超声造影在肝癌消融治疗中的作用

目的 探讨超声造影(CEUS)在肝癌消融治疗中对病例选择、疗效判断和引导穿刺的作用.方法 应用第二代超声造影剂声诺维2.4 ml经肘静脉团注、采用低机械指数连续成像技术对比脉冲序列(CPS)成像技术对137例肝癌病人(肝细胞性肝癌HCC 131例,转移性肝癌MLC 6例)共计168个肝癌灶消融前后进行CEUS检查,观察消融前造影前后肿瘤数目、大小、血供情况的变化,分析消融后CEUS在肿瘤诊断和疗效判断中的作用,并以同期CT或MRI或病理作为金标准进行比较.所有病例均取得病理诊断.结果 137例肝癌(微波消融MWA 80例、Quadra-Fuse多极酒精消融QEA 57例)的完全消融91.1%,不完全消融8.9%,局部复发8.3%,远处复发20.4%.造影前后肿瘤大小差异明显者4例(2.9%);造影后肿瘤数目增多者16例,减少者5例,平扫超声不能显示只能通过CEUS确认病灶8例,29例(21.2%)造影后与造影前比较肿瘤数目有改变,12例(8.8%)因肿瘤数目的 变化而改变了治疗方案.消融后平扫超声不能确定的局部残留灶15处和局部复发灶11处再消融前需要CEUS定位穿刺治疗.其中1处局部复发灶和1处残留灶CT未能检出,均由CEUS先诊断,并得到病理活检证实.CEUS与CT或MRI比较,对消融治疗后有无残留和局部复发判断的准确性达98.8%和98.8%.结论 消融前CEUS有助于正确选择消融病例和治疗方案、显示平扫超声无法显示的肿瘤.消融后CEUS能准确确定消融范围、判断消融疗效、能敏感的检出平扫超声未能检出的小残留灶和复发灶,并定位引导残留灶和复发灶的穿刺治疗.

Application of contrast ultrasound in ablation treatment of liver cancer

Objective To investigate the effectiveness of contrast ultrasound (CEUS) in patient selection, efficacy verification and guidance during ablation treatment of liver cancer. Methods A to-tal of 168 focal liver lesions in 137 patients with liver cancer (131 with HCC, 6 with metastasis liver cancer-MLC) were examined using CEUS before and after ablation treatment. As for the CEUS, the low MI real time imaging technique-CPS and 2.4 ml SonoVue-the 2nd generation of ultrasound con-trast agent by bolus injection through the elbow vein were used. The effectiveness of ablation treat-ment was evaluated by CEUS after the ablation treatment. The results of CECT/CEMRI or biopsy ob-tained at the same stage with CEUS examination were adopted as gold standard. The biopsy diagnosis was obtained for all cases before ablation. Results Completed ablation was achieved in 91.1 % of 137 recruited cases (80 cases received microwave ablation, 57 multi-probe Ethanol ablation-QRA), un-completed ablation was observed in 8. 9 % cases, local recurrence was found in 8.3 % cases. Before ab-lation treatment, significant difference of tumor size pre and post contrast administration were ob-served in 4 patients(2.9%). More tumors were found for 16 cases, less tumor were found for 5 cases with CEUS comparing with un-enhanced US examination. Eight lesions were confirmed by CEUS but cannot be determined by un-enhanced US. There were 29 cases (21.2%) whose observed tumor num-ber was changed after SonoVue administration and the treatment protocol was changed for 12 cases (8.8%)due to the modification of tumor number after CEUS examination. After the ablation treat-ment, residue tumor tissue in 15 cases and local recurrence in 11 cases were confirmed by CEUS, which cannot he observed by no-enhanced US, and the re-ablations were performed under the guidance of CEUS. Meanwhile, there was one local recurrence lesion, and one lesion with residual tumor tissue hadn't been detected by CECT, but were confirmed by CEUS, and verified by biopsy later. Comparing with CECT/or CEMRI, the accuracy of diagnosis of the local recurrence lesion and residual tumor tis-sue after ablation treatment were 98.8 %. Conclusion Before the ablation treatment, CEUS can be helpful for selecting appropriate patients, making reasonable treatment protocol and detecting the tumor which cannot be seen under un-enhanced US. After the ablation treatment, CEUS can define ablation margin, provide accurate judgment for ablation result, sensitively detect the small residual tumor tissue and focal recurrence which cannot be detected by US. Meanwhile, CEUS can be used for guiding the needle when re-treatment is performed for residual tumor or focal recurrence.