多次肝动脉化疗栓塞术联合射频消融在肝癌治疗中的临床应用

目的评价多次肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗肝癌的临床疗效。方法对经多次TACE治疗后仍有肿瘤残余的10例肝癌患者分别行B超引导下射频消融治疗,术后随访监测甲胎蛋白(AFP)的动态变化及肝脏CT表现来评价疗效。结果 RFA治疗后3~6个月,生存率为100%,其中9例患者AFP<400 ng/mL,CT检查无肿瘤复发征象者8例,有肿瘤复发征象者2例。9~12个月复查,8例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发征象;有肿瘤复发征象的患者2例,再次行射频消融治疗。8例患者随访时间达到24个月,其中6例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发者7例;1例患者死亡。结论多次TACE联合射频消融为中晚期肝癌治疗提供了新的治疗思路与途径。     

肝动脉化疗栓塞联合CT引导下射频消融术治疗肝癌的疗效分析

目的 评价肝动脉化疗栓塞(TACE)联合CT引导下射频消融术(RFA)治疗肝癌的疗效.方法 HCC患者200例先行TACE术,然后在CT引导下行RFA术.200例患者共行TACE术495例次.肿瘤病灶共计378个,直径为O.5-16 cm,共行RFA术362人次,663个位点.结果 术前、术后12个月AFP分别为(2 156.79±574.61)ng/ml、(269.53±146.65)ng/ml,两者差异有统计学意义(t=16.11,P<0.01).术前、术后3、6和12个月的肿瘤体积分别是(72.64±24.74)cm3、(46.78±18.95)cm3、(28.27±11.70)cm3和(10.82±8.31)cm3,差异有统计学意义(F=10.77,P<0.01).肿瘤完全坏死率为87.8%.结论 肝TACE联合CT引导下RFA治疗肝癌是一种有效的微创治疗方法.     

IMRT与γ刀联合TACE术治疗原发性肝癌的疗效比较

 目的 比较调强放疗(IMRT))与伽马刀(γ刀)联合经肝动脉化疗栓塞(TACE)术治疗原发性肝癌(PHC)的疗效。方法 选择自2012-03至2014-06武警总医院收治的PHC患者94例,按照随机数表将患者分为对照组和观察组,每组47例。对照组患者行IMRT联合TACE术治疗,而观察组患者行γ刀联合TACE术治疗。对比分析两组患者的近期及远期疗效、药物不良反应发生情况及血清中甲胎蛋白(AFP)水平。结果 治疗1个月后,观察组有效率为82.98%(39/47),明显高于对照组的57.45%(27/47) ,且差异具有统计学意义(P<0.05);与治疗前相比,两组患者治疗后血清中AFP水平明显下降,而观察组患者血清中AFP水平显著低于对照组,且差异均具有统计学意义(P<0.05或P<0.01);观察组患者药物不良反应发生率为14.89%(7/47)明显低于对照组的25.53%(12/47),且差异具有统计学意义(P<0.05); 两组患者在治疗后6个月及12个月的生存率之间的差异无统计学意义(P>0.05),而治疗后24个月,观察组患者的生存率显著高于对照组(P<0.05)。结论 相对于IMRT联合TACE术,伽马刀联合TACE术治疗原发性肝癌具有较高的近期及远期疗效,不仅可以有效降低药物毒物反应发生率,而且可以显著抑制血清AFP水平,值得推广应用。     

CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤的疗效

 目的 探讨CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤的疗效。方法 回顾性分析CT引导下经皮细针穿刺化学消融术治疗28例腹膜后淋巴结转移瘤患者的临床资料,其中原发病灶为肝癌12例,胃癌10例,胰腺癌3例,结肠癌3例(共31个病灶)。采用22G Chiba针穿刺,制备化学消融剂[无水乙醇(18 ml)、聚桂醇(2 ml)、碘化油(2 ml)、洛铂(10 mg)、表阿霉素(10 mg)按9∶1∶1∶3∶3比例制成混悬液],术后1、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,采用VAS评分评价疼痛缓解情况,随访时间为12个月。结果 28例(31个病灶)手术均获得成功,术中及术后无严重不良反应。治疗前VAS评分为(6.3±1.5)分,治疗后1个月VAS评分为(1.3±1.2)分(t=13.773,P<0.05);治疗前病灶最大径为(4.2±0.8)cm,治疗后12个月病灶最大径为(1.7±0.5)cm(t=14.755,P<0.05)。结论 CT引导下经皮穿刺化学消融术治疗腹膜后淋巴结转移瘤是一种效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步的研究。     

超声引导经皮射频消融治疗肝癌的临床疗效分析

目的：探讨超声引导经皮射频消融治疗肝癌的临床疗效。方法对我院接受超声引导经皮射频消融治疗的56例原发性肝癌患者的临床资料进行分析。结果在术后1周,超声检查显示肝癌病灶为不均匀的回声增强,边界模糊,范围大于原病灶,内无血流信号,1个月后病灶表现为高回声,增强CT示病灶无强化。本组56例患者中8例患者的AFP在正常范围内,为14．29％（8/56）,术前及术后均＜10ng/ml,其余48例患者AFP值均不同程度地增高。结论超声引导下经皮射频消融治疗是一种安全有效的微创治疗法,值得临床推广。     

肾动脉支架成形术两种置入途径的疗效比较

 目的 对比经肱动脉和经股动脉途径行肾动脉支架成形术(percutaneous transluminal renal artery stenting,PTRAS)安全性及有效性。方法 回顾性分析132例接受PTRAS的肾动脉狭窄(renal artery stenosis,RAS)患者,比较经肱动脉与经股动脉途径完成操作患者的临床资料、介入手术参数及结果。结果 所有入选患者(n=132)术前收缩压(150.72±22.57 )mmHg与术后收缩压(136.67±20.43)mmHg相比明显下降,差异具有统计学意义(t=4.974, P<0.01);术前舒张压(81.46±12.19)mmHg与术后舒张压(76.52±10.45) mmHg相比也有明显下降,差异有统计学意义(t=4.418, P<0.01)。术后6个月所有入选患者门诊随访收缩压(132.20±20.42)mmHg与术前相比明显下降,差异有统计学意义(t=18.523, P<0.01);门诊随访舒张压(74.22±10.57)mmHg与术前相比明显下降,差异有统计学意义(t=7.242, P<0.01)。两组靶病变狭窄程度、平均支架长度、平均置入支架直径、穿刺部位出血并发症、平均手术时间、造影剂用量比较,差异均无统计学意义(P>0.05)。结论 行PTRAS时,肱动脉途径是股动脉途径有效替代方式。     

CT引导下射频消融治疗肝癌的临床应用

目的:探讨CT引导下射频消融(radiofrequency ablation,RFA)治疗肝癌的方法及疗效。方法:回顾性分析我院43例肝癌患者RFA治疗的临床资料。其中原发性肝癌41例,转移性肝癌2例,AFP阳性者38例,术后通过AFP监测及CT增强扫描随访观察1¹2个月。结果:术后CT增强扫描显示肿瘤完全消融33个病灶,不完全消融10个病灶。38例AFP阳性者32例AFP水平明显下降,维持2例,升高4例。并发症中3例包膜下少量出血,2例少量气胸。结论:CT引导下RFA治疗是一种疗程短、操作安全、疗效确切的肝癌微创治疗方法。     

中药联合TACE对原发性肝癌患者免疫功能的影响

 目的 观察中药联合肝动脉灌注化疗栓塞术(transcatheter arterial chemoembolization,TACE)对原发性肝癌患者免疫功能的影响。方法 原发性肝癌80例被分为治疗组(中药联合TACE组,40例)和对照组(TACE组,40例)。两组均于TACE术前24 h、术后1周和4周,检查外周血T淋巴细胞亚群、CD4CD25调节性T淋巴细胞(Treg),以及AFP含量,并进行临床疗效及生活质量评分(KPS)比较。结果 治疗1周后,对照组CD3⁺[(45.26±2.83) vs (50.16±6.31)]、CD4⁺[(22.65±2.35) vs (27.12±3.36)]、CD4⁺/CD8⁺[ (0.85±0.16) VS (1.16±0.27)]较术前降低,CD8⁺[(32.48±6.21) vs (27.36±5.64)]及CD4⁺CD25⁺[(12.65±5.12) vs (9.15±3.63)]调节性T淋巴细胞(Treg)呈升高趋势,差异有统计学意义(P<0.05);治疗组CD3⁺[(46.55±3.94) vs (49.33±3.12)]、CD4⁺[(23.13±2.72) vs (25.53±2.52)]、CD8⁺[(25.26±3.52) vs (27.69±5.13)]、CD4⁺/CD8⁺[(1.13±0.39) vs (1.22±0.16)]及Treg细胞[(10.36±5.62) vs (8.20±2.25)]较治疗前变化无统计学意义(P>0.05)。治疗4周后,两组患者T细胞亚群各项指标均较术前明显改善(P<0.05),组间比较差异无统计学意义(P>0.05);Treg细胞组间比较,治疗组优于对照组[(3.96±1.32) vs (6.21±3.42)],有统计学意义(P<0.05)。AFP测定及KPS评分,治疗组均优于对照组。结论 中药联合TACE可以更好的改善原发性肝癌患者的免疫状况及生活质量。     

肝动脉化疗栓塞联合射频消融治疗肝癌疗效及预后分析

目的 探究肝癌患者采用肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗的临床疗效以及对患者预后的影响.方法 分析2016年7月-2019年7月接受TACE联合RFA治疗的肝癌患者52例的临床资料、治疗方法、治疗结果以及随访结果.结果 52例患者均接受TACE以及CT引导下的RFA治疗,治疗均顺利完成.术后随访12-36个月,平均(18.64±5.2)个月,术后1年患者的AFP明显低于术前,差异有统计学意义(P＜0.05);术后1年,患者的肿瘤体积低于术前,差异有统计学意义(P＜0.05);术后1年,肿瘤完全坏死率达到(56/64).患者的并发症发生率为3.85％(2/52).结论 TACE联合RFA治疗肝癌的疗效显著,能明显改善患者预后.     

TACE治疗78例巨块型肝癌临床疗效观察

目的:观察TACE治疗巨块型肝癌的疗效。方法:78例不宜手术切除的巨块型肝癌患者,使用Seldinger技术,分别行多次(1⁹次)TACE治疗。根据术前术后CT或MRI表现、DSA表现、血清AFP值及生存期来评估TACE术后的疗效。结果:78例术中造影均表现为肝脏肿瘤血管丰富及巨大肿瘤染色灶,术后肝功能均于4周内基本恢复至术前或正常水平。术后3个月54例AFP值较术前明显降低,差异有统计学意义(P<0.05),肿瘤体积缩小达10%9次)TACE治疗。根据术前术后CT或MRI表现、DSA表现、血清AFP值及生存期来评估TACE术后的疗效。结果:78例术中造影均表现为肝脏肿瘤血管丰富及巨大肿瘤染色灶,术后肝功能均于4周内基本恢复至术前或正常水平。术后3个月54例AFP值较术前明显降低,差异有统计学意义(P<0.05),肿瘤体积缩小达10%⁵0%者38例(48.7%),其中3例行2期外科手术切除术;肿瘤体积无明显进展者34例(43.6%);5例病灶持续进展。总体TACE术后6个月、12个月、24个月、36个月生存率分别为84.2%、71.6%、47.3%、25.7%。结论:TACE治疗能有效控制肝癌病灶进展,延长患者生存期,提高生活质量,对中晚期巨块型肝癌的治疗有重要意义。     

Imaging features of hepatocellular carcinoma after transcatheter arterial chemoembolization and radiofrequency ablation

OBJECTIVE: The purpose of this pictorial essay is to show the imaging features of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and radiofrequency thermal ablation on CT, MRI, and contrast-enhanced sonography and to describe the advantages and limitations of each imaging technique in evaluating the therapeutic effect on HCC. CONCLUSION: CT is the standard imaging technique for monitoring the effectiveness of TACE and radiofrequency ablation. Contrast-enhanced sonography and MRI can complement CT in evaluating the therapeutic response.     

CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效

 目的 探讨CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌的疗效。方法 选择2013-03至2015-03在CT引导下经皮微波消融治疗26例不能手术切除的巨块型肺癌患者,所有病例诊断均经术前穿刺病理证实,其中鳞癌18例,腺癌7例,腺鳞癌1例。术后即刻、3、6、12个月复查增强CT,评价肿瘤体积缩小及坏死情况,分别于术前与术后1个月采用KPS评分评价患者生存质量,随访时间为12个月。结果 26例32次微波手术均获得成功,其中6例于术后1周行二次微波消融手术。微波消融治疗结束后即刻行CT增强扫描,其中CA 5例(19.2%),PA19例(73.1%),SD 2例(7.7%),总体有效率为92.3%。所有患者瘤体负荷显著减轻,治疗前KPS评分为78.23±11.54,治疗后1个月KPS评分为85.13±10.22(t=-2.282,P＜0.05);消融术前肿瘤最大径为(10.4±1.3)cm,消融术后3、6、12个月肿瘤最大径分别为(7.6±2.4)cm、(6.2±2.8)cm 和(5.7±2.5)cm,与术前比较,差异有统计学意义(F=21.482,P＜0.05)。结论 CT引导下经皮穿刺微波消融治疗老年人巨块型肺癌是一种安全、微创、减瘤效果显著的介入方法,其远期疗效和对患者生存期的影响还有待进一步研究。     

Massive Hemoptysis from Pulmonary Artery Pseudoaneurysm Caused by Lung Radiofrequency Ablation: Successful Treatment by Coil Embolization

A 75-year-old man received lung radiofrequency (RF) ablation to treat lung metastases from hepatocellular carcinoma. Massive hemoptysis occurred 1 week after lung RF ablation. Emergent contrast-enhanced CT and pulmonary arteriography revealed a pulmonary artery pseudoaneurysm, which was embolized with coils. The postembolization course was uneventful. Hemoptysis did not recur for 5 months.     

Radiofrequency thermal ablation of hepatocellular carcinoma: using contrast-enhanced harmonic power doppler sonography to assess treatment outcome

OBJECTIVE: We evaluated the accuracy of contrast-enhanced harmonic power Doppler sonography in assessing the outcome of radiofrequency thermal ablation of hepatocellular carcinoma. SUBJECTS AND METHODS: Fifty patients with 65 hepatocellular carcinoma nodules (1-5 cm in diameter; mean diameter, 2.5 cm) were studied using unenhanced and contrast-enhanced harmonic power Doppler sonography before and after IV administration of a microbubble contrast agent. The examinations were repeated after treatment of the tumors with radiofrequency ablation. Findings of the Doppler studies were compared with those of dual-phase helical CT, which were used as points of reference for assessing treatment outcome. RESULTS: Before radiofrequency treatment, intratumoral blood flow was revealed by unenhanced power Doppler sonography in 48 (74%) of 65 hepatocellular carcinoma nodules. After injection of the contrast agent, intratumoral enhancement was observed in 61 (94%) of 65 hepatocellular carcinomas (p < 0.01). After radiofrequency treatment, all 51 (84%) of the 61 hepatocellular carcinomas found to be necrotic on helical CT scans failed to show enhancement on power Doppler sonograms. In nine of the 10 lesions that showed a residual viable tumor on helical CT scans, persistent intratumoral enhancement-matching the enhancing areas on helical CT images-was revealed by power Doppler sonography. These nine hepatocellular carcinomas were subjected to repeated radiofrequency thermal ablation with the guidance of contrast-enhanced power Doppler sonography. Complete necrosis was seen after the second treatment session in six of the nine lesions. CONCLUSION: Contrast-enhanced harmonic power Doppler sonography is an accurate technique for assessing the outcome of radiofrequency thermal ablation of hepatocellular carcinoma and may be useful in guiding additional treatment in patients with incomplete response to initial efforts.     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

Biplane fluoroscopy-guided radiofrequency ablation combined with chemoembolisation for hepatocellular carcinoma: initial experience

Objective

The purpose of this study was to assess the technical feasibility and local efficacy of biplane fluoroscopy-guided percutaneous radiofrequency (RF) ablation combined with transcatheter arterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC).

Method

Our retrospective study was approved by the institutional review board and informed consent was waived. 18 patients with 19 HCCs (mean 2.5 cm diameter; range 2–4.2 cm) were treated with percutaneous RF ablation combined with TACE. After segmental TACE, 18 (95%) of 19 HCCs were visible on fluoroscopy. Shortly (median 2 days; range 1–4 days) after TACE, percutaneous RF ablation was performed under real-time biplane fluoroscopic guidance. We evaluated major complications, rate of technical success at immediate post-RF ablation CT images and local tumour progression at follow-up CT images.

Results

Major complication was not observed in any patients. Technical success was achieved for all 18 visible HCCs. During the follow-up period (median 20 months; range 5–30 months), no local tumour progression was found.

Conclusion

Biplane fluoroscopy-guided RF ablation combined with TACE is technically feasible and effective for treatment of HCC.Percutaneous radiofrequency (RF) ablation has been widely implemented in the management of hepatocellular carcinoma (HCC) with promising results. Although its local efficacy for small tumours (i.e. <2 cm) is similar to surgical outcomes [1], results for medium-sized and large tumours are less robust. Thus, multimodal treatments such as combined percutaneous RF ablation with transarterial chemoembolisation (TACE) have been explored for medium or large HCCs in order to enhance the therapeutic effect. In a recent study, RF ablation combined with TACE was similar to surgical resection in patients with early-stage disease [2].Percutaneous RF ablation shortly following TACE has been usually performed under guidance of either ultrasonography or CT/CT fluoroscopy. Since intratumoural retention of radio-opaque iodised oil induced by TACE conveniently provides radiographic contrast to the index lesion, biplane fluoroscopy (anterior posterior and lateral projections) can be used as an alternative guiding modality for RF ablation combined with TACE. Easier targeting of dome lesions, often difficult to visualise on ultrasound, through an oblique approach without pleural transgression is one potential advantage of biplane fluoroscopy guidance. Also unlike on ultrasound, microbubble formation during ablation would not obscure the index lesion on biplane fluoroscopy, allowing easier and more spatially accurate application of overlapping ablations that are often needed for larger tumours. However, to our knowledge, there have been no studies investigating the role of biplane fluoroscopy as a guidance modality in this clinical setting. The purpose of our study was to retrospectively assess the technical feasibility and local efficacy of biplane fluoroscopy-guided percutaneous RF ablation combined with TACE for HCC ≥2 cm.     

Radiofrequency ablation of hepatocellular carcinoma: therapeutic response using contrast-enhanced coded phase-inversion harmonic sonography

OBJECTIVE: This study was performed to evaluate the usefulness of contrast-enhanced coded phase-inversion harmonic sonography in assessing the therapeutic response of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma. SUBJECTS AND METHODS: Sixty-seven patients with a total of 107 examinations on 91 hepatocellular carcinoma nodules underwent coded harmonic angio, a technique of coded phase-inversion harmonic sonography, using the IV microbubble contrast agent Levovist before and after percutaneous radiofrequency ablation. The intratumoral blood vessels and tumor parenchymal stain were detected in the early arterial phase and the late vascular phase, respectively. The results of contrast-enhanced imaging with coded harmonic angio were compared with those of three-phase dynamic CT. RESULTS: Before treatment, all examined 107 hepatocellular carcinoma nodules were found to be hypervascular on contrast-enhanced imaging with coded harmonic angio. After radiofrequency ablation, contrast-enhanced coded harmonic angio detected persistent signal enhancement in 41 examined nodules (38.3%), whereas this technique showed no intratumoral enhancement in the remaining 66 (61.7%) examined nodules. Compared with dynamic CT, the sensitivity, specificity, and diagnostic accuracy of contrast-enhanced coded harmonic angio were 95.3%, 100%, and 98.1%, respectively. With contrast-enhanced coded harmonic angio, we found that it was difficult to identify the safety margin that can be detected on dynamic CT. CONCLUSION: Contrast-enhanced imaging with coded harmonic angio may provide an alternative approach that has high diagnostic agreement with dynamic CT in assessing the therapeutic effect of radiofrequency ablation in hypervascular hepatocellular carcinomas, in spite of having limitations in identifying the safety margin.     

Therapeutic response assessment of percutaneous radiofrequency ablation for hepatocellular carcinoma: utility of contrast-enhanced agent detection imaging

PURPOSE: To assess the utility of contrast-enhanced agent detection imaging (ADI) in the assessment of the therapeutic response to percutaneous radiofrequency (RF) ablation in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ninety patients with a total of 97 nodular HCCs (mean, 2.1+/-1.3 cm; range, 1.0-5.0 cm) treated with percutaneous RF ablation under the ultrasound guidance were evaluated with contrast-enhanced ADI after receiving an intravenous bolus injection of a microbubble contrast agent (SH U 508A). We obtained serial contrast-enhanced ADI images during the time period from 15 to 90 s after the initiation of the bolus contrast injection. All of the patients underwent a follow-up four-phase helical CT at 1 month after RF ablation, which was then repeated at 2-4 month intervals during a period of at least 12 months. The results of the contrast-enhanced ADI were compared with those of the follow-up CT in terms of the presence or absence of residual unablated tumor and local tumor progression in the treated lesions. RESULTS: On contrast-enhanced ADI, technical success was obtained in 94 (97%) of the 97 HCCs, while residual unablated tumors were found in three HCCs (3%). Two of the three tumors that were suspicious (was not proven) for incomplete ablation were subjected to additional RF ablation. The remaining one enhancing lesion that was suspicious of a residual tumor on contrast-enhanced ADI was revealed to be reactive hyperemia at the 1-month follow-up CT. Therefore; the diagnostic concordance between the contrast-enhanced ADI and 1-month follow-up CT was 99%. Of the 94 ablated HCCs without residual tumors on both the contrast-enhanced ADI and 1-month follow-up CT after the initial RF ablation, five (5%) had CT findings of local tumor progression at a subsequent follow-up CT. CONCLUSION: Despite its limitations in predicting local tumor progression in the treated tumors, contrast-enhanced ADI is potentially useful for evaluating the early therapeutic effect of percutaneous RF ablation for HCCs.     

Use of fusion imaging combining contrast-enhanced ultrasonography with a perflubutane-based contrast agent and contrast-enhanced computed tomography for the evaluation of percutaneous radiofrequency ablation of hypervascular hepatocellular carcinoma

Objective

We evaluated the efficacy of fusion imaging, which fuses contrast-enhanced ultrasonography images with arterial-phase, contrast-enhanced CT images as a reference on a single screen in real time, for the evaluation of the effectiveness of radiofrequency ablation for treatment of hypervascular hepatocellular carcinoma.

Materials and methods

Eighty hepatocellular carcinoma lesions with a maximum diameter of between 1 and 3 cm that were scheduled for treatment with radiofrequency ablation were enrolled in this prospective study. After bolus injection of perflubutane-based contrast agent, fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images was performed one day after radiofrequency ablation. We used two functions, which were subsets of the fusion imaging, to confirm the location of the hepatocellular carcinoma lesions in the ablated areas and to evaluate the presence or absence of an adequate safety margin. Contrast-enhanced CT was performed one month after the ablation. Two blinded observers reviewed the images obtained using both modalities to evaluate the effect of ablation.

Results

When the one-month contrast-enhanced CT images were used as the reference standard, the sensitivity, specificity, and accuracy of the one-day fusion imaging for the diagnosis of adequate ablation were 97%, 83%, and 96%, respectively; the kappa value for the agreement between the findings obtained using the two modalities was 0.75.

Conclusion

Fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images as a reference appears to be a useful method for the early evaluation of the efficacy of radiofrequency ablation for the treatment of hypervascular hepatocellular carcinoma.