超声造影在肝癌病灶诊断及引导射频消融治疗中的应用价值

目的探讨超声造影（CEUS）在肝恶性肿瘤病灶诊断及引导射频消融（RFA）治疗中的应用价值。方法对经病理确诊并经RFA治疗的56例肝癌患者资料进行回顾性分析，术前比较增强cT、普通彩色多普勒超声（二维＋多普勒）和超声造影对肝癌（原发及转移）的检出率，观察二维及超声造影病灶图像差异及特点。对普通彩色多普勒超声引导组（62个病灶）和超声造影引导组（so个病灶）在术中引导RFA的消融效果进行对比并利用超声造影观察射频消融术后疗效。结果56例肝癌患者，112个病灶（原发灶36个，转移灶76个）。超声造影对肝癌病灶检出率为94．6％（106／112），增强CT对肝癌病灶检出率为96．4％（108／112），两者检出率比较差异无统计学意义0（x^2=0．42，P〉O．05）。普通彩色多普勒超声对肝癌病灶检出率为74．1％（83／112），其与超声造影的检出率差异有统计学意义0（2=16，P〈0．05）。在普通彩色多普勒超声引导下进行RFA完全消融率为69％（43／62），超声造影引导下完全消融率为84％（42／50），两者的完全消融率差异无统计学意义舒=1．6，P〉0．05）。结论超声造影在RFA术前对肝脏肿瘤的诊断，术中对病灶的准确定位及实时引导穿刺，术后对手术疗效的随访观察都具有重要的应用价值。

The value of contrast-enhanced ultrasound in the diagnosis of liver cancers and guidance of radiofrequencyablation

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound （CEUS） in hepatic tu mor and its clinical value in guiding radiofrequency ablation （RFA） in hepatic tumor. Methods Data of 56 patients with final diagnosis of hepatic tumor pathologically and having undergone RFA were analysed retrospectively. Thepositive diagnostic rates of contrast-enhanced computed tomography （CECT） and conventional ultrasound （two-dimen sional ultrasound combined with Color Doppler flow imaging） were compared with those of CEUS. And the differences of the images of two-dimensional ultrasound and CEUS were analysed. The therapeutic effect of conventional uhra sound group（62 lesions） on the RFA treatment was also compared with that of CEUS group（50 lesions）. Results In the 56 cases with 112 liver lesions （36 primary carcinomas and 76 metastasis）, the positive diagnostic rates of CEUS, CECT and conventional ultrasound were 94.6% （106/112）, 96.4% （108/112） and 74.1% （83/112） respectively. There was no significant difference between CEUS and CECT examination （X2=0.42,P〉0.05）, but the difference between the conventional ultrasound group and the CEUS group was statistically significant）（x^2=17.9,P〈0.05）. The rate of com plete tumor ablation of RFA treatment by conventional ultrasound and CEUS were 69.4%（43/62） and 84%（42/50） re spectively,but there was no significant difference between them （x^2=1.6,P〉0.05）. Conclusion CEUS is really a practical and reliable diagnostic technique in making scheme before RFA treatment, guiding electrode position and e valuating the therapeutic efficacy after RFA treatment.