【摘要】 目的评价超声造影(CEUS)早期判断肝肿瘤微波消融疗效的临床价值。方法 43例肝恶性肿瘤共57个病灶经微波消融治疗后1周行CEUS检查,其中原发性肝癌35例42个病灶,转移癌8例15个病灶。全部病灶采用超声造影剂SonoVue团注法行CEUS检查,并与同期增强CT(CECT)检查结果比较。结果 CEUS观察57个病灶中,43个(75.4%)病灶在造影各时相均未强化,提示肿瘤完全灭活;11个(19.3%)病灶边缘局部动脉期增强,判断有肿瘤残存;3个(5.3%)病灶判断不清。最终诊断依据2种以上影像学检查并结合肿瘤标志物水平、穿刺活检、3个月以上随访进行综合判断。以最终诊断为金标准,CEUS诊断准确性91.2%(52/57),CECT为87.7%(50/57),两者之间差异无统计学意义,但CEUS在评价肿瘤复发或残留方面的灵敏性优于CECT。结论 CEUS可较准确地判断微波消融后肿瘤灭活程度,是早期评价微波消融疗效的有效方法,可成为肝癌局部治疗随访的重要手段,具有较高临床应用价值。更多还原

【Abstract】 Objective To investigate the role of contrast enhanced ultrasonography (CEUS) in evaluating early therapeutic response of hepatic tumors treated with microwave(MV).Methods A total of 43 patients with 57 lesions were enrolled.Among them,35 patients had 42 primary hepatocellular carcinoma and 8 patients had 15 hepatic metastases. All cases underwent CEUS with contrast agent (SonoVue)in one week after microwave ablation therapy,and CEUS results were compared with contrast enhanced CT(CECT) results performed at the same time.Aloka-α10 and contrast harmonic enhanced (CHE) technique were adopted.Results After MV,43 of the 57 lesions ( 75.4% ) were without enhancement in entire CEUS procedure,which indicated complete necrosis.Eleven lesions(19.3%)showed local enhancement at tumor margin in arterial phase and were diagnosed as tumor residual,3 lesions(5.3%)presented no typical enhancement and were diagnosed as suspected tumor residue.The final diagnosis was achieved synthetically by more than two kinds of imaging examinations among the level of tumor marker,biopsy and more than 3 months’ follow up.According to the final diagnosis,the accuracy was 91.2%(52/57)for CEUS and 87.7%(50/57)for CECT respectively. There was no statistical significance between CEUS and contrast CECT,but the former was superior to the latter in sensitivity.Conclusions CEUS can accurately differentiate tumor necrosis and viable tissue after MV,and evaluate therapeutic efficacy of MV in early phase.It can become a sensitive tool to follow up hepatic tumors after local treatment and play an important role in clinic.更多还原