CEUS联合MRI实时融合导航技术在评估肝癌消融疗效中的临床应用

目的 探索超声造影联合MRI融合导航技术在评估肝癌消融疗效的临床应用价值。方法 前瞻性纳入三家临床中心自2020年9月至2022年12月行消融的肝细胞肝癌（HCC）患者,随机分为超声造影（CEUS）组和CEUS联合MRI导航组,分别于术前1天及术后30天行超声造影或CEUS联合MRI导航检查。以术后30天普美显增强MRI为标准,判断是否达到安全边界及是否完全消融。结果 本多中心研究最终纳入CEUS组46例患者,46个病灶,CEUS联合MRI导航组31例患者,31个病灶。77个病灶中,27例行射频消融治疗,50例行微波消融治疗。CEUS组46例病灶中,14例未达到安全边界,CEUS联合MRI导航组31例病灶中,4例未达到安全边界,两组无显著差异（P = 0.063）。位于特殊位置（距离肝包膜、大血管旁、胆囊旁、膈肌小于5mm）的病灶中,CEUS组有6例未达到安全边界（6/29）,CEUS联合MRI导航组有2例未达到安全边界（2/17）（P < 0.001）。等回声或边界不清的病灶中,CEUS组有5例未达到安全边界（5/25）,CEUS联合MRI导航组有2例未达到安全边界（2/18）（P < 0.001）。结论 CEUS联合MRI融合导航技术有助于准确判断肝癌消融后的安全边界,尤其是位于特殊位置的病灶及等回声或边界不清的病灶。

Clinical application of CEUS combined with MRI virtual navigation in evaluating the thermal ablation of hepatocellular carcinoma

Purposes: To investigate the clinical application of CEUS combined with MRI virtual navigation in evaluating the thermal ablation of hepatocellular carcinoma. Methods: From September 2020 to December 2022, patients who were diagnosed with HCC and going to be treated with thermal ablation were enrolled from three hospitals. Patients were divided into two groups randomly, CEUS group and CEUS combined with MRI virtual navigation group separately. Then, patients underwent CEUS examination or CEUS combined with MRI examination 1 day before and 30 days after treatment. All patients underwent Gd-EOB-DTPA MRI after treatment to evaluate the ablative margin and to define whether the lesions were complete ablation. Results: 46 patients with 46 lesions in the CEUS group and 31 patients with 31 lesions in CEUS combined with MRI virtual navigation group were enrolled in our multi-center study. Among 77 lesions, 27 were treated by radiofrequency ablation and 50 by microwave ablation. After treatment, 14 lesions were not reached the ablative margin (5mm) in the CEUS group and 4 lesions in CEUS combined with MRI virtual navigation group (P = 0.063). The number of lesions at specific locations (the distance with liver capsule, portal vein, hepatic vein, bile duct, gallbladder, and diaphragm within 5mm) that didn’t reach the ablative margin was 6 in the CEUS group and 2 in the CEUS combined with MRI group (P < 0.001). The number of iso-echoic lesions at B-mode ultrasound or with an ill-defined margin that didn’t reach the ablative margin was 5 in the CEUS group and 2 in the CEUS combined with the MRI group (P < 0.001). Conclusions: CEUS combined with MRI virtual navigation is helpful in evaluating the ablative margin of HCC, especially for lesions at specific locations, iso-echoic and ill-defined margin lesions.