超声造影对高强度聚焦超声联合肝动脉栓塞化疗治疗肝癌的疗效评价

目的探讨超声造影(CEUS)评价高强度聚焦超声(HIFU)联合肝动脉栓塞化疗(TAE)治疗肝恶性肿瘤疗效的应用价值。方法 24例肝癌患者,其中原发性肝癌15例,转移癌9例,治疗病灶总计31个,TAE治疗后1周内行HIFU治疗,于治疗前和治疗后7～14 d行CEUS检查,并与同期彩色多普勒超声(CDFI)、增强MRI检查结果比较。结果 CEUS观察31个病灶治疗覆盖区,19个(61.3%)在各期均为无增强,提示肿瘤完全灭活,12个(38.7%)病灶边缘或中央局部动脉期高增强,门脉期或延迟期减退为低增强,提示为肿瘤残存。以最终诊断为金标准,CEUS诊断准确性90.3%,增强MRI为93.5%,彩色多普勒超声为48.4%。CEUS与增强MRI在评价肿瘤灭活方面的敏感性、特异性、准确性差异均无统计学意义(P>0.05),CEUS对肿瘤灭活诊断的准确性高于CDFI(P<0.05)。结论 CEUS可较准确地判断HIFU联合TAE治疗后肿瘤灭活程度,可为肝癌治疗近期疗效评价提供依据,有较高临床应用价值。

Evaluation of Contrast Enhanced Ultrasound for Treatment of Liver Cancer with High Intensity Focused Ultrasound Combined with Transcatheter Arterial Embolization

Objective To investigate the value ofcontrast enhanced ultrasound （CEUS）in evaluati- ng the effect of high intensity focused ultrasound （HIFU） combined with transcatheter arterial embol- ization （TAE）on liver cancer. Methods Fifteen patients with primary liver cancer and 9 patients with metastatic hepatocellular carcinoma （31 lesions） underwent HIFU within 1 week after TAE. Contrast enhanced ultrasound was performed before and 7-14 days after treatment and ultrasound findings were compared with color Doppler ultrasound and contrast enhanced MRI. Results Among the 31 lesions, contrast enhanced ultrasound showed no enhancement（complete tumor growth inhibition）in 19（61.3%）, and edge or central local arterial phase hyperenhancement and portal phase and delayed phase hypoenhancement tumor persistence in 12（38.7%）. According to the final diagnosis as the gold standard, the diagnostic accuracy of CEUS,contrast enhanced MRI and color Doppler ultrasound was 90.3%, 93.5% and 48.4% ,respectively.There were no significant differences in the sensitivity, speci-ficity and accuracy for evaluating tumor inactivation between CEUS and contrast enhanced MRI. However,the accuracy of contrast-enhanced ultrasound was higher than that of color Doppler ultrasound for evalu- ating tumor inactivation （P〈0.05）. Conclusion CEUS can accurately determine the degree of tumorinactivation after HIFU combined with TAE in patients with liver cancer. Therefore, CEUS provides a basis for evaluating short-term efficacy and has a high clinical value in liver cancer.