超声造影对乙醇消融量化治疗肝癌疗效评判与随访价值

目的探讨超声造影对乙醇消融量化治疗肝细胞癌疗效判断以及在随访中的临床应用价值。方法经超声引导无水乙醇消融量化治疗肝癌54例,计54个肿瘤结节,分为A、B、C三组。A组于乙醇消融治疗结束时以及治疗后1个月复查,B组于治疗后12～14个月复查,C组于治疗24个月后复查。采用彩色多普勒超声及超声造影技术观察肿瘤结节大小、内部回声、血流及造影改变,并行超声引导穿刺活检。结果二维超声检查3组肝癌结节均较治疗前有不同程度缩小。A组肿瘤结节治疗结束时均为高回声,1个月后表现高回声或偏高回声者为52.4%(11/21),明显低于B、C两组表现为高回声或偏高回声的87.5%(14/16)、88.2%(15/17)(均P<0.05),而B、C两组间无明显差异(P>0.05)。彩色多普勒超声检查各组均未见血流信号。超声造影检查,A组结节在治疗结束时造影剂缺损区直径均超出原肿瘤,除A组3个肿瘤结节内见小片区域轻微增强外,余51个结节均未见增强。细针活检除A组3个结节内见残留肝癌细胞外,余均为纤维瘢痕组织及坏死组织。结论超声造影可较好评判肝癌乙醇消融量化治疗疗效,随访中能提供更多的诊断信息。

Contrast-enhanced ultrasound for assessment and follow-up of percutaneous quantified ethanol injection in hepatocellular carcinoma

Objective To evaluate the therapeutic efficacy of percutaneous quantified ethanol injection (PQEI) for patients with hepatocellular carcinoma (HCC) and follow-up by contrast-enhanced gray-scale harmonic ultrasound. Methods Fifty-four patients with 54 tumoral nodes treated by PQEI were divided into 3 groups. Rescanning those nodes was performed at the end of treatment and 1 month later fro group A, in 2 to 14 months after PQEI for group B and in 24 months after PQEI for group C. Rescanning was completed with techniques of both color Doppler ultrasound and contrast-enhanced gray-scale harmonic ultrasound. The size, internal echo, blood flow and contrast enhancement of nodes were observed. Immediate ultrasound guided biopsies were followed. Results The size of all nodes after treatment was smaller than that before treatment. In group A, all nodes appeared hyperechoic at the end of treatment and only 11 nodes (52.4%) were hyperechoic in 1 month later follow-up, which was less than that there were 14 hyperechoic nodes (87.5%) in group B and 15 heperechoic nodes (88.2%) in group C. The echogenicity of nodes in group B and C was significantly higher than that in group A (P<0.05). However, there was no significant difference between group B and C (P>0.05). Blood signals were absent within nodes in all groups. At the end of treatment, the enhancement defect area in nodes of group A was larger than that before treatment on contrast-enhanced gray-scale harmonic ultrasound. Only three nodes in group A had patchy enhancement. Besides relic hepatic carcinoma cells were detected only in 3 nodes in group A, fibrotic scar and necrotic tissue were evident in all other nodes. Conclusion Contrast-enhanced harmonic ultrasound is well promised in efficient evaluation of PQEI for HCC.