剪切波弹性成像评价肝脏微波消融灶边界的实验研究  

Ultrasound shear wave elastography for evaluation of boundary of liver lesions ablated with microwave

作　　者：魏珊[1] 田超[4] 林小影[4] 朱才义 林香桃 程秋华 张植兰 高燕玲 Wei Shan;Tian Chao;Lin Xiaoying;Zhu Caiyi;Lin Xiangtao;Cheng Qiuhua;Zhang Zhilan;Gao Yanling(Department of Ultrasound,Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China;Department of Pathology, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China;Department of Hepatobiliary Surgery, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou 570000, China;Department of Ultrasound, Affiliated Shenzhen Bao′an Maternity & Child Health Hospital, Jinan University, Shenzhen 518000, China;Department of Obstetrics, Affiliated Shenzhen Bao′an Maternity & Child Health Hospital, Jinan University, Shenzhen 518000, China)

机构地区：[1]中南大学湘雅医学院附属海口医院超声医学科,570000 [2]中南大学湘雅医学院附属海口医院病理科,570000 [3]中南大学湘雅医学院附属海口医院肝胆外科,570000 [4]暨南大学附属宝安妇幼保健院超声科,深圳518000 [5]暨南大学附属宝安妇幼保健院产科,深圳518000

出　　处：《中华医学超声杂志（电子版）》2019年第2期147-153,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：海南省自然科学基金(20168311)

摘　　要：目的探讨超高速剪切波弹性成像(SWE)在定量评估肝脏微波消融边界中的可行性与准确性。方法取健康雄性5月龄五指山猪15只,行开腹直视下肝脏微波消融术,消融功率选定40 W,根据消融时间分设为15 s、30 s、60 s三组。消融后即刻采用SWE测量消融灶的弹性模量值。术后利用HE染色、烟酰胺腺嘌呤二核苷酸(NADH)黄递酶组织化学染色评估肝组织的损伤程度。结果本实验共进行有效消融156次,有效SWE测量740次,得到有效病理结果 131个。消融灶弹性模量值呈阶梯式同心圆分布,从中心向外周可分为3个区域。同一消融时间下弹性模量值在周边正常组织区域、消融边界区域、消融中心区域阶梯式增高(P均<0.01)。消融功率40 W,消融时间15 s、30 s、60 s在周边正常组织区域和消融边界区域的弹性模量值差异无统计学意义(P均> 0.05),但在消融中心区域,其弹性模量值随消融时间的缩短而呈阶梯式降低,[60 s:(97.16±14.58)kPa> 30 s:(77.84±9.64)kPa> 15 s:(38.92±3.12)kPa],差异有统计学意义(F=2 131.832,P <0.01)。不同消融时间的消融边界区域弹性模量值保持在22.68~23.56 kPa。结论微波消融灶消融边界区域弹性模量值范围相对固定,SWE有助于定量评估肝脏微波消融边界,其在超声消融的监测与评估方面具有较强的实用价值。Objective To explore the feasibility and accuracy of ultra-high speed shear wave elastography(SWE) in quantitative evaluation of the boundary of liver lesions ablated with microwave. Methods Fifteen healthy five-month-old Wuzhishan pigs weighing(15±0.5) kg underwent microwave ablation under an open laparotomy. The ablation power was selected at 40 W, and the ablation time was set at 15 s, 30 s, and 60 s. Immediately after ablation, SWE was used to measure the elastic modulus of the lesion. The degree of liver tissue damage was assessed by HE staining and nicotinamide adenine dinucleotide(NADH)-diaphorase histochemical staining. Results In the study,156 effective ablation procedures were performed, 740 effective SWE measurements were performed,and 131 effective pathological results were obtained. The elastic modulus of the lesions was distributed in a regional stepped concentric circle, which can be divided into three regions from the center to the outer circumference. At the same ablation time, the elastic modulus value increased stepwise from the surrounding normal tissue region to the ablation boundary region and ablation center region(P < 0.01).There was no significant difference in the elastic modulus between the normal tissue region and the ablation boundary region(P > 0.05), regardless of the ablation time(15 s, 30 s, and 60 s);however, the elastic modulus values in the ablation region showed a significantly stepwise decrease with the decrease in the ablation time [60 s:(97.16±14.58) kPa, 30 s:(77.84±9.64) kPa, 15 s:(38.92±3.12) kPa;F=2131.832, P < 0.01]. The elastic modulus values of the ablation boundary regions at different ablation time points were maintained at 22.68 to23.56 kPa. Conclusion The range of elastic modulus in the boundary region of microwave ablated lesions is relatively fixed. SWE can help quantitatively evaluate the effective damage range and type of liver microwave ablation, and has practical value in monitoring and evaluation of microwave ablation.

关 键 词：弹性成像技术 剪切波 微波 消融技术 弹性模量 肝 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]