超声造影对肝癌射频消融筛选适应证的应用价值

目的通过射频消融前超声造影观察肿瘤大小、数目及分布,探讨其对筛选适应证的应用价值.方法北京大学临床肿瘤学院超声科就诊的164例确诊肝细胞癌（hepatocellular carcinoma,HCC）并符合经皮射频消融（radiofrequency Ablation,RFA）入选标准患者,随机分为两组进行对照研究.81例射频消融前采用SonoVue行超声造影（contrast-enhanced ultrasound,CEUS）检查（CEUS组）,83例射频消融前未行超声造影检查（对照组）.男121例、女43例;年龄38～72岁,平均52.4岁.造影前两组病例的临床资料差异无统计学意义.肿瘤平均直径超声造影组3.6 cm,对照组3.5 cm.治疗后采用常规超声,增强CT和/或超声造影等影像检查进行规律性随访.结果超声造影组81例造影后9例（11.1%）因发现肿瘤数目 〉5个 （5例）、范围测量〉8 cm（2例）、侵及2支大血管或肠管（2例）被确定为非射频消融适应证,余72例101灶行射频消融治疗.其中超声造影新发现≤1.7 cm 8例12灶中,5例为肝硬化及肝细胞癌治疗后随访病例,3例7个灶为肝细胞癌卫星灶.另有16灶为常规超声不能定性或误诊良性,经超声造影确认并指导射频消融治疗.两组随访6～36个月,超声造影组与对照组消融成功率分别为95.0%和89.6%（P〉0.05）.对照组新生率高于超声造影组（22.9% vs 9.7%,P〈0.05）.结论射频消融前超声造影有助于筛选适应证,显著减少新生转移病例.造影所获信息为早期检出微小癌灶提供了手段和依据,从而有效的提高射频消融对肝癌的治疗水平.

Application of contrast-enhanced ultrasonography in selecting indication of radiofrequency ablation among hepatocellular carcinoma patients

OBJECTIVE: To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in selection of the patients with hepatocellular carcinoma (HCC) indicated to radiofrequency ablation (RFA). METHODS: 164 patients with HCC, 121 males and 43 females, aged 52.4 (38-72), who asked for RFA were randomly divided into 2 groups: 81 patients undergoing CEUS before RFA (CEUS Group), and 83 patients not undergoing CEUS before RFA (Control Group). There were not significant differences in the TNM staging, liver function Child-Pugh classing, and average tumor size between the 2 groups. Follow-up by conventional ultrasonography, enhanced CT and/or enhanced ultrasonography was conducted for 6-36 months. RESULTS: Nine of the 81 patients in CEUS Group (11.8%) were determined by CEUS as unsuitable for RFA; 5 of the 9 patients had more than 5 lesions, 2 of the 9 patients had lesions > 8 cm in diameter, and the tumor had invaded 2 large vessels or intestine in 2 of the 9 patients. The other 72 patients in CEUS Group, with 101 lesions, underwent RFA after CEUS. CEUS discovered 12 lesions < or = 1.7 cm that had not been discovered by conventional ultrasonography and CT in 8 patients, 3 of which were patients with cirrhosis undergoing follow-up, and 2 of which were HCC patients undergoing follow-up after treatment. Of these 8 patients, 3 had 7 newly discovered satellite lesions around the main lesions. The successful rates of CEUS Group and Control Group were 95.0% and 89.6% respectively (P > 0.05). The distant recurrence rate of Control Group was 22.9%, significantly higher than that of CEUS Group (9.7%, P < 0.05). CONCLUSION: Helping find minute tumors, CEUS is useful in selecting HCC patients suitable for RFA, thus decreasing the intrahepatic recurrence after RFA.