实时超声弹性成像评价肝细胞癌射频消融灶的价值

发布时间：2019-04-02 05:31

【摘要】：目的：射频消融(Radiofrequency Ablation, RFA)是肝癌局部的非手术的有效治疗方法之一，治疗后对于疗效的评估是关键步骤。有研究证明超声造影(Contrast Enhanced Ultrasound, CEUS)与增强CT或MR一样可用来评估疗效，但即时的疗效评估因射频过程产生的气体及治疗导致的炎症充血影响而存在技术难点。我们先进行动物试验(体内/外)，结果发现实时超声弹性成像(Real-time Ultrasound Elastography, RTE)可用于评估消融范围，其能否用于评估人体内消融病灶的报道甚少，值得研究。因此，本研究拟利用RTE观察人体内肝癌射频消融病灶，并与常规超声(Base-line Ultrasound,BUS)、CEUS比较，探讨RTE判断RFA疗效的临床应用价值。方法：2012年5月至2013年3月，在我院肝胆外科住院行RFA治疗的29个患者共34个肝癌病灶纳入本研究，全部病灶均经肝穿活检病理证实为肝细胞癌(Hepatocellular Carcinoma, HCC)。BUS、RTE及CEUS分别于RFA治疗前一周内、RFA治疗后24h进行。观察三种方法对RFA消融灶的显示，以经过射频针的最大切面为测量切面并测量消融灶长轴、短轴，并进行对比分析。定量资料以均数±标准差表示。正态资料分布采用配伍组设计方差分析，，Pearson相关分析。以Ｐ＜0.05(双侧)定义为差异有统计学意义。使用SPSS16.0进行统计分析。结果：RFA治疗后24h，BUS显示全部病灶呈不均质回声；RTE图像显示32(94.1%)例呈消融区均匀蓝色或蓝色为主分布，与周围组织分界清晰，而2(5.9%)例呈蓝绿色相间颜色分布，与周围肝组织分界不清；CEUS图像显示消融区动脉期、门脉期及延迟期均为无增强，消融灶周边组织因炎症反应而呈现为动脉期高增强，门脉期及延迟期表现为等增强或稍低增强。BUS、RTE及CEUS显示消融范围测值的比较有显著性差异(P0.01)，两两比较显示BUS与RTE、BUS与CEUS测值差别有统计学意义(P＜0.05)，而RTE与CEUS测值差别无统计学意义(P＞0.05)。pearson相关分析显示RTE与CEUS显示消融灶长轴、短轴的相关系数分别为0.878与0.788。结论：RTE有望为评估肝癌射频消融灶提供一种有效的、简便的方法。
[Abstract]:Objective: radiofrequency ablation (Radiofrequency Ablation, RFA) is one of the effective methods for local non-surgical treatment of hepatocellular carcinoma (HCC), and it is a key step to evaluate the curative effect after treatment. Some studies have shown that contrast-enhanced (Contrast Enhanced Ultrasound, CEUS) can be used to evaluate the efficacy as well as enhanced CT or MR, but there are technical difficulties in the immediate evaluation of therapeutic efficacy due to the gas produced by the radiofrequency process and the effects of inflammatory congestion caused by treatment. We first conducted animal experiments (in vivo / in vitro) and found that real-time ultrasound elastography (Real-time Ultrasound Elastography, RTE) can be used to assess the extent of ablation, and whether it can be used to evaluate ablation lesions in human body is rarely reported, which is worth studying. Therefore, the purpose of this study is to observe the radiofrequency ablation focus of human hepatocellular carcinoma by RTE and compare it with conventional ultrasound (Base-line Ultrasound,BUS), CEUS) to evaluate the clinical value of RTE in evaluating the curative effect of RFA. Methods: from May 2012 to March 2013, 34 HCC lesions from 29 patients treated with RFA in our hepatobiliary surgery were included in this study. All the lesions were pathologically proved to be hepatocellular carcinoma (Hepatocellular Carcinoma, HCC). BUS,) by liver biopsy. RTE and CEUS were performed within one week before RFA treatment and 24 hours after RFA treatment. The display of RFA ablation focus by three methods was observed. The maximum section of radiofrequency needle was used as the measuring section and the long axis and short axis of ablation focus were measured and compared and analyzed. The quantitative data were expressed as mean 卤standard deviation. Normal data distribution was analyzed by compatibility group design analysis of variance and Pearson correlation analysis. The difference was statistically significant in terms of P < 0.05 (bilateral). SPSS16.0 was used for statistical analysis. Results: twenty-four hours after RFA treatment, bus showed heterogeneous echo of all lesions. RTE images showed that 32 cases (94.1%) showed a uniform blue or blue distribution in the ablation area, and the boundary was clear with the surrounding tissues, while in 2 (5.9%) cases, the color distribution was blue-green and not clear with the surrounding liver tissue. CEUS showed no enhancement in the arterial phase, portal phase and delayed phase in the ablation area. The peripheral tissue of the ablation area showed a high enhancement due to inflammation, and an equal or slightly low enhancement in the portal phase and delayed phase. Bus, the arterial phase, the portal phase and the delayed phase of the ablation area showed no enhancement in the arterial phase, portal vein phase and delayed phase. RTE and CEUS showed significant difference in ablation range (P0.01). There was significant difference between BUS and RTE,BUS and CEUS in pairwise comparison (P < 0.05). There was no significant difference between RTE and CEUS (P > 0.05). Pearson correlation analysis showed that RTE and CEUS showed long axis and short axis correlation coefficient was 0.878 and 0.788 respectively. Conclusion: RTE may provide an effective and simple method for evaluating radiofrequency ablation of hepatocellular carcinoma.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37;R445.1

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