声脉冲辐射力成像技术评价肝癌射频消融效果的初步研究
发布时间：2019-03-01 16:47
【摘要】：目的： 观察肝脏恶性肿瘤射频消融术后消融区及其边缘和周边肝实质在声辐射力脉冲成像(acoustic radiation force impulse, ARFI)(包括声触诊组织弹性成像(virtual touch tissue imaging, VTI)和声触诊组织量化(virtual touch tissue quantification,VTQ)中的表现及变化,探讨ARFI在肝脏恶性肿瘤射频消融术中的临床应用价值。 资料和方法： 对拟行超声引导下经皮射频消融治疗的38例肝脏恶性肿瘤患者的38个肝癌结节行常规超声和ARFI成像检查。术后定期随访,并对可疑有残余癌或原位复发者做增强MRI检查,并行穿刺活检确诊。比较治疗前病灶与其周边肝实质的硬度差异,对比消融区在VTI、常规超声上显示的大小。观察消融区内及其边缘充血带的硬度变化。 结果： 1.射频消融术前,38例肝脏恶性肿瘤患者中,26例原发性肝癌患者(A组)病灶内VTQ值(1.77±0.82)m/s与周边肝实质VTQ值(2.25±0.58)m/s,12例转移性肝癌(B组)患者病灶内VTQ值(2.16±1.35)m/s与周边肝实质VTQ值(1.43±0.72)m/s,两组病灶内VTQ值差异无显著统计学意义(P=0.516),两组肝实质VTQ值差异有显著统计学意义(P=0.000)。 2.消融区的VTQ值：2例原发性肝癌消融区内可测得数值,其余24例均为x.xxm/s,4例转移性肝癌消融区内可测得数值,其余8例均为x.xx m/s;VTI成像范围大于常规超声的范围,且两者的差异有显著统计学意义(P0.05)。 3.射频消融术后,消融区边缘的VTQ值大于消融区周边肝实质的VTQ值,且在各个时间段两者之间的差异均有显著统计学意义(P0.05)。 4.射频消融术后7天、1个月、2个月、3个月,消融区边缘随着时间的推移VTQ值呈逐渐减小趋势,但是差异无显著统计学意义(P0.05)。 5.随访期间1例MLC患者出现原位复发。 结论： ARFI成像技术能够反复、无创地观察肝脏恶性肿瘤射频消融治疗后短期内肿瘤凝固坏死的形态和范围及消融区周边组织的硬度变化,对原位复发病灶有潜在诊断价值,有望成为有效评估肝肿瘤射频消融疗效的方法之一。
[Abstract]:Objective: to observe the radiative power pulse imaging (acoustic radiation force impulse, ARFI) () including acoustic palpation tissue elastography (virtual touch tissue imaging,) in the ablation area, margin and peripheral liver parenchyma after radiofrequency ablation for malignant liver tumors. To explore the clinical value of ARFI in radiofrequency ablation of liver malignant tumor. VTI) and quantitative (virtual touch tissue quantification,VTQ (acoustic palpation tissue) were used to evaluate the clinical value of MRI in radiofrequency ablation of liver malignant tumor. Materials and methods: 38 HCC nodules in 38 patients with hepatic malignant tumor were examined by conventional ultrasound and ARFI. The patients with suspected residual carcinoma or recurrence in situ were examined by enhanced MRI and confirmed by puncture biopsy. The hardness difference between the lesion and the surrounding hepatic parenchyma before treatment was compared, and the size of the ablation area on VTI, conventional ultrasound was compared. The hardness changes of the hyperemia zone in the ablation zone and its edge were observed. Results: 1. Before radiofrequency ablation, in 26 patients with primary liver cancer (group A), the VTQ value was (1.77 卤0.82) mm2 in the lesion and (2.25 卤0.58) mm2 in the peripheral hepatic parenchyma, among 38 patients with liver malignant tumor, the VTQ value in the lesion was (1.77 卤0.82) mm2 in the patients with primary liver cancer (group A). The VTQ values in 12 patients with metastatic liver cancer (group B) were (2.16 卤1.35) m / s and (1.43 卤0.72) m / s in peripheral hepatic parenchyma. There was no significant difference in VTQ values between the two groups (P < 0. 516), but there was no significant difference in VTQ values between the two groups (P > 0. 516). There was a significant difference in VTQ between the two groups (P < 0. 000). 2. The values of VTQ in the ablation area were measured in 2 cases of primary liver cancer, the rest 24 cases were x.xxmm2, 4 cases of metastatic liver cancer were measured in ablation area, and 8 cases of x.xxm/s were detected in the ablation area of primary liver cancer, the other 24 cases were measured in the ablation area of HCC, the other 8 cases were VTQ in the ablation area of metastatic HCC. The range of VTI imaging was larger than that of conventional ultrasound, and the difference was statistically significant (P0.05). 3. After radiofrequency ablation, the VTQ value at the edge of the ablation area was higher than that of the hepatic parenchyma around the ablation area, and the difference between the two groups was statistically significant (P0.05). 4. 7 days, 1 month, 2 months, 3 months after radiofrequency ablation, the VTQ value of the edge of the ablation area decreased gradually with the passage of time, but there was no significant difference (P0.05). 5. One patient with MLC recurred in situ during the follow-up period. Conclusion: ARFI imaging can repeatedly and non-invasively observe the shape and extent of tumor coagulation and necrosis after radiofrequency ablation (RFCA) and the hardness changes of the surrounding tissue in the ablation area after radiofrequency ablation (RFCA), which may be of potential value in the diagnosis of recurrent lesions in situ. It is expected to be one of the effective methods to evaluate the efficacy of radiofrequency ablation of liver tumors.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R735.7
本文编号：2432616
[Abstract]:Objective: to observe the radiative power pulse imaging (acoustic radiation force impulse, ARFI) () including acoustic palpation tissue elastography (virtual touch tissue imaging,) in the ablation area, margin and peripheral liver parenchyma after radiofrequency ablation for malignant liver tumors. To explore the clinical value of ARFI in radiofrequency ablation of liver malignant tumor. VTI) and quantitative (virtual touch tissue quantification,VTQ (acoustic palpation tissue) were used to evaluate the clinical value of MRI in radiofrequency ablation of liver malignant tumor. Materials and methods: 38 HCC nodules in 38 patients with hepatic malignant tumor were examined by conventional ultrasound and ARFI. The patients with suspected residual carcinoma or recurrence in situ were examined by enhanced MRI and confirmed by puncture biopsy. The hardness difference between the lesion and the surrounding hepatic parenchyma before treatment was compared, and the size of the ablation area on VTI, conventional ultrasound was compared. The hardness changes of the hyperemia zone in the ablation zone and its edge were observed. Results: 1. Before radiofrequency ablation, in 26 patients with primary liver cancer (group A), the VTQ value was (1.77 卤0.82) mm2 in the lesion and (2.25 卤0.58) mm2 in the peripheral hepatic parenchyma, among 38 patients with liver malignant tumor, the VTQ value in the lesion was (1.77 卤0.82) mm2 in the patients with primary liver cancer (group A). The VTQ values in 12 patients with metastatic liver cancer (group B) were (2.16 卤1.35) m / s and (1.43 卤0.72) m / s in peripheral hepatic parenchyma. There was no significant difference in VTQ values between the two groups (P < 0. 516), but there was no significant difference in VTQ values between the two groups (P > 0. 516). There was a significant difference in VTQ between the two groups (P < 0. 000). 2. The values of VTQ in the ablation area were measured in 2 cases of primary liver cancer, the rest 24 cases were x.xxmm2, 4 cases of metastatic liver cancer were measured in ablation area, and 8 cases of x.xxm/s were detected in the ablation area of primary liver cancer, the other 24 cases were measured in the ablation area of HCC, the other 8 cases were VTQ in the ablation area of metastatic HCC. The range of VTI imaging was larger than that of conventional ultrasound, and the difference was statistically significant (P0.05). 3. After radiofrequency ablation, the VTQ value at the edge of the ablation area was higher than that of the hepatic parenchyma around the ablation area, and the difference between the two groups was statistically significant (P0.05). 4. 7 days, 1 month, 2 months, 3 months after radiofrequency ablation, the VTQ value of the edge of the ablation area decreased gradually with the passage of time, but there was no significant difference (P0.05). 5. One patient with MLC recurred in situ during the follow-up period. Conclusion: ARFI imaging can repeatedly and non-invasively observe the shape and extent of tumor coagulation and necrosis after radiofrequency ablation (RFCA) and the hardness changes of the surrounding tissue in the ablation area after radiofrequency ablation (RFCA), which may be of potential value in the diagnosis of recurrent lesions in situ. It is expected to be one of the effective methods to evaluate the efficacy of radiofrequency ablation of liver tumors.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R735.7
【共引文献】
相关硕士学位论文 前1条
1 何石林;腹腔镜与开腹肝切除术治疗肝硬化肝癌的安全性及预后分析[D];浙江大学;2014年
，本文编号：2432616
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