实时动态三维超声造影评价索拉非尼靶向治疗中晚期肝癌早期疗效的观察性研究

摘要

目的 探讨实时动态三维超声造影(3D-CEUS)在评价索拉非尼靶向治疗中晚期肝癌早期疗效中的应用价值.方法 选取2015年7月至2017年7月于新疆医科大学附属中医医院住院经临床确诊的中晚期原发性肝癌患者60例作为研究对象,均给予索拉非尼靶向治疗.治疗前首先进行肝脏增强CT检查,确定目标病灶,然后行实时动态3D-CEUS检查.比较治疗前动态3D-CEUS与2D-CEUS对患者动脉期肿瘤滋养血管的显示率及显示质量评分;比较治疗后动态3D-CEUS与2D-CEUS对肿瘤灭活诊断的敏感度、特异度和诊断正确率.结果 本研究60例原发性肝癌患者共计60个肿瘤病灶,治疗前,2D-CEUS检查观察到40个病灶的动脉期肿瘤滋养血管,显示率为66.7％ (40/60),动态3D-CEUS检查观察到60个病灶的动脉期肿瘤滋养血管,显示率为100.0％ (60/60),二者显示率比较差异有统计学意义(x2=5.459,P=0.027).治疗前,动态3D-CEUS对动脉期肿瘤滋养血管显示质量评分1分5例、2分22例、3分33例,而2D-CEUS对动脉期肿瘤滋养血管显示质量评分1分29例、2分24例、3分7例,二者差异有统计学意义(P=0.023).治疗后,动态3D-CEUS与2D-CEUS对肿瘤灭活诊断的敏感度、特异度以及诊断正确率差异均无统计学意义(均P＞0.05).结论 2D-CEUS与实时动态3D-CEUS在评价索拉非尼靶向治疗中晚期肝癌早期疗效中均具有较高的应用价值,但是在动脉期肿瘤滋养血管显示质量评价方面,实时动态3D-CEUS效果更佳.%Objective To evaluate the value of real-time three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in evaluating the effectiveness of sorafenib targeted therapy for middle and advanced liver carcinoma.Methods Sixty middle and advanced liver cancer patients who had sorafenib targeted therapy from July 2015 to July 2017 in Chinese Medicine Hospital Affiliated to Xinjiang Medical University were enrolled.Contrast-enhanced CT,two-dimensional contrast-enhanced ultrasonography(3D-CEUS) and 3 D-CEUS were performed before and after therapy.Display rate and display quality score of tumor nourishing vessels,sensitivity,specificity and accuracy of tumor inactivation diagnosis were analyzed between 3D-CEUS and 2D-CEUS.Results In 60 tumor lesions,the display rate of arterial phase tumor nourishing vessels of 2D-CEUS was 66.7％ (40/60),and the display rate of 3 D-CEUS was 100.0％ (60/60),which was significantly higher than that of 2 D-CEUS (x2 =5.459,P =0.027).Display quality score of arterial phase tumor nourishing vessels also showed a significant difference between 3D-CEUS and 2D-CEUS[3D-CEUS:5 cases of 1 point,22 cases of 2 points,33 cases of 3 points;2D-CEUS:29 cases of 1 point,24 cases of 2 points,7 cases of 3 points] (P =0.023).After treatment,sensitivity,specificity and accuracy of tumor inactivation diagnosis showed no significant differences between 3D-CEUS and 2D-CEUS (P ＞0.05).Conclusion Both 2D-CEUS and 3D-CEUS have high values in evaluating the effectiveness of sorafenib targeted therapy for middle and advanced liver cancer;3D-CEUS is more effective in displaying tumor nourishing vessels.