应用SonoVue超声造影评价经皮射频消融治疗肝癌的疗效

目的:探讨常规超声(US)与Sono Vue超声造影(CEUS)在评估经皮射频消融治疗(PRFA)肝癌术后PRFA疗效中的应用价值。方法:采用PRFA治疗43例52个肝癌病灶,术后1月分别采用常规US及CEUS检查,以临床综合评定为参考标准,计算US与CEUS评估肝癌患者PRFA术后对病灶灭活情况的诊断灵敏度、漏诊率、特异度、误诊率及正确诊断指数,以此评价两种检查方法的优劣。结果:临床综合评定结果为经PRFA治疗1月后灭活病灶33个,未灭活病灶19个。US诊断灭活病灶34个,未灭活病灶18个,与临床综合评定结果比较,US诊断灵敏度为78.8%,漏诊率为21.2%,特异度为57.9%,误诊率42.1%,正确诊断指数(YI指数)0.367,总符合率为71.2%。CEUS诊断灭活病灶35个,未灭活病灶17个,与临床综合评定结果比较,CEUS诊断灵敏度90.9%,漏诊率9.1%,特异度为73.7%,误诊率26.3%,YI指数0.646,总符合率为84.6%。YI指数比较,US与CEUS诊断指数差异无统计学意义(P>0.05);总体52个病灶灭活情况诊断符合率比较,US与CEUS诊断符合率差异具有统计学意义(P<0.01)。结论:常规US与CEUS检查均是评估PRFA疗效有价值的方法,CEUS评价治疗效果的诊断符合率明显优于常规US;CEUS可准确显示射频消融范围及肿瘤灭活后的血流灌注情况,有助于临床后续治疗方案的制定。

Application of SonoVue Contrast Enhanced Ultrasonography in Therapeutic Effect Evaluation of Percutaneous Ra- dio Frequency Ablation for Treating Hepatic Carcinoma

Objective To explore and compare the clinical value of ultrasonography（US） and SonoVue contrast enhanced ultrasonography（CEUS） on evaluating the therapeutic effects of percutaneous radio frequency ablation（PRFA） for treating hepatic carcinoma. Methods Forty-three patients with 52 hepatic carcinoma lesions were treated with PRFA and then underwent US and CEUS at 1 month post-operation. Based on the clinical comprehensive assessment, the diagnostic sensitivity,omission diagnose rate, specificity, mistake diagnose rate and correct diagnosis index of US and CEUS using for evaluating lesion inactivation after PRFA were calculated and comparatively analyzed. Results After treating with PRFA for 1 month,the clinical comprehensive assessment demonstrated that 33 lesions were inactivated, but the other 19 lesions were not. The diagnostic results of US were 34 lesions inactivated, 18 lesions not, compared with above comprehensive assessment, the diagnostic sensitivity, omission diagnose rate, specificity, mistake diagnose rate and correct diagnosis index of US were 78.8 %, 21.2% ,57.9% ,42.1% ,0.367 ,respectively,the coincidence rate was 71.2%. The diagnostic results of CEUS were 35 lesions inactivated, 17 lesions not, compared with above comprehensive assessment, the diagnostic sensitivity, omission diagnose rate, specificity, mistake diagnose rate and correct diagnosis index of US were 90.9% ,9.1% ,73： 7% ,26.3% ,0. 646, respectively,the coincidence rate was 84.6%. The correct diagnosis index between US and CEUS had no significant difference（P 〉0.05）. The diagnostic coincidence rate of all 52 lesions between US and CEUS had significant difference（ P 〈 0. 01 ）. Conclusion Although both US and CEUS are the valid methods for evaluating therapeutic effect of PRFA,but CEUS works more accurately. CEUS could clearly show the range of PRFA, and the blood perfusion after carcinoma inactivation, which are helpful for clinical foUow-up treatment selection.