采用超声造影检查评价疗效,并与同期增强 CT 检查结果进行比较,12 个病灶治疗区取病理标本送检,21 个病灶治疗区接受随访观察.结果:微波治疗后超声造影显示 22 个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11 个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及 6 个月以上的随访,证实微波治疗联合肝动脉栓塞化疗(TACE),的 2 个 HCC 病灶,增强 CT 判断失误,增强 CT 诊断肿瘤灭活准确率为 94%(31/33);超声造影诊断肿瘤灭活准确率为 97%(32/33).统计结果显示,两者诊断肿瘤灭活差异无统计学意义(P>0.05).结论:超声造影不仅能评价 HCC 微波治疗的疗效,且能有效地评价 TAE 和微波凝固联合治疗 HCC 的疗效,因不受碘油干扰可优于增强 CT.     

高强度聚焦超声消融术治疗围绝经期子宫肌瘤的效果及腹壁损伤影响因素分析

目的分析高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗围绝经期子宫肌瘤的临床效果及腹壁损伤的相关影响因素。方法选取2012年9月至2014年9月在深圳市龙华新区人民医院妇科诊治的50例围绝经期子宫肌瘤患者为研究对象。均予以HIFU消融治疗,对治疗效果及并发症发生情况进行回顾性分析评价。结果治疗后MRI增强扫描提示肌瘤的消融率超过50%。治疗3个月后患者围绝经期、子宫肌瘤临床症状均较治疗前明显改善(P0.05),肌瘤平均体积显著低于治疗前(P0.05)。发生皮肤损伤并发症患者的辐照时间、治疗总能量消耗均显著多于无并发症者(P0.05),但单位投射时间、肌瘤后缘至前腹壁的距离无显著性差异(P0.05)。结论 HIFU消融治疗围绝经期子宫肌瘤疗效值得肯定;其治疗后常见并发症——腹壁损伤与辐照时间、治疗总能量呈正相关性。     

高强度聚焦超声治疗子宫肌瘤18例的疗效观察

目的：探讨高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗子宫肌瘤的有效性和安全性。方法：选择我院确诊的18例子宫肌瘤患者，通过HIFU治疗后观察比较治疗前后肌瘤回声、大小、血流及临床症状的改变。结果：子宫肌瘤内部回声增强，瘤体缩小，临床症状改善，无严重副作用。结论：HI-Fu治疗子宫肌瘤安全、有效，值得进一步研究、观察。     

高强度聚焦超声治疗子宫肌瘤18例的疗效观察

目的:探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗子宫肌瘤的有效性和安全性.方法:选择我院确诊的18例子宫肌瘤患者,通过HIFU治疗后观察比较治疗前后肌瘤回声、大小、血流及临床症状的改变.结果:子宫肌瘤内部回声增强,瘤体缩小,临床症状改善,无严重副作用.结论:HIFU治疗子宫肌瘤安全、有效,值得进一步研究、观察.     

超声消融子宫肌瘤后残余瘤组织的核磁共振影像学转归

  目的   研究超声消融子宫肌瘤后残余瘤组织的核磁共振成像(MRI)转归。   方法   对重庆医科大学附属第一医院74例子宫肌瘤患者(77个肌瘤)进行超声消融治疗。根据超声消融后1个月内所测体积消融率(消融率), 将74例患者分为三组。A组(24例): 消融率 > 90%;B组(28例): 消融率70%~90%;C组(22例): 消融率 < 70%。MRI监测三组治疗后1、3、6、12个月残余瘤组织的体积变化, 随访超声消融治疗后靶肌瘤的再治疗情况。   结果   1) 治疗后1、3、6、12个月所测残余瘤组织平均体积, 消融率 > 90%组分别为(3.18±1.70)cm3、(1.88±0.99)cm3、(1.00±0.54)cm3、(0.44±0.20)cm3, 呈明显缩小趋势(P < 0.01)。消融率70%~90%组为(6.72±3.06)cm3、(7.41±4.67)cm3、(5.19±3.91)cm3、(4.75±3.17)cm3, 呈现缩小趋势(P < 0.05)。消融率 < 70%组为(17.95±8.85)cm3, (22.10±13.30)cm3、(23.31±13.37)cm3、(23.93±12.85)cm3, 体积变化差异无显著性统计学意义(P > 0.05)。2)治疗后12个月再次治疗情况: 消融率 > 90%者, 无一例在治疗后12个月内需要再次干预治疗, 消融率70%~90%者及消融率 < 70%者分别有10.7%及54.5%患者在治疗后12个月内再次行超声消融或手术治疗。   结论   超声消融率≥70%组的残余瘤组织的体积在术后12个月内呈明显缩小转归趋势, 并且治疗后靶肌瘤的再干预情况明显少于消融率 < 70%组。消融的体积越大, 再治疗的机会越小。      

Value of contrast-enhanced ultrasound in diagnosis ot focal liver lesions

Objective： By observing the pattern of the focal liver lesions （FLL） in different phases by real time contrast-enhanced ultrasound （CEUS）, compared to enhanced CT, investigate the value of CEUS in diagnosing focal liver lesions. Meth. ods： 35 patients with unconfirmed focal liver lesions were studied by contrast agent SonoVue and Technos DU 8 produced by Esaote company. Results： Among the 14 cases of hepatocellular carcinoma （HCC）, 10 were typical, presented with early artery enhancement and immediate wash-out. The enhancement patterns of 6 livers metastasis were diverse, including peripheral or entire degree enhancement. The wash-out time in malignant tumors was eadier than other focal liver lesions （P 〈 0.05）, appeared as hypoechoic in the portal phase or parenchyma phase. The 6 cases of hemangioma were enhanced centripetally nodular in artery phase and washed out after several minutes. The patterns of different lesions were similar compared to contrast-enhanced CT, without significant statistic differences. Conclusion： The contrast enhanced ultrasound technique can significantly improved the value of diagnosing focal liver lesions.     

超声造影在肝脏局灶性病变诊断中的价值

Objective: By observing the pattern of the focal liver lesions (FLL) in different phases by real time contrast-enhanced ultrasound (CEUS), compared to enhanced CT, investigate the value of CEUS in diagnosing focal liver lesions. Methods: 35 patients with unconfirmed focal liver lesions were studied by contrast agent SonoVue and Technos DU 8 produced by Esaote company. Results: Among the 14 cases of hepatocellular carcinoma (HCC), 10 were typical, presented with early artery enhancement and immediate wash-out. The enhancement patterns of 6 livers metastasis were diverse, including peripheral or entire degree enhancement. The wash-out time in malignant tumors was earlier than other focal liver lesions (P＜0.05), appeared as hypoechoic in the portal phase or parenchyma phase. The 6 cases of hemangioma were enhanced centripetally nodular in artery phase and washed out after several minutes. The pattems of different lesions were similar compared to contrast-enhanced CT, without significant statistic differences. Conclusion: The contrast enhanced ultrasound technique can significantly improved the value of diagnosing focal liver lesions.     

Role of contrast-enhanced ultrasound in evaluating the efficiency of ultrasound guided percutaneous microwave ablation in patients with renal cell carcinoma

Background

The aim of the study was to evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS) with Sonovue in assessing of renal cell carcinomas (RCCs) following ultrasound (US)-guided percutaneous microwave ablation (MWA).

Patinets and methods

Seventy-nine patients (60 males and 19 females) with 83 lesions (mean size 3.2±1.6 cm) were treated by US-guided percutaneous MWA. The CEUS results of the third day after the ablation were compared with the synchronous contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) results and biopsy pathological results. The follow-up was performed by CEUS and CT/MRI after 1, 3, 6 months and every 6 months subsequently. The combination of clinical follow-up results and CT/MRI imaging findings was the reference standard of CEUS results for evaluating the therapeutic effect. The identification of residual or recurrence tumour was assessed by two blinded radiologists.

Results

On the third day after MWA, CEUS showed 68 of 83 lesions (68/83, 81.9%) successfully ablated and 15 of 83 (18.1%) with residual tumours. Among residual tumours, 13 (86.7%) were confirmed by contrast-enhanced CT/MRI findings and biopsy results. The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS evaluating the short-term MWA effectiveness were 100%, 97.1%, 97.6%, 86.7% and 100%, respectively. During the six years follow-up (median 26 months), the CEUS showed recurrence in 7 patients, and six of them achieved consistent results on CEUS and CT/MRI imaging. The sensitivity, specificity, accuracy, positive and negative predictive value for CEUS evaluating long-term MWA effectiveness were 85.7%, 98.7%, 97.6%, 85.7% and 98.7%, respectively.

Conclusions

The post-procedural CEUS demonstrated as an effective and feasible method in evaluating a therapeutic effect of RCCs following MWA.     

Percutaneous Radiofrequency Ablation Guided by Contrastenhanced Ultrasound in Treatment of Metastatic Hepatocellular Carcinoma after Liver Transplantation

This study evaluated the advantages and applications of contrast-enhanced ultrasound (CEUS)-supportedpercutaneous radiofrequency ablation (RFA) in the treatment of metastatic hepatocellular carcinoma after livertransplantation, based on clinical details. CEUS-supported percutaneous RFA was adopted to treat 12 patientswith hepatic metastatic carcinomas after liver transplantation. The diameters of the metastatic carcinomas variedfrom 1 cm to 5 cm, and the foci were discovered after 3 months to 12 months. Each focus was diagnosed andlocalised by CEUS for RFA once or twice. Curative effects were evaluated by CEUS or contrast-enhanced CTafter the treatment. The re-examination results at 2 weeks post-treatment showed that the foci of 11 patients wereablated completely, whereas one patient with the largest focus required retreatment by RFA because of a partialresidue. No local recurrence was found one month later in the re-examination. CEUS-supported percutaneousRFA in the treatment of hepatic metastatic carcinoma after liver transplantation has the advantages of accuratelocalisation, good efficacy, easy operation, and minimal invasion without any complications. Therefore, it canbe recommended as the preferred therapy for hepatic metastatic carcinoma after liver transplantation.     

米非司酮治疗子宫肌瘤166例疗效分析

目的：探讨米非司酮治疗子宫肌瘤的疗效。方法：子宫肌瘤166例行口服来非司酮治疗。12．5mg每日一次睡前口服,连服3个月,结果：患者在治疗期间均出现闭经,症状缓解,子宫体积平均缩小52．68％（P＜0．01）,肌瘤体积平均缩小49．86％（P＜0．05）,疗效评价CR25例（15．06％）,PR134例（80．72％）,有效率为（CR＋PR）95．78％,血红蛋白恢复正常（100％）,性激素各项均有下降,其中孕酮,催乳素下降明显（P＞0．05）,结论：米非司酮治疗子宫肌瘤有一定疗效,副作用小,适用于肌瘤直径小于6cm或者子宫小于妊娠70天大小的病例,是一种可行的有效保守治疗方法。     

The percentage of serum thyroglobulin rise in the first-week did not predict the eventual success of high-intensity focussed ablation (HIFU) for benign thyroid nodules

Abstract

Background: Given that high-intensity focussed ultrasound (HIFU) of benign thyroid nodules often causes a massive release of thyroglobulin (Tg) into the circulation, we hypothesised a greater initial Tg rise may result in a greater nodule shrinkage 6?months after ablation.

Methods: One hundred and five patients who underwent HIFU for symptomatic benign thyroid nodule from 2015 to 2016 were analysed. Serum Tg and anti-Tg autoantibody were checked on treatment day (baseline) and 4?d after treatment. The % of Tg rise?=?[serum Tg on day-4 – baseline serum Tg]/[baseline serum Tg] * 100 while the nodule shrinkage as measured by volume reduction ratio (VRR)?=?[baseline volume – volume at 6-month]/[baseline volume] * 100. Treatment success was defined as VRR?>50%.

Results: At 6-month, the mean VRR was 62.2?±?25.0% and 59 (76.6%) patients had treatment success. The mean baseline Tg level increased from 292.8?±?672.7?ng/mL to 2022.7?±?1759.8?ng/mL in the first-week. The % of Tg rise did not significantly correlate with either 3-month or 6-month VRR (p?=?0.920 and p?=?0.699, respectively). The mean % of Tg rise in the first week was not different between those with and without 6-month treatment success (368.2% vs. 1068.7%, p?=?0.381). No clinical factors significantly correlated with treatment success.

Conclusions: There was an almost seven-fold increase in the mean Tg level 4?d after HIFU ablation. The % of Tg rise in the first week did not appear to correlate with the 6-month nodule shrinkage or treatment success.     

Clinical diagnosis and treatment of alpha-fetoprotein-negative small hepatic lesions

Objective

We examined 103 cases over the last five years and discussed diagnosis and treatment of alpha-fetoprotein (AFP)-negative small hepatic lesions.Background: Small hepatic lesions (less than 2 cm in diameter) usually have no typical imaging characteristics and therefore are difficult to diagnose, especially when AFP tests provide a negative result.

Methods

A total of 103 patients with AFP-negative small hepatic lesions from January 2003 to December 2008 were retrospectively reviewed. Differential diagnosis was performed by digital subtraction angiography (DSA), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), contrast-enhanced ultrasound (CEUS), or positron emission tomography-computed tomography (PET-CT) based on the multiplicity of lesions. Ninety-four patients with suspected cancers underwent partial hepatectomy. Clinical data were collected from hospital records and follow-up questionnaires.

Results

Hepatocellular carcinoma (HCC) diagnostic sensitivity of DSA, DCE-MRI, CEUS and PET-CT was 88.2%, 93.9%, 88.9% and 88.9%, respectively. The surgery-related complication rate was 6.4%. Prognosis was good, with 1- and 3-year survival rates of 98.8% and 76.1%, respectively.

Conclusions

DSA, DCE-MRI, CEUS and PET-CT are valuable for diagnosis of small hepatic lesions. Partial hepatectomy is a preferred surgical procedure. Surgery for small liver cancers usually has little risk and good prognosis, therefore it can be actively applied in suspected HCC cases.Key Words: Alpha-fetoprotein (AFP)-negative small hepatic lesions, contrast-enhanced ultrasound (CEUS), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), hepatectomy     

Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study

Purpose: The purpose of this study was to assess the diagnostic accuracy of our early experience with contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions (FLLs) using histopathology, contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI) or other imaging follow-up as the standard of reference. Materials and Methods: Seventy-three patients with 82 FLLs who underwent liver CEUS from January 2006 to December 2008 were retrospectively reviewed. CEUS was performed with up to 4.8 mL of SonoVue® (Bracco, Milan, Italy) using a low mechanical index mode. The CEUS findings were compared with histopathology, or where histopathology was not available, clinical and imaging follow-up over at least 12 months was used as the standard of reference. Results: Of the 82 FLLs, 50 were malignant and 32 were benign at final diagnosis. CEUS correctly identified 43 malignant FLLs, with final diagnosis confirmed by histopathology in 13 lesions and clinico-radiological follow-up in 30 lesions. Twenty-nine lesions were correctly identified as benign on CEUS, with all these lesions confirmed on clinico-radiological follow-up. CEUS demonstrated a sensitivity of 86.0% and a specificity of 90.6% in the characterisation of liver lesions as malignant, with an overall accuracy of 87.8% (P < 0.05). Conclusion: Our early experience has shown that CEUS can be accurate in differentiating malignant from benign FLLs and may become a useful first-line imaging tool where CT or MRI are not available or contra-indicated.