超声造影在肝细胞癌诊断及射频消融治疗效果评估中的应用  

Application of contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma and evaluation of the therapeutic efficacy of radiofrequency ablation

作　　者：潜潇 陈志辉[2] 周芳芳 Qian Xiao;Chen Zhihui;Zhou Fangfang(Graduate School,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang Province,China;Department of Ultrasonography,Lishui Central Hospital,Lishui 323000,Zhejiang Province,China)

机构地区：[1]浙江中医药大学研究生院,杭州310053 [2]丽水市中心医院超声科,丽水323000

出　　处：《中国基层医药》2025年第3期326-330,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划(2022ZH087)。

摘　　要：目的探讨超声造影(CEUS)在肝细胞癌(HCC)诊断及射频消融治疗效果评估中的应用价值。方法采用病例对照研究,在丽水市中心医院2019年1月至2023年1月诊治的HCC高风险患者(接受穿刺活检)中,选取确诊为HCC患者118例为病例组,按1∶1原则选取乙型病毒性肝炎肝硬化患者118例为对照组;两组患者均进行CEUS检查,对比分析CEUS对HCC的诊断价值;病例组给予1个月射频消融治疗,以钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)检查结果为标准,评估CEUS在HCC射频消融疗效评估中的应用价值。结果CEUS检查结果与病理诊断结果比较,病例组误诊6例,对照组漏诊8例。CEUS检查诊断准确率为94.07%,CEUS检查Cohen´s Kappa值为0.88,提示CEUS诊断结果和病理诊断结果一致性较好。射频消融后,病例组甲胎蛋白水平[(59.78±14.55)μg/L]较射频消融前[(141.27±34.90)μg/L]显著降低,病灶最长径[(28.47±5.41)mm]较射频消融前[(17.44±4.17)mm]增大(t=24.32、-16.46,均P<0.001)。CEUS评估术后肿瘤最长径与Gd-EOB-DTPA增强MRI结果差异无统计学意义(P>0.05);CEUS评估射频消融疗效与Gd-EOB-DTPA增强MRI结果比较,真阳性8例,真阴性107例,误诊3例。CEUS检查在HCC射频消融疗效评估中准确率为97.46%,Cohen´s Kappa为0.83。结论CEUS在HCC诊断中具有较高的准确率,并可作为射频消融疗效评估的有效手段,与病理诊断及Gd-EOB-DTPA增强MRI结果一致性良好,具有较高的临床应用价值。Objective To investigate the application of contrast-enhanced ultrasound(CEUS)in the diagnosis of hepatocellular carcinoma(HCC)and evaluate the therapeutic efficacy of radiofrequency ablation.Methods A case-control study was conducted among high-risk HCC patients who underwent puncture biopsies at Lishui Central Hospital from January 2019 to January 2023.A total of 118 confirmed HCC patients were selected as the case group,and 118 patients with hepatitis B cirrhosis were selected as the control group,following a 1:1 matching principle.All patients underwent a CEUS examination,and the therapeutic efficacy of CEUS in detecting HCC was analyzed.The case group underwent radiofrequency ablation for 1 month.The case group underwent 1 month of radiofrequency ablation treatment,and the application value of CEUS in assessing the efficacy of radiofrequency ablation for HCC was evaluated based on the results of Gd-EOB-DTPA-enhanced magnetic resonance imaging.Results The results of the CEUS examination were compared with the pathological diagnosis results.In the case group,6 cases were misdiagnosed,while in the control group,8 cases were missed.The diagnostic accuracy of CEUS was 94.07%,and the Cohen's Kappa value for CEUS was 0.88,indicating a good consistency between CEUS and pathological diagnosis results.After radiofrequency ablation,the alpha-fetoprotein levels in the case group decreased significantly from[(141.27±34.90)μg/L]before the procedure to[(59.78±14.55)μg/L]after the procedure(t=24.32,P<0.001).However,the longest diameter of the lesions increased from[(17.44±4.17)mm]before the procedure to[(28.47±5.41)mm]after the procedure(t=-16.46,P<0.001).There was no statistically significant difference in the longest diameter of the tumors assessed by CEUS postoperatively compared to the Gd-EOB-DTPA-enhanced MRI results(P>0.05).When comparing the efficacy of radiofrequency ablation assessed by CEUS to the results from Gd-EOB-DTPA-enhanced MRI,there were 8 true positive cases,107 true negative cases,and 3 cases that

关 键 词：癌 肝细胞 超声检查 多普勒 彩色 血管造影术 导管消融术 磁共振成像 钆塞酸二钠 

分 类 号：R73[医药卫生—肿瘤]