目的 评价影像融合超声造影技术对常规超声甚至超声造影检出困难的肝癌病灶的诊断价值和引导肝癌介入治疗的疗效分析.方法 对常规超声中显像不佳而其他影像学检查明确有肝癌病灶的213例患者共计265个病灶,先行超声造影检查,可显示的病灶在超声造影引导下行射频消融术(CEUS组),不显示的病灶改用影像融合超声造影技术定位病灶并引导介入治疗(RVS+ CEUS组).评估影像融合超声造影对检出肝癌病灶、引导并监测介入治疗以及术后即时评价疗效的价值.结果 常规超声显示不清的所有265个病灶中,超声造影显示率为65.7％(174/265).超声造影不显示的91个病灶,影像融合超声造影显示率90.1％ (82/91),两组病灶检出率比较差异具有统计学意义(x2=18.85,P＜0.0001).射频消融术后1个月CEUS组完全消融率为86.2％ (150/174),RVS+ CEUS组完全消融率为91.5％(75/82),两者差异有统计学意义(P＜0.05).1年内RVS+ CEUS组和CEUS组的病灶进展率分别为10.4％、13.9％.结论 影像融合超声造影对检出及引导常规超声甚至超声造影不显示的病灶有很大价值,可有效避免偏心性消融,提高肝癌射频消融疗效.%Objective To evaluate the feasibility and therapeutic efficacy of real-time virtual navigation system (RVS) combined with contrast-enhanced ultrasonography (CEUS) for hepatocellular carcinoma undetectable by conventional ultrasound and CEUS.Methods A total of 213 patients with 265 lesions (undetectable on conventional ultrasound but detectable by other imaging examinations) were enrolled in this study.CEUS was performed,and lesions which were detected with CEUS were given CEUS guided radio-frequency ablation (RFA) (CEUS group).RVS combined with CEUS was performed to locate the rest lesions and guide RFA (RVS + CEUS group).Diagnostic value and therapeutic efficacy of RVS + CEUS were assessed.Results In 256 lesions,174 (65.7％) could be detected with CEUS,and among the rest 91 lesions,82 (90.1％) lesions could be detected by RVS combined with CEUS.The technique effectiveness rate of RVS + CEUS was significantly higher than that of CEUS (x2 =18.85,P ＜0.0001).Complete ablation rate after one month in RVS+ CEUS group was 9t.5％ (75/82),which was significantly higher than that in CEUS group [86.2％ (150/174),P ＜0.05].Local progression in one year in CEUS group and RVS + CEUS group were 13.4％ and 10.9％,respectively.Conclusions RVS combined with CEUS is feasible for hepatocellular carcinoma undetectable by conventional ultrasonography and CEUS,and the therapeutic efficacy of RVS + CEUS guided RFA is satisfactory.
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