超微血管成像技术预测肝癌射频消融疗效的初步研究  

Evaluation of therapeutic efficacy of radiofrequency ablation on hepatic cancer:a preliminary study using superb microvascular imaging

作　　者：何子朋[1] 唐华[1] 蒋鹏程[1] 赵鸿雁[1] 董姝英 He Zipeng;Tang Hua;Jiang Pengcheng;Zhao Hongyan;Dong Shuying(Department of Ultrasound,West Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Hepatobiliary-pancreatic-splenic Surgery,West Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院西院超声科,北京100043 [2]首都医科大学附属北京朝阳医院西院肝胆胰脾外科,北京100043

出　　处：《中华肝胆外科杂志》2021年第9期663-666,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(8180110554)。

摘　　要：目的分析超微血管成像(SMI)技术对肝癌射频消融疗效的预测价值。方法回顾分析2017年2月至2018年2月首都医科大学附属北京朝阳医院西院行射频消融治疗的55例(72个病灶)肝癌患者资料,其中男性31例,女性24例,年龄范围37~68岁,平均56岁。病灶长径21.3~45.6 mm,平均31.2 mm。所有病灶术前均采用SMI技术进行微血流分级(Adler法)和行增强CT检查。术后1个月以2种以上影像学检查(增强CT、增强MRI、超声造影)结果为"金标准"评估完全消融率。Kappa检验分析SMI技术微血流分级与增强CT动脉期强化程度的一致性。结果SMI技术显示病灶内微血流1级12个(16.7%)、2级28个(38.9%)、3级32个(44.4%)。增强CT动脉期无明显强化37个(51.4%)、明显强化35个(48.6%)。SMI技术病灶微血流分级与增强CT明显强化一致性较好(Kappa值=0.861,P<0.001),微血流分级越高,强化越明显。SMI技术微血流分级1、2、3级病灶完全消融率分别为100.0%(12/12)、92.9%(26/28)、71.9%(23/32)。3级病灶完全消融率明显低于1级、2级病灶,差异有统计学意义(P均<0.05)。结论SMI技术评估肝癌内微血流与增强CT结果一致性较好,SMI技术微血流分级可能成为肝癌射频消融疗效的预测手段。Objective To study the predictive value of superb microvascular imaging(SMI)in evaluating therapeutic efficacy of hepatic cancer treated by percutaneous radiofrequency ablation(PRFA).Methods From Feb 2017 to Feb 2018,55 patients(male:31,female:24,age range:37-68 years,mean age:56years)with 72 hepatic carcinoma lesions(length:21.3-45.6 mm,average:31.2 mm)were detected by SMI and contrast-enhanced CT(CECT)before PRFA.One month after treatment,more than two imaging examinations(CECT,CEMR,ultrasonic imaging)were used as the"gold standard"to evaluate the complete ablation rates.Consistency between the SMI grading and the arterial phase enhancement of CECT was analyzed by the Kappa-test.Results Before PRFA,SMI showed 12 lesions(16.7%)to be in gradeⅠ,28 lesions(38.9%)in gradeⅡand 32 lesions(44.4%)in gradeⅢ.The arterial phase of CECT showed 37 lesions(51.4%)to have no obvious enhancement and 35 lesions(48.6%)to have obvious enhancement.Consistency analysis showed that there was a high consistency between SMI and CECT(Kappa=0.861,P<0.001).The higher the SMI grading,the more obvious the enhancement on CECT.The complete ablation rates of the gradeⅠ,gradeⅡand gradeⅢlesions were 100%(12/12),92.9%(26/28)and 71.9%(23/32),respectively.The complete ablation rate of the lesions in gradeⅢwas significantly lower than that in gradeⅠand gradeⅡ(both P<0.05).Conclusion SMI showed a good consistency with CECT in evaluating the blood flow signals of hepatic cancer,SMI grading could be used in predicting the therapeutic efficacy of hepatic cancer treated by PRFA.

关 键 词：肝肿瘤 体层摄影术 X线计算机 超微血管成像 射频消融 

分 类 号：R735.7[医药卫生—肿瘤]