声脉冲辐射力成像技术早期评估肝细胞癌射频消融疗效的应用价值

发布时间：2018-03-29 14:33

本文选题：声脉冲辐射力成像技术　切入点：肝细胞癌　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨声脉冲辐射力成像技术(acoustic radiation force impulse,ARFI)早期评估肝细胞性肝癌(hepathocellcular carcinoma,HCC)射频消融(radiofrequency ablation,RFA)疗效的临床应用价值。材料和方法:2015年12月~2016年6月我院行射频消融治疗的22例患者共23个HCC病灶纳入本研究。所有病灶均经穿刺活检病理或临床证实为HCC。分别于RFA术前1周、术后24h及术后1个月行常规超声、超声造影(contrast enhanced ultrasound,CEUS)及ARFI检查,用常规超声、CEUS及ARFI的声触诊组织弹性成像(virtual touch tissue imaging,VTI)技术测量消融灶最大长轴及最大短轴,计算消融灶面积,以消融灶面积表示消融范围,对比不同时间点三种方法对消融灶范围的显示情况;用ARFI的声触诊组织量化(virtual touch tissue quantification,VTQ)软件测量不同时间点消融灶内部、边缘及周边肝实质VTQ值,比较RFA术前、术后消融灶不同区域硬度变化。结果:23个消融灶RFA术后24h及术后1个月VTI弹性图均表现为黑暗色(质硬),较术前质硬,边界清晰,范围增大。术后24h消融灶内部及边缘VTQ值较术前明显升高,差异有统计学意义(P0.01、P0.01),与术后1个月比较差异无统计学意义(P=0.46、P=0.50);术后24h及术后1个月消融灶周边肝实质VTQ值较术前差异无统计学意义(P=0.74,P=0.92)。RFA术前BUS、CEUS及ARFI显示病灶面积比较差异无统计学意义(P=0.81),术后24h及术后1个月ARFI与CEUS显示消融灶面积比较均无统计学差异(P=0.88、P=0.49),与BUS比较差异有统计学意义(P0.01,P0.01)。结论:ARFI能够清晰显示RFA术后24h消融灶范围,与CEUS结果相似,优于BUS,并能定量反应消融灶硬度变化情况,为早期判断消融效果提供重要依据。
[Abstract]:Objective: to evaluate the clinical value of acoustic pulse radiography (radiation) technique for early evaluation of radiofrequency ablation of hepatocellular carcinoma (HCC) with radiofrequency ablation (RFA). Materials and methods: radiofrequency ablation of hepatocellular carcinoma from December 2015 to June 2016. A total of 23 HCC lesions were included in this study in 22 patients. 24 hours after operation and 1 month after operation, conventional ultrasound, contrast enhanced ultrasound usus and ARFI were performed. The maximum long axis and the maximum short axis of ablation were measured by using the technique of conventional ultrasound CEUs and ARFI with virtual touch tissue imagingVTI, and the ablation area was calculated. The extent of ablation was expressed by the area of ablation, and the extent of ablation was compared with three methods at different time points, and the VTQ values of liver parenchyma in different time points were measured by using ARFI's acoustic palpation tissue quantification and virtual touch tissue quantification (VTQQ) software. Results: 24 hours after RFA and 1 month after RFA, the changes of hardness in different regions of the ablation focus were compared. Results: the VTI elastogram of 23 ablation foci showed dark color, which was more rigid than that before RFA, and the boundary was clear. The VTQ value of the ablation focus was significantly higher than that of the preoperative ablation at 24 hours after ablation. The difference was statistically significant (P 0.01) and there was no significant difference compared with one month after operation. The VTQ value of hepatic parenchyma around ablation focus 24 hours after operation and 1 month after operation were not significantly different from those before operation. There was no significant difference between preoperative VTQ and preoperative BUSCEUS and ARFI. There was no significant difference in ablation area between ARFI and CEUS 24 hours after operation and 1 month after operation. There was no significant difference in ablation area between ARFI and CEUS, but there was significant difference compared with BUS. Conclusion the range of ablation foci at 24 hours after RFA can be clearly demonstrated by ARFI. The results were similar to those of CEUS, and were superior to those of bus, and could quantitatively reflect the change of ablation focus hardness, which provided an important basis for early evaluation of ablation effect.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R735.7

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