CEUS评价肝癌射频治疗后的局部进展:与初发肝癌的自身对比

目的探讨原发性肝细胞癌(HCC)射频消融(RFA)治疗后局部进展病灶的CEUS灌注特征,并与初发HCC的CEUS灌注模式进行自身对照比较。方法收集本院RFA治疗后,经随访发现局部进展病灶并于治疗前后均接受CEUS检查的HCC患者33例。比较初发病灶与RFA治疗后局部进展病灶CEUS灌注特征,包括增强时相、荷瘤血管、增强形态、增强边界、增强过程、廓清时相、内部坏死等。结果 RFA治疗后局部进展病灶100%(33/33)呈动脉期或门静脉期增强,96.97%(32/33)呈实质或延迟期廓清,与初发病灶差异无统计学意义(P0.05)。灌注特征比较:HCC初发病灶多见荷瘤血管(29/33,87.88%)、增强形态规整(27/33,81.82%)、边界清(26/33,78.79%);增强过程以周边至中心多见(18/33,54.55%),部分病灶出现内部坏死(9/33,27.27%)。RFA后局部进展病灶多见无荷瘤血管(20/33,60.61%)病灶、增强形态不规则(31/33,93.94%)、边界不清(27/33,81.82%);增强模式以整体增强多见(19/33,57.58%),内部坏死相对少见(2/33,6.06%)。结论 RFA后局部进展病灶造影灌注特征具有特殊表现,有助于其早期诊断及生物学行为检测。

Perfusion features of local progression after radiofrequency ablation of hepatocellular carcinoma with CEUS: Compared with primary hepatocellular carcinoma

Objective To investigate the perfusion characteristics of CEUS in local progressive hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA), and compared with the primary HCC. Methods Totally 33 patients with local progressive HCC after RFA underwent CEUS examination were enrolled in this study. The perfusion features of initial HCC lesions and local progressive lesions after RFA treatment including enhancement time, order, border, morphology, washout time, feeding vessels, inter necrosis were compared. Results 100% (33/33) of local progressive lesions after RFA treatment showed enhancement at arterial phase or portal phase and 96.97% (32/33) showed wash out in late phase, which was similar to primary HCC (P>0.05). In primary HCC, it was more frequent to find tumor feeding vessels (29/33, 87.88%), regular in shape (27/33, 81.82%), well defined border (26/33, 78.79%); The main enhancement patter was enhanced from peripheral to center (18/33, 54.55%), and 27.27% (9/33) lesions had inner necrosis. Local progressive lesions after RFA treatment showed less feeding vessels (20/33, 60.61%), irregular in shape (31/33, 93.94%), poor defined border (27/33, 81.82%); The main pattern of enhancement was homogeneous enhancement (19/33, 57.58%), and the inner necrosis rate was less (2/33, 6.06%). Conclusion Local progressive lesions after RFA has specific perfusion features, which is help to early diagnosis and design optimal treatment strategies.