超声造影定量分析在不可手术切除的肝细胞癌门静脉癌栓放疗中的应用价值  

Application of contrast-enhanced ultrasonography quantitative analysis in the radiotherapy of non-resectable portal vein tumor thrombus in patients with hepatocellular carcinoma

作　　者：李红学[1] 李航[1] 丁战玲[1] 刘连凤[1] 赵盛发[1] 李想[1] 苏芳[2] 刘军杰[1] LI Hongxue;LI Hang;DING Zhanling;LIU Lianfeng;ZHAO Shengfa;LI Xiang;SU Fang;LIU Junjie(Department of Ultrasound,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China;Department of Radiotherapy,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院超声科,南宁530021 [2]广西医科大学附属肿瘤医院放疗科,南宁530021

出　　处：《中华实用诊断与治疗杂志》2020年第11期1148-1151,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广西自然科学基金(2017GXNSFBA1982322018);广西肝癌诊疗工程技术研究中心建设项目(2014GCZX20);广西教育厅中青年教师基础能力提升项目(KY2016YB082)。

摘　　要：目的分析肝细胞癌(hepatocellular carcinoma,HCC)并门静脉癌栓(portal vein tumor thrombus,PVTT)患者三维适形放疗(three-dimensional conformal radiotherapy,3DCRT)前后PVTT超声造影参数变化,探讨超声造影评估PVTT放疗效果的价值。方法79例HCC并PVTT患者,分别于3DCRT前1周内及3DCRT后1个月行超声造影和增强CT检查。计算PVTT分型降型率;比较超声造影、增强CT评价HCC、PVTT的客观缓解率;比较3DCRT前后PVTT区域超声造影参数包括:到达时间、达峰时间、峰值强度、流出时间和曲线下面积。结果3DCRT治疗后,79例患者PVTT分型降型率为48.1%。超声造影评价HCC、PVTT的客观缓解率(53.2%、57.0%)与增强CT(51.9%、54.4%)比较差异均无统计学意义(P>0.05)。3DCRT后PVTT内部峰值强度[(13.15±4.79)dB]和曲线下面积[(793±106)dB/s]低于3DCRT前[(36.47±5.78)dB、(2237±219)dB/s](P<0.05),到达时间[(10.22±3.99)s]、达峰值时间[(30.67±6.03)s]和流出时间[(97.38±5.94)s]与3DCRT前[(10.14±4.18)、(30.98±5.79)、(98.53±5.35)s]比较差异无统计学意义(P>0.05)。结论超声造影参数可量化评估PVTT内部3DCRT前后变化,可用于PVTT疗效的评估。Objective To analyze the parameter changes of contrast-enhanced ultrasonography(CEUS)in patients with hepatocellular carcinoma(HCC)complicated with portal vein tumor thrombus(PVTT)before and after three-dimensional conformal radiotherapy(3DCRT),and to investigate the value of CEUS to the assessment of the therapeutic effect of 3DCRT on PVTT.Methods Seventy-nine patients with HCC and PVTT were performed CEUS and enhanced CT one week before 3DCRT and one month after 3DCRT to calculate PVTT reduction rate.The objective response rates of CEUS and enhanced CT in evaluating HCC and PVTT were compared.The arrival time,time to peak,peak intensity,washout time and area under the curve of PVTT were compared before and after 3DCRT.Results After 3DCRT,the PVTT reduction rate was 48.1%.There were no significant differences in objective response rates between CEUS(53.2%,57.0%)and enhanced CT(51.9%,54.4%)in evaluating HCC and PVTT(P>0.05).The peak intensity((13.15±4.79)dB)and area under the curve((793±106)dB/s)of PVTT after 3DCRT were lower than those before 3DCRT((36.47±5.78)dB,(2237±219)dB/s)(P<0.05),while the arrival time((10.22±3.99)s),time to peak((30.67±6.03)s)and washout time((97.38±5.94)s)after 3DCRT showed no significant differences compared with those before 3DCRT((10.14±4.18),(30.98±5.79),(98.53±5.35)s)(P>0.05).Conclusion CEUS parameters can quantitatively evaluate the changes of PVTT before and after 3DCRT and can be used to evaluate the efficacy on PVTT.

关 键 词：肝细胞癌 门静脉癌栓 超声造影 三维适形放疗 

分 类 号：R735.7[医药卫生—肿瘤]