超声造影联合影像导航在小肝癌微创诊治中的应用研究
|
摘要
目的:探讨超声造影(contrast-enhanced ultrasound,CEUS)联合影像导航技术在小肝癌诊治中的应用价值。方法:选取2017年9月—2018年12月于复旦大学附属中山医院就诊的小肝癌患者24例,CEUS检查前增强磁共振成像(magnetic resonance imaging,MRI)显示肝内有增强病灶,但常规超声对可疑病灶显示不清,故采用MRI导航下的CEUS,分析其对病灶的显示率及增强表现,并进行定性诊断、微创治疗前定位及治疗后的随访。结果:24例患者共26个病灶纳入研究,均完成MRI-CEUS图像融合导航,融合成功率100%。26个病灶均小于20 mm,常规超声显示等回声8个、稍低或低回声10个、稍高回声或高回声8个。单独采用CEUS发现18个病灶(18/26,69.2%),CEUS联合MRI导航检出26个病灶(26/26,100%),两者间差异有统计学意义(P=0.004)。在实时MRI导航CEUS中,16个病灶(61.5%,16/26)动脉期表现为快速增强,10个表现为同步增强;门静脉期18个病灶(69.2%,18/26)呈等回声,8个(30.8%,8/26)呈低回声;延迟期10个病灶(38.5%,10/26)仍表现为等回声,余16个病灶呈低回声。检查完成后,4例患者行外科手术切除,10例行射频消融或乙醇注射治疗,4例行介入治疗,6例随访半年后行射频治疗。术后随访中,增强MRI显示所有病灶均完全坏死。结论:CEUS联合影像导航技术能显著提高小肝癌的检出率,指导选择治疗方案,值得在临床上推广应用。
Objective: To explore the application of contrast-enhanced ultrasound(CEUS) combined with imaging navigation in the diagnosis and treatment of small liver cancer. Methods: Twenty-four patients with small liver cancer admitted to Zhongshan Hospital, Fudan University from Sep. 2017 to Dec. 2018 were involved in the study. Contrast-enhanced magnetic resonance imaging(MRI) showed intrahepatic enhanced lesions, which were not clearly displayed on conventional ultrasound, and then ultrasound navigation was performed. The enhancement appearance and detection rate of the lesions by CEUS combined with imaging navigation were analyzed. All the lesions were diagnosed de?nitely, localized before minimally invasive treatment and followed up after treatment. Results: Twenty-six lesions of 24 patients were included in the study. All the patients underwent MRI-CEUS image fusion navigation, and the success rate of fusion was 100%. The size of all the 26 lesions was less than 20 mm. Eight lesions were isoechoic, 10 lesions were hypoechoic and the other 10 lesions were hyperechoic on conventional ultrasound. Eighteen lesions(18/26,69.2%) were detected by CEUS alone, whereas all the 26 lesions(26/26, 100%) were detected by MRI-CEUS image fusion navigation. And there existed statistically signi?cant difference(P=0.004) between them. In real-time MRI-CEUS navigation, 16 lesions(61.5%, 16/26) showed rapid enhancement in the arterial phase, and 10 showed synchronous enhancement. In the portal phase, 18 lesions(69.2%, 18/26) were isoechoic and 8 were hypoechoic. In the delayed phase, 10 lesions(38.5%, 10/26) were isoechoic and the other 16 lesions(61.5%, 16/26) were hypoechoic. After the examinations, 4 patients underwent surgical resection, 10 underwent radiofrequency ablation or alcohol injection treatment, and 4 underwent interventional treatment. The other 6 patients underwent radiofrequency ablation treatment after follow-up for half a year. All the lesions showed complete necrosis on enhanced MRI during follow-up. Conclusion: CEUS combined with imaging navigation can signi?cantly improve the detection rate of small liver cancer and guide the choice of treatment options. It is worthy of clinical application.
Objective: To explore the application of contrast-enhanced ultrasound(CEUS) combined with imaging navigation in the diagnosis and treatment of small liver cancer. Methods: Twenty-four patients with small liver cancer admitted to Zhongshan Hospital, Fudan University from Sep. 2017 to Dec. 2018 were involved in the study. Contrast-enhanced magnetic resonance imaging(MRI) showed intrahepatic enhanced lesions, which were not clearly displayed on conventional ultrasound, and then ultrasound navigation was performed. The enhancement appearance and detection rate of the lesions by CEUS combined with imaging navigation were analyzed. All the lesions were diagnosed de?nitely, localized before minimally invasive treatment and followed up after treatment. Results: Twenty-six lesions of 24 patients were included in the study. All the patients underwent MRI-CEUS image fusion navigation, and the success rate of fusion was 100%. The size of all the 26 lesions was less than 20 mm. Eight lesions were isoechoic, 10 lesions were hypoechoic and the other 10 lesions were hyperechoic on conventional ultrasound. Eighteen lesions(18/26,69.2%) were detected by CEUS alone, whereas all the 26 lesions(26/26, 100%) were detected by MRI-CEUS image fusion navigation. And there existed statistically signi?cant difference(P=0.004) between them. In real-time MRI-CEUS navigation, 16 lesions(61.5%, 16/26) showed rapid enhancement in the arterial phase, and 10 showed synchronous enhancement. In the portal phase, 18 lesions(69.2%, 18/26) were isoechoic and 8 were hypoechoic. In the delayed phase, 10 lesions(38.5%, 10/26) were isoechoic and the other 16 lesions(61.5%, 16/26) were hypoechoic. After the examinations, 4 patients underwent surgical resection, 10 underwent radiofrequency ablation or alcohol injection treatment, and 4 underwent interventional treatment. The other 6 patients underwent radiofrequency ablation treatment after follow-up for half a year. All the lesions showed complete necrosis on enhanced MRI during follow-up. Conclusion: CEUS combined with imaging navigation can signi?cantly improve the detection rate of small liver cancer and guide the choice of treatment options. It is worthy of clinical application.
引文
[1]徐辉雄,伯小皖.基于超声新技术的结直肠癌肝转移诊断与治疗临床研究进展[J].肿瘤影像学,2017,26(1):1-6.
[2]王文平,季正标,董怡,等.实时导航超声造影在小肝癌诊断中的应用研究[J].中华医学超声杂志(电子版),2016,13(1):56-60.
[3]李凯,袁树芳,郑荣琴,等.虚拟导航超声造影与常规超声造影定位检测肝局灶性病变的比较[J].中华超声影像学杂志,2011,20(5):390-392.
[4]戴戈扬,戴琳,刘志,等.虚拟导航超声造影指导常规超声不能检出肝脏小占位病灶微波消融术的精准定位研究[J].实用医学杂志,2017,33(21):3643-3646.
[5]PARK H J,LEE M W,LEE M H,et a1.Fusion imaging-guided percutaneous biopsy of focal hepatic lesions with poor conspicuity on conventional sonography[J].J Ultrasound Med,2013,32(9):1557-l564.
[6]KIM P N,CHOI D,RHIM H,et a1.Planning ultrasound for percutaneous radiofrequency ablation to treat small(≤3 cm)hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging:a multicenter prospective study to assess factors affecting ultrasound visibility[J].J Vasc Interv Radiol,2012,23(5):627-634.
[7]JUNG E M,FRIEDRICH C,HOFFSTETTER P,et a1.Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions:first results[J].PLoS One,2012,7(3):e33956.
[8]LAI Y,LI K,LI J,et al.Cost-effectiveness of navigated radio-frequency ablation for hepatocellular carcinoma in China[J].Int J Technol Assess Health Care,2014,30(4):400-408.
[9]MAURI G,COVA L,DE BENI S,et al.Real-time US-CT/MRIimage fusion for guidance of thermal ablation of liver tumors undetectable with US:results in 295 cases[J].Cardiovasc Intervent Radiol,2015,38(1):143-151.
[10]YOON S H,LEE K H,KIM S Y,et a1.Real-time contrastenhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound[J].Eur Radiol,2010,20(8):2047-2056.
[11]LIU F Y,YU X L,LIANG P,et al.Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography[J].Eur J Radiol,2012,81(7):1455-1459.
[12]TAKAYAMA T,MAKUUCHI M,KOJIRO M,et al.Early hepatocellular carcinoma:pathology,imaging,and therapy[J].Ann Surg Oncol,2008,15(4):972-978.
[13]王俊东,刘长珠,李宝金,等.超声造影联合影像融合导航技术在特殊部位小肝癌微波消融治疗中的价值[J].中国中西医结合影像学杂志,2018,16(4):394-396,400.
[14]蒋天安,陈燕,敖建阳,等.实时影像虚拟导航系统在肝癌微创治疗中的初步应用[J].中华超声影像学杂志,2009,18(9):768-771.
[2]王文平,季正标,董怡,等.实时导航超声造影在小肝癌诊断中的应用研究[J].中华医学超声杂志(电子版),2016,13(1):56-60.
[3]李凯,袁树芳,郑荣琴,等.虚拟导航超声造影与常规超声造影定位检测肝局灶性病变的比较[J].中华超声影像学杂志,2011,20(5):390-392.
[4]戴戈扬,戴琳,刘志,等.虚拟导航超声造影指导常规超声不能检出肝脏小占位病灶微波消融术的精准定位研究[J].实用医学杂志,2017,33(21):3643-3646.
[5]PARK H J,LEE M W,LEE M H,et a1.Fusion imaging-guided percutaneous biopsy of focal hepatic lesions with poor conspicuity on conventional sonography[J].J Ultrasound Med,2013,32(9):1557-l564.
[6]KIM P N,CHOI D,RHIM H,et a1.Planning ultrasound for percutaneous radiofrequency ablation to treat small(≤3 cm)hepatocellular carcinomas detected on computed tomography or magnetic resonance imaging:a multicenter prospective study to assess factors affecting ultrasound visibility[J].J Vasc Interv Radiol,2012,23(5):627-634.
[7]JUNG E M,FRIEDRICH C,HOFFSTETTER P,et a1.Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions:first results[J].PLoS One,2012,7(3):e33956.
[8]LAI Y,LI K,LI J,et al.Cost-effectiveness of navigated radio-frequency ablation for hepatocellular carcinoma in China[J].Int J Technol Assess Health Care,2014,30(4):400-408.
[9]MAURI G,COVA L,DE BENI S,et al.Real-time US-CT/MRIimage fusion for guidance of thermal ablation of liver tumors undetectable with US:results in 295 cases[J].Cardiovasc Intervent Radiol,2015,38(1):143-151.
[10]YOON S H,LEE K H,KIM S Y,et a1.Real-time contrastenhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound[J].Eur Radiol,2010,20(8):2047-2056.
[11]LIU F Y,YU X L,LIANG P,et al.Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography[J].Eur J Radiol,2012,81(7):1455-1459.
[12]TAKAYAMA T,MAKUUCHI M,KOJIRO M,et al.Early hepatocellular carcinoma:pathology,imaging,and therapy[J].Ann Surg Oncol,2008,15(4):972-978.
[13]王俊东,刘长珠,李宝金,等.超声造影联合影像融合导航技术在特殊部位小肝癌微波消融治疗中的价值[J].中国中西医结合影像学杂志,2018,16(4):394-396,400.
[14]蒋天安,陈燕,敖建阳,等.实时影像虚拟导航系统在肝癌微创治疗中的初步应用[J].中华超声影像学杂志,2009,18(9):768-771.