应用超声单模态融合成像技术指导微波消融治疗原发性肝癌即时疗效评价的价值研究

目的研究超声单模态融合成像技术在微波消融治疗原发性肝癌(PLC)患者中的应用价值。方法2018年3月~2019年12月我院诊治的88例PLC患者,其中44例采用超声单模态融合成像(观察组),另44例采用CT/MRI多模态融合成像(对照组)指导微波消融治疗。结果观察组配准评估时间为(3.8±1.3)min,显著短于对照组【(5.2±1.7)min,P<0.05】,观察组和对照组融合成像成功率分别为63.6%和56.8%,无显著性差异(P>0.05);在44例观察组发现52个病灶,单模态融合成功36个病灶(69.2%),在44例对照组发现54个病灶,多模态融合成功32个病灶(59.3%),两组病灶融合成功率比较,无显著性差异(P>0.05);两组肿瘤完全消融率分别为97.7%和93.2%,无显著性差异(P>0.05);观察组消融治疗后发热、局部疼痛、胆道出血和胆漏并发症发生率分别为9.1%、20.5%、4.5%和0.0%,与对照组的13.6%、27.3%、9.1%和2.3%比,差异无统计学意义(P>0.05);随访3~20个月,观察组生存32例(72.7%),总体生存(OS)为15.1(5.0,20.0)个月,无进展生存(PFS)为12.8(4.9,20.0)个月,对照组生存32例(72.7%),OS为14.2(4.8,20.0)个月,PFS为13.3(4.7,20.2)个月(Log rank χ^2=0.592,P=0.442;χ^2=1.103,P=0.294)。结论超声单模态融合成像与CT/MRI多模态融合成像均可用于指导微波消融治疗PLC患者,但超声单模态融合成像更为简便,经济,可提供即时影像学资料,为后续治疗提供依据。

Application of ultrasound single mode fusion imaging in the immediate evaluation of microwave ablation in treatment of patients with primary liver cancer

Objective The aim of this study was to investigate the application of ultrasound single mode fusion imaging (USMFI) in the immediate evaluation of microwave ablation (MWA) in treatment of patients with primary liver cancer (PLC). Methods The clinical data of 88 patients with PLC were recruited in our hospital from March 2018 through December 2019, and all underwent MWA treatment. During MWA procedures, the USMFI guidance was performed in 44 patients, and CT/MRI multimodal fusion imaging was performed in other 44 patients.Results The registration time in US-guided group was (3.8±1.3) minutes, statistically significantly shorter than (5.2±1.7) minutes in CT/MIR-guided group (P<0.05), and the success rates of fusion imaging were 63.6% vs. 56.8%, not significantly different(P>0.05); 52 foci out of 44 patients in US-guided group were found and the successful fusion imaging was obtained in 36 foci(69.2%), and 54 out 44 patients in CT/MRI-guided group were found and the successful fusion was got in 32 foci (59.3%,P>0.05); the complete ablation rates were 97.7% and 93.2% in the two groups(P>0.05) and the incidences of compliattions such as fever, local pain, bile duct bleeding and bile leakage were 9.1%, 20.5%, 4.5% and 0.0% vs. 13.6%, 27.3%, 9.1% and 2.3%, respectively(P>0.05) in the two groups; at the end of 3 to 20 month followed-up, 32 (72.7%) patients in US-guided group survived with total survival (OS) of 15.1(5.0, 20.0) months and with progress free survival (PFS) of 12.8(4.9, 20.0)months, and 32 (72.7%) patients in CT/MRI-guided group survived with OS of 14.2(4.8, 20.0) months, and PFS of 13.3(4.7, 20.2) months (Log rank x²=0.592, P=0.442; x²=1.103, P=0.294). Conclusion Both the single-mode ultrasound fusion imaging and CT/MRI multi-mode fusion imaging could be applied to guide the MWA in the treatment of patients with PLC, but the former is relatively simple and cheap, and should be chosen first.