超声造影在肝恶性肿瘤介入治疗疗效评估中的应用价值

目的观察肝恶性肿瘤介入治疗后超声造影表现,并与其他影像学方法比较,评估其对介入治疗疗效判定的临床应用价值。方法评估介入治疗疗效66例次,病灶78个,介入治疗后均行超声造影检查及同期CT/MRI/DSA检查(超声造影前后2周内),包括经肝动脉插管栓塞化疗(TACE)38例次46个病灶,射频(RF)消融治疗13例次15个病灶,经皮乙醇注射(PEI)治疗15例次17个病灶。超声造影显像将病灶分为有增强和无增强两类。结果介入治疗后,超声造影显示44个病灶(56.4%)动脉相局部增强区,34个病灶无增强。同期CT/MRI/DSA诊断41个病灶(52.6%)有肿瘤复发/残存,以后者为对照,实时谐波超声造影评估肝恶性肿瘤介入治疗疗效的敏感性为87.8%,特异性为78.4%,符合率为83.3%。TACE、RF、PEI三种肝脏恶性肿瘤治疗方式中,超声造影对TACE治疗后疗效评估的敏感性、特异性及符合率最高,分别为92.0%,85.7%,89.1%。结论超声造影可以作为肝脏恶性肿瘤介入治疗疗效评估的可靠方法,且更适于TA-CE治疗后的疗效评价。

Therapeutic effects of malignant hepatic masses treated by interventional procedures: usefulness of contrast-enhanced harmonic ultrasound imaging

Objective To observe the findings and assess the usefulness of contrast-enhanced harmonic ultrasonographic imaging in evaluating the therapeutic effects of malignant hepatic masses to treatment with interventional procedures. Methods Sixty-six examinations on 78 malignant hepatic masses underwent harmonic ultrasonographic imaging using the microbubble contrast agent SonoVue after interventional procedures treatment. The results of contrast-enhanced harmonic imaging were compared with those of contrast-enhanced CT/MRI and DSA less than 2 weeks before or after contrast-enhanced harmonic imaging obtained. The therapeutic methods used to treat the malignant hepatic masses were TACE (38 examinations, 46 masses), RF ablation (13 examinations, 15 masses) and PEI (15 examinations, 17 masses). The criteria of contrast-enhanced harmonic ultrasound imaging used to determine the residual, inadequately treated tumors were based on the presence or absence of hypervascular enhancement. Results After treatment, studies using contrast-enhanced harmonic imaging identified residual tumor enhancement in 44(56.4%) of 78 lesions and did not identify enhancement in any of the remaining 34 lesions. Follow-up CT/MRI/DSA revealed incomplete tumor responses in 41(52.6%) of 78 cases after the therapeutic procedures. Compared with CT/MRI/DSA, the diagnostic sensitivity, specificity and accuracy of contrast-enhanced harmonic imaging were 87.8%, 78.4% and 83.3%. For detecting viable tumors, the sensitivity, specificity and accuracy of contrast-enhanced harmonic imaging after TACE were higher than those of imaging after RF or PEI. Conclusion Preliminary data suggests that contrast-enhanced harmonic imaging can be a useful and effective technique for evaluating the therapeutic effects of malignant hepatic masses and more suitable for detecting viable tumors after TACE.