Role of contrast enhanced ultrasound in evaluating hepatic malignancies after ablation
-
摘要:
肝癌消融术后影像学评价是临床须要解决的重要问题。超声造影技术无创、安全,可获得治疗区域微循环信息。简要介绍超声造影方法、局部及异位复发的表现。当肝消融灶超声造影各时相无增强、无异常廓清,治疗区域呈灌注缺失状态表明消融完全。局部残存活性或复发灶形态多样,常位于病灶周边,以结节状、不规则形增强多见,超声造影动脉期发现异常强化为阳性诊断指标,可以检出大部分活性灶。随访中病灶增大提示肿瘤局部复发或有活性。认为超声造影与增强CT在评价肝肿瘤消融后的价值相近,是可用于疗效判断和随访的影像方法。
-
关键词:
- 肝肿瘤 /
- 超声检查 /
- 造影剂 /
- 体层摄影术,X线计算机 /
- 磁共振成像
Abstract:Imaging evaluation of hepatic malignancies after ablation is an important clinical problem to be solved.Contrast enhanced ultrasound (CEUS) is a noninvasive, safe technique for acquiring the microcirculation information of treatment areas.The CEUS technique and the findings of local and distant recurrence were reviewed.Complete ablation was defined as follows: the ablation area had neither enhancement nor abnormal wash-out and was presented as perfusion deficiency in each phase of CEUS.Local residual or recurrent tumor had various patterns, and their common location was in the periphery of the lesions, being nodular or in irregular enhancement.The positive indicator of recurrence was that CEUS found abnormal enhancement in arterial phase.Most lesions with viability can be detected by this criteria.During follow-up, local recurrence or viability of tumor should be considered when the lesion was increased in size.Most current studies have demonstrated that CEUS has a similar value as contrast enhanced computed tomography in evaluating hepatic malignancies after ablation and that CEUS offers an imaging option for treatment evaluation and follow-up.
-
Key words:
- liver neoplasms /
- ultrasonography /
- contrast media /
- tomography /
- X-ray computed
-
[1]MELONI MF, GOLDBERG SN, LIVRAGHI T, et al.Hepatocellu-lar carcinoma treated with radiofrequency ablation:comparison ofpulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT[J].AJRAm J Roentgenol, 2001, 177 (2) :375-380. [2]GOLDBERG SN, GAZELLE GS, COMPTON, et al.Treatment of intra-hepatic malignancy with radiofrequency ablation:radiologic-pathologiccorrelations[J].Cancer, 2000, 88 (11) :2452-2463. [3]LYU K, JIANG YX, DAI Q, et al.Therapeutic effects of malignant he-patic masses treated by interventional procedures:usefulness of contrast-enhanced harmonic ultrasound imaging[J].Chin J Med Imaging Technol, 2007, 23 (1) :98-101. (in Chinese) 吕珂, 姜玉新, 戴晴, 等.超声造影在肝恶性肿瘤介入治疗疗效评估中的应用价值[J].中国医学影像技术, 2007, 23 (1) :98-101. [4]LIU JB, GOLDBERG BB, MERTON DA, et al.The role of contrast-enhanced sonographypor radiofrequency ablation of liver tumors[J].JUltrasound Med, 2001, 20 (5) :517-523. [5]CHOI D, LIM HK, KIM SH, et al.Hepatocellular carcinoma trea-ted with percutaneous radio-frequency ablation:usefulness of pow-er doppler US with a microbubble contrast agent in evaluationg ther-apeutic response-preliminary results[J].Radiology, 2000, 217 (2) :558-563. [6]LU DS, YU NC, RAMAN SS, et al.Radiofrequency ablation ofhepatocellular carcinoma:treatment success as defined by histologicexamination of the explanted liver[J].Radiology, 2005, 234 (3) :954-960. [7]ZHANG XM, YAN K, CHEN MH, et al.The contrast-enhanced Ultra-sonography patterns and the diagnostic values of local treatment of primaryhepatic carcinoma and hepatic matastasis[J/CD].Chin J Med Ultra-sound (Electronic Edition) , 2009, 6 (1) :14-18. (in Chinese) 张秀梅, 严昆, 陈敏华, 等.原发性肝癌及肝转移癌局部治疗后超声造影表现类型及其诊断价值[J/CD].中华医学超声杂志 (电子版) , 2009, 6 (1) :14-18. [8]WU W, CHEN MH, YIN SS, et al.The role of contrast-enhancedsonography of focal liver lesions before percutaneous biopsy[J].AJRAm J Roentgenol, 2006, 187 (3) :752-761. [9]LUO BM, ZHI H, WEN YL, et al.Importance of immediate contrast-enhanced sonography to evaluate therapeutic responses of ablation treat-ment for malignant liver tumors[J].Chin J Ultrasound Med, 2006, 22 (7) :535-537. (in Chinese) 罗葆明, 智慧, 文艳玲, 等.肝脏恶性肿瘤局部消融治疗后即刻超声造影必要性探讨[J].中国超声医学杂志, 2006, 22 (7) :535-537. [10]DROMAIN C, de BAERE T, ELIAS D, et al.Hepatic tumors treatedwith percutaneous radio-frequency ablation:CT and MR imaging follow-up[J].Radiology, 2002, 223 (1) :255-262. [11]SOLBIATI L, IERACE T, TONOLINI M, et al.Guidance and mo-nitoring of radiofrequency liver tumor ablation with contrast-en-hanced ultrasound[J].Eurn J Radiol, 2004, 51 (Suppl) :s19-s23. [12]LIM HK, CHOL D, LEE WJ, et al.Hepatocellular carcinoma trea-ted with percutaneous radio-frequency ablation:evaluation withfollow-up multiphase helical CT[J].Radiology, 2001, 221 (2) :447-454. [13]WU W, CHEN MH, DAI Y, et al.Enhancement patterns of con-trast-enhanced ultrasound of regenerative nodules in liver cirrhosis[J].Chin J Ultrasonogr, 2006, 15 (4) :293-296. (in Chinese) 吴薇, 陈敏华, 戴莹, 等.肝硬化增生结节的超声造影模式及诊断价值[J].中华超声影像学杂志, 2006, 15 (4) :293-296. [14]CHEN MH, DAI Y, YAN K, et al.Enhancement Patterns and di-agnostic criteria of Contrast-enhanced Ultrasound of Hepatocellularcarcinoma[J].Chin J Med, 2006, 41 (4) :32-34. (in Chinese) 陈敏华, 戴莹, 严昆.肝细胞肝癌超声造影增强模式及诊断标准探讨[J].中国医刊, 2006, 41 (4) :32-34. [15]HOHMANN J, ALBRECHT T, HOFFMANN CW, et al.Ultrasono-graphic detection of focal liver lesions:increased sensitivity and spe-cificity with microbubble contrast agents[J].Eur J Radiol, 2003, 46 (2) :147-159. [16]SOLBIATI L, IERACE T, TONOLINI M, et al.Guidance and con-trol of percutaneous treatments with contrast-enhanced ultrasound[J].Eur Radiol, 2003, 13 (Suppl 3) :n87-n90. [17]OLDENBURG A, HOHMANN J, FOERT E, et al.Detection of he-patic metastases with low MI real time contrast enhanced sonographyand SonoVue[J].Ultrashall Med, 2005, 26 (4) :277-284. [18]EDWARD L, SENTHIL K, SHAHID AK, et al.Contrast-enhanced 3Dultrasound in the radiofrequency ablation of liver tumors[J].World JGastroenterol, 2009, 15 (3) :289-299. [19]LI K, SU ZZ, ZHENG RQ, et al.Virtual navigation assisted 3-Dcontrast-enhanced ultrasound in evaluating ablative margin after ra-diofrequency ablation[J].Chin J Ultrasonogr, 2011, 20 (8) :672-675. (in Chinese) 李凯, 苏中振, 郑荣琴, 等.虚拟导航三维超声造影评估肝癌消融安全边界的初步研究[J].中华超声影像学杂志, 2011, 20 (8) :672-675.
计量
- 文章访问数: 3447
- HTML全文浏览量: 34
- PDF下载量: 743
- 被引次数: 0