三维超声融合成像可视化技术在引导肝细胞癌热消融精准布针中的初步应用  

Preliminary application of three-dimensional ultrasound fusion imaging visualization technology guiding precise needle placement for thermal ablation of hepatocellular carcinoma

作　　者：孙月婷 郭语清 刘家铭 刘明[1] 丛龙飞 刘保娴 谢晓燕[1] 黄光亮[1] Sun Yueting;Guo Yuqing;Liu Jiaming;Liu Ming;Cong Longfei;Liu Baoxian;Xie Xiaoyan;Huang Guangliang(Department of Medical Ultrasound,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Medical Ultrasound,Huadong Hospital,Fudan University,Shanghai 200040,China;Shenzhen Mindray Bio-medical Electronics.LTD,Shenzhen 518000,China)

机构地区：[1]中山大学附属第一医院超声医学科,广州510080 [2]复旦大学附属华东医院超声医学科,上海200040 [3]深圳迈瑞生物医疗电子股份有限公司技术研究所,深圳518000

出　　处：《中华超声影像学杂志》2024年第2期158-164,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金重大研究计划项目(92059201)。

摘　　要：目的初步探索三维超声融合成像(3DUS FI)可视化技术在引导肝细胞癌(HCC)热消融术中精准布针的临床价值。方法回顾性分析2019年11月至2021年12月于中山大学附属第一医院行3DUS FI引导下热消融治疗的56例HCC患者(59个病灶)。术前采集患者三维超声容积图像并与实时二维超声图像融合配准, 将肿瘤及5 mm安全边界分割标记出来后在三维可视化下进行术前规划并实时引导热消融。术后1个月行增强CT/MRI评估病灶是否消融完全并测量消融边界, 分析消融边界与局部肿瘤进展(LTP)发生率的关系。结果所有病灶术中均可成功配准并三维显示。术后超声造影显示所有病灶均达到完全消融。共有37个病灶可依据术后1个月增强CT/MRI评估消融效果和消融边界, 其中32个(86.5%)病灶达到完全消融且消融边界≥ 5 mm。随访期间, 4个病灶发生LTP, 其中3个发生在消融边界<5 mm处, 所有病灶1年和2年的累积LTP率均为7.1%。所有患者均未发生与热消融治疗相关的严重并发症以及死亡事件。结论 3DUS FI可视化技术引导HCC热消融术中精准布针是可行并且安全的。Objective To preliminarily explore the clinical value of three-dimensional ultrasound fusion imaging(3DUS FI)visualization technology in guiding precise needle placement during thermal ablation of hepatocellular carcinoma(HCC).Methods A total of 56 HCC patients(59 lesions)who underwent 3DUS FI guided thermal ablation were retrospectively analyzed in the First Affiliated Hospital of Sun Yat-sen University from November 2019 to December 2021.All patients were collected with three-dimensional ultrasound volume image before ablation which were fused with real-time two-dimensional ultrasound image for registration,and then the tumor and the safety margin of 5 mm were segmented and marked.Finally,the thermal ablation was performed under three-dimensional visualization.Contrast-enhanced CT/MRI was performed 1 month after thermal ablation to evaluate whether the lesion was completely ablated and measure the ablative margin,and the relationship between ablative margin and the incidence of local tumor progression(LTP)was also analyzed.Results During the ablation,all lesions could be successfully registered and displayed in three-dimension.Postoperative contrast-enhanced ultrasound showed that all lesions were completely ablated.A total of 37 lesions could be evaluated for ablative efficacy and ablative margin based on contrast-enhanced CT/MRI 1 month after themal ablation,of which 32(86.5%)lesions achieved complete ablation and obtained at least 5 mm ablative margin.During the follow-up period,LTP was occurred in 4 lesions,3 of the lesions occurred at the ablative margin<5 mm.Both 1-year and 2-year cumulative LTP rates were all 7.1%.None of patients had serious complications or deaths associated with thermal ablation.Conclusions 3DUS FI real-time guidance technology is feasible and safe in visually guiding precise needle placement during thermal ablation of HCC.

关 键 词：三维超声融合成像 肝细胞癌 热消融 精准布针 

分 类 号：R735.7[医药卫生—肿瘤]