超声造影评价高强度聚焦超声治疗局限性前列腺癌早期疗效的临床研究

目的 探讨超声造影对高强度聚焦超声（HIFU）治疗局限性前列腺癌早期疗效评价的应用价值.方法 采用HIFU-2001型高强度聚焦超声肿瘤治疗系统,对17例局限性前列腺癌进行治疗.治疗前及治疗后1个月分别行超声造影检查,观察瘤体内部及周边组织血流灌注信号特点,据此判定疗效.同时根据直肠指检、经直肠前列腺B超检查前列腺肿块大小、血清PSA等结果进行客观疗效判定.将两疗效判定结果进行对比分析.结果 HIFU治疗前,所有前列腺低回声结节均呈快速高增强.HIFU治疗后,超声造影显示治疗有效15例,其中无增强12例、少量低增强3例;无效2例,仍表现为快速高增强.客观疗效判定有效15例,血清PSA下降幅度均≥50%,其中2例前列腺结节体积缩小≥50%;无效2例,血清PSA、前列腺低回声结节大小体积均与治疗前水平相当.客观疗效判定结果与超声造影结果相符.结论 超声造影能准确显示HIFU治疗局限性前列腺癌的消融范围及程度,是评价早期治疗效果的可靠方法.

Clinical study on assessment of the early curative effects of high-intensity focused ultrasound in treatment of localized prostate cancer by contrast-enhanced ultrasound

Objective To determine the value of contrast-enhanced ultrasound in evaluating the early efficacy of localized prostate cancer treated by high-intensity focused ultrasound （HIFU）. Methods 17 cases of localized prostate cancer were treated with HIFU-2001 system （Shanghai Jiao Tong University SUNTEC Corporation）. Contrast-enhanced ultrasound examination were performed before and one month after HIFU treatment. The efficacy was divided into active and inactive ac- cording to the perfusion signal change of the tumor nodules and surrounding tissues. On the other hand, efficacy was also evaluated by clinical examinations （digital rectal examination, transrectal ul- trasound and PSA level）. These two results were compared. Results Before HIFU treatment, the perfusion of all the tumor nodules were enhanced rapidly. One month after HIFU treatment, accord- ing to the contrast-enhanced image, 15 cases were diagnosed with active, among which 12 cases had no contrast agent signal in tumor nodules, 3 cases had a little contrast agent signal which was weaker than normal prostate tissue; 2 cases were diagnosed with inactive, whose tumors were still enhanced rapidly. According to the clinical examinations, 15 cases were diagnosed with active （15 cases PSA decrease≥50%, 2 cases tumor nodules volume decrease≥50%） ; 2 cases were diagnosed with inac- tive （no significant change of PSA level and nodules volume）. These two results were equal with each other. Conclusions Contrast-enhanced ultrasound can indicate the ablation area correctly, it can help to assess the therapeutic efficacy of HIFU treatment.