超声造影联合MRI融合导航技术在评估肝细胞肝癌消融疗效中的临床价值  

Clinical value of contrast-enhanced ultrasound combined with MRI fusion navigation technology in evaluating the ablation efficacy of hepatocellular carcinoma

作　　者：张琪 王坤 曹佳颖 经翔[3] 严昆 董怡 王文平 ZHANG Qi;WANG Kun;CAO Jiaying;JING Xiang;YAN Kun;DONG Yi;WANG Wenping(Department of Ultrasound,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院超声科,上海市200032 [2]上海交通大学附属新华医院超声科 [3]天津市第三中心医院超声科 [4]北京大学肿瘤医院超声科

出　　处：《临床超声医学杂志》2024年第2期100-104,共5页Journal of Clinical Ultrasound in Medicine

基　　金：国家自然科学基金项目(82071942、82272013);上海申康中心重大临床研究项目(SHDC2020CR1031B、SHDC2020CR4060)。

摘　　要：目的探讨超声造影(CEUS)联合MRI融合导航技术在评估肝细胞肝癌(HCC)消融疗效中的临床应用价值。方法前瞻性选取2020年9月至2022年12月我院、天津市第三中心医院及北京大学附属肿瘤医院行消融治疗的HCC患者77例,随机分为CEUS组46例(46个病灶)和CEUS联合MRI导航组31例(31个病灶),分别于消融前1 d及消融后30 d行CEUS或CEUS联合MRI融合导航检查。以消融后30 d普美显增强MRI为标准,比较两组消融疗效情况。结果CEUS组46个病灶中,39个完全消融,其中32个病灶达到安全边界;CEUS联合MRI导航组31个病灶中,27个完全消融,且均达到安全边界,两组消融疗效比较差异无统计学意义(P=0.063)。CEUS组中,7个未完全消融,CEUS准确诊断5个;CEUS联合MRI导航组中,MRI诊断3个未消融完全,CEUS联合MRI导航技术诊断4个未消融完全。CEUS联合MRI导航融合成功率为100%。位于特殊位置(距离肝包膜、大血管旁、胆囊旁、膈肌<5 mm)的病灶中,CEUS组中79.3%(23/29)的病灶达到安全边界,CEUS联合MRI导航组中88.2%(15/17)的病灶达到安全边界,两组比较差异有统计学意义(P<0.001)。消融前二维超声呈等回声或边界不清晰的病灶中,CEUS组中80.0%(20/25)的病灶达到安全边界,CEUS联合MRI导航组中88.9%(16/18)病灶达到安全边界,两组比较差异有统计学意义(P<0.001)。结论CEUS联合MRI融合导航技术有助于准确判断HCC消融的安全边界,尤其对位于特殊位置的病灶及二维超声呈等回声或边界不清晰的病灶消融疗效更佳。Objective To investigate the clinical application value of contrast-enhanced ultrasound(CEUS)combined with MRI(CEUS/MRI)fusion navigation technology in evaluating the ablation efficacy of hepatocellular carcinoma(HCC).Methods A total of 77 patients diagnosed with hepatocellular carcinoma in our Hospital,Tianjin Third Central Hospital and Beijing Cancer Hospital from September 2020 to December 2022 were prospectively selected and randomly divided into the CEUS group(46 cases,46 lesions)and the CEUS/MRI fusion navigation group(31 cases,31 lesions).The CEUS examination,either alone or in combination with MRI navigation were performed 1 d before ablation and 30 d after ablation.The ablation efficacy was compared,taking promethazine-enhanced MRI 30 d after ablation as the standard.Results Among the 46 lesions in the CEUS group,39 lesions were successfully complete ablated,with 32 lesions achieved the safety boundary.Among the 31 lesions in the CEUS/MRI fusion navigation group,27 lesions were successfully complete ablated,and all achieved complete ablation within the safety boundary.There was no statistically significant difference between the two groups(P=0.063).In the CEUS group,7 lesions were not complete ablated,and 5 lesions were accurately diagnosed by CEUS.In the CEUS/MRI fusion navigation group,3 lesions with uncomplete ablation were diagnosed by MRI and 4 lesions with uncomplete ablation by CEUS/MRI fusion navigation technology.The successful rate of the CEUS/MRI fusion navigation was 100%.Among lesions located in special sites(less than 5 mm from the liver capsule,large vessel,gallbladder,diaphragm),79.3%(23/29)lesions in the CEUS group achieved the safety boundary and 88.2%(15/17)lesions in the CEUS/MRI fusion navigation group achieved the safety boundary,with statistically significant difference(P<0.001).Among the lesions with equal echogenicity or indistinct boundaries prior to ablation,80.0%(20/25)lesions in the CEUS group achieved the safety boundary,while 88.9%(16/18)lesions in the CEUS/MRI fusion navig

关 键 词：超声检查 造影剂 MRI 融合成像 肝细胞肝癌 消融治疗 安全边界 

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]