经皮微波消融肾细胞癌疗效的超声造影评价  

Percutaneous microwave ablation for renal cell carcinoma: evaluation of therapeutic effect with contrast- enhanced ultrasound

作　　者：李鑫[1] 梁萍[1] 于晓玲[1] 于杰[1] 程志刚[1] 韩志宇[1] 刘方义[1] 穆梦娟[1] 陈超男[1] 

机构地区：[1]北京中国人民解放军总医院介入超声科,100853

出　　处：《介入放射学杂志》2014年第8期688-692,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金81127006;国家科技部国际合作项目2012DFG32070

摘　　要：目的：探讨低机械指数灰阶超声造影（CEUS）评估经皮微波消融肾细胞癌临床疗效的可行性与准确性。方法2006年3月-2013年7月，105例肾细胞癌患者109个病灶，平均直径（3．1±1．3）cm行超声引导下经皮微波消融治疗。消融后3 d，CEUS对消融区检查结果与同期增强CT/MRI及穿刺活检病理结果进行比较，对近期消融疗效进行评估；随后1、3和6个月及之后每6个月进行CEUS和CT/MRI检查，对远期消融疗效进行评估。结果微波消融后3 d，CEUS检查显示94个（94/109，86．2%）病灶呈完全消融状态，15个（15/109，13．8%）病灶有残癌。其中，13个（13/15，86．7%）残癌病灶由同期增强CT/MRI检查或活检病理证实。 CEUS对微波消融肾癌近期疗效评价的灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为100%、97．9%、98．2%、86．7%和100%。在3-90个月（中位24．6个月）的随访期内， CEUS检查显示有7例复发（1例肾实质内、2例外凸靠近肠道及4例内凸靠近肾盂），其中6例与同期CT/MRI检查相一致，CEUS对消融区的远期疗效评价的灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为85．7%、99．0%、98．2%、85．7%和99．0%。结论实时灰阶CEUS在评估经皮微波消融肾细胞癌疗效方面具有灵敏、准确、便捷的应用价值。Objective To evaluate low-mechanical-index contrast-enhanced ultrasound （CEUS） in assessing the clinical efficacy and feasibility of percutaneous microwave ablation （MWA） for the treatment of renal cell carcinoma （RCC）. Methods From March 2006 to July 2013, a total of 105 RCC patients with 109 lesions, mean size being （3.1 ± 1.3） cm, were treated with ultrasound-guided percutaneous MWA. CEUS results obtained on the third day after MWA were compared with the contrast-enhanced CT/MRI and biopsy findings in the corresponding period. Follow-up examinations with CEUS and CT/MRI were carried out 1, 3 and 6 months after the treatment and once every 6 months thereafter to evaluate the short-term and the long-term therapeutic effectiveness. Results Three days after MWA, CEUS showed that 94 of 109 lesions （86.2%） were completely ablated, and residual tumor tissue was seen in 15 of 109 lesions （13.8%）. Among the 15 lesions with residual tumor tissue, 13 （86.7%） were proved by contrast-enhanced CT/MRI and/or biopsy performed in the corresponding period. The sensitivity, specificity, accuracy, positive predictive value （PPV） and negative predictive value （NPV） of CEUS for the evaluation of the short-term MWA effectiveness were 100%, 97.9%, 98.2%, 86.7% and 100%, respectively. Patients were followed up for 3 - 90 months with a median period of 24.6 months. During the follow - up period, CEUS detected recurrence in 7 patients, and 6 of them were consistent with CT/MRI results. The sensitivity, specificity, accuracy, positive and negative predictive value of＆amp;nbsp;CEUS for the evaluation of the long-term MWA effectiveness were 85.7%, 99.0%, 98.2%, 85.7% and 99.0%, respectively. Conclusion For the evaluation of the effectiveness of percutaneous microwave ablation in treating renal cell carcinoma, CEUS is a sensitive, reliable and convenient technique.

关 键 词：超声造影 微波消融 肾细胞癌 

分 类 号：R737.11[医药卫生—肿瘤]