声脉冲辐射力成像技术在肝癌射频消融中的初步应用  

Preliminary application of acoustic radiation force impulse imaging in radiofrequency ablation of hepatic malignancies

作　　者：李巧凤[1] 蒋天安[2] 

机构地区：[1]浙江省湖州市第三人民医院超声科,313000 [2]浙江大学医学院附属第一医院超声科

出　　处：《中华超声影像学杂志》2015年第7期584-588,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨声脉冲辐射力成像（ARFI）技术在肝癌射频消融中的临床应用价值。方法对原发性肝癌组26例（包括25例肝细胞肝癌、1例肝内胆管细胞癌）和转移性肝癌组12例共38个肝癌结节在行射频消融（RFA）治疗前后分别行常规超声和ARFI检查。比较治疗前后病灶在声触诊组织成像（VTI）、常规超声上显示的大小及其与周边肝实质的硬度差异和变化，观察消融区内及其边缘充血带的硬度变化。术后定期随访，观察可疑残余癌或原位复发灶的ARFI表现，并行增强MRI及穿刺活检证实。结果VTI显示病灶范围大于常规超声（P〈0．05）。消融区边缘的剪切波速度（SWV）大于消融区周边肝实质（P〈0．05），且随着时间的推移呈递减趋势，差异无统计学意义（P〉0．05）。随访期间1例转移性肝癌（MLC）患者出现原位复发，VTI表现为较周边消融灶稍亮的灰色区域。结论ARFI技术能够反复、无创地观察肝癌RFA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的诊断价值。Objective To evaluate the clinical value of acoustic radiation force impulse （ARFI） imaging in radiofrequency ablation of hepatic malignancies. Methods Twenty-six patients with primary carcinoma of the liver （including 25 cases of hepatocellular carcinoma and 1 case of intrahepatic cholangiocarcinoma） and 12 patients with metastatic hepatic carcinoma were enrolled and a total of 38 hepatic nodules were studied. All patients underwent ARFI imaging and conventional ultrasound before and after radiofrequency ablation. The sizes of lesions were assessed with virtual touch tissue imaging （VTI） and conventional ultrasound before and after radiofrequency ablation, and the stiffness of lesions, adjacent congestion zone and surrounding parenchyma were assessed with virtual touch tissue quantification （VTQ）. Regular follow-up by ARFI was conducted for suspected residual tumor or local recurrence, and enhanced MRI examination or liver biopsy was performed for confirmation. Results The mean size of lesions assessed with VTI was bigger than that on conventional ultrasound （ P ~0.05）. Shear wave velocity （SWV） value at the edge of the ablation zone were higher than that at surrounding parenchyma （ P ~0.05）, and was decreasing with the time passed by, but the difference was not of statistical significance （P ~ 0.05）. Recurrence was observed in one metastatic hepatic carcinoma patient during the follow-up, and the lesion was gray which is slightly brighter than the surrounding ablation lesions on VTI. Conclusions ARFI plays a potential role in estimating recurrence by observing the shape and range of coagulation necrosis, and the changes of stiffness in the surrounding parenchyma of ablation zone in a short time after radiofrequency ablation of liver malignancies, and can be used effectively in the assessments of thermal ablation of hepatic malignancies.

关 键 词：超声检查 肝肿瘤 导管消融术 声辐射力脉冲成像 

分 类 号：R735.7[医药卫生—肿瘤]