目的：探讨声脉冲辐射力成像技术（Acoustic radiation force impulse，ARFI）对评估肝细胞癌（Hepathocellular carcinoma，HCC）射频消融（Radiofrequency ablation，RFA）术后24 h疗效的临床价值。材料与方法：2015年12月—2016年6月我院行RFA治疗22例患者共23个HCC病灶纳入本研究。分别于RFA术前1 d、术后24 h及术后1月行常规超声、超声造影（Contrast enhanced ultrasound，CEUS）及ARFI检查，观察消融灶硬度变化，对比3种方法对消融灶范围的显示情况。结果：23个消融灶RFA术后24 h及术后1月ARFI弹性图均表现为黑暗色（质硬），较术前质硬，边界清晰，范围增大。术后24 h消融灶内部及边缘ARFI弹性值较术前显著升高，差异有统计学意义（P<0.01，P＜0.01），与术后1月比较无统计学差异（P=0.46，P=0.50）；术后24 h及术后1月消融灶周边肝实质ARFI弹性值较术前无统计学差异（P=0.74，P=0.92）。术后24 h及术后1月ARFI与CEUS显示面积的大小比较均无统计学差异（P=0.88，P=0.49），与常规超声比较差异有统计学意义（P<0.01，P＜0.01）。结论：ARFI能够清晰显示RFA术后24 h消融灶范围，与CEUS结果相似，优于常规超声，并能定量反应消融灶硬度变化情况。
Abstract
Objective: To explore the role of acoustic radiation force impulse(ARFI) in assessing the therapeutic response 24 h after radiofrequency ablation(RFA) in hepatocellular carcinoma(HCC). Materials and Methods: A total of 22 patients with 23 HCC lesions who received RFA in our hospital from December 2015 to June 2016 were enrolled. All the patients were examined with base-line ultrasound(BUS), contrast enhanced ultrasound(CEUS) and ARFI one day before RFA, 24 h after RFA and one month after RFA, respectively. The change of ablation area stiffness was measured by virtual touch tissue quantification(VTQ). The ablation lesion area was measured by BUS, virtual touch tissue imaging(VTI) and CEUS. The area of ablation lesions measured by the three methods were compared. Results: Twenty-three tumors showed low-echo on VTI 24 h after RFA and one month after RFA, which were easily detected. The extent of ablation area was enlarged compared to preoperative. After 24 h of RFA procedure, the VTQ value of the internal and marginal ablation lesion area was higher than preoperative(all P<0.01), respectively, but there was no statistically significant difference for one month after RFA(P=0.46, P=0.50). The value of VTQ in peripheral parts of the primary tumor did not change significantly at one week before RFA, 24 h after RFA or one month after RFA(all P>0.05). The ablation lesion areas 24 h after RFA and one month after RFA measured by VTI and CEUS were larger than that by BUS(all P<0.01). However, there was no statistically significant difference of ablation lesion area between VTI and CEUS(P=0.88, P=0.49). Conclusion: ARFI, as a non-invasive, effective and feasible method, can accurately measure the ablation area and provide the change of lesion stiffness immediately after RFA of HCC.
关键词
癌 /
肝细胞；导管消融术；超声检查 /
多普勒 /
彩色
Key words
Carcinoma, hepatocellular /
Catheter ablation /
Ultrasonography, Doppler, color
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基金
国家自然科学基金资助项目（编号81060202，81260222）；广西卫生厅重点课题（编号桂卫重2011089）。
