虚拟导航超声造影指导常规超声不能检出肝脏小占位病灶微波消融术的精准定位研究

摘要

Objective To evaluate the feasibility and accuracy of virtual navigation contrast enhanced sonography in accurately location of small liver tumors which cannot be detected by conventional sonography during microwave ablation therapy. Methods Twenty-three patients with 28 small liver tumors,which could not be detected by conventional sonography but CT/MRI,underwent microwave ablation with virtual navigation contrast enhanced sonography from January 2015 to March 2017 at Nanfang Hospital. After fusion of images from both sonography and CT/MRI,small liver tumors were ablated under the real-time monitoring of navigated sonography. Virtual navigation contrast enhanced sonography was also utilized to evaluate the efficacy of ablation after the ablation.All patients underwent CT/MRI examination at one month post-ablation to evaluate the efficacy of ablation. Results Virtual navigation system successfully provided image fusion for all patients and all lesions(image fusion efficacy was 100%). All patients underwent virtual navigation contrast enhanced sonography monitored microwave ablation.Only one patient received extra ablation since a small proportion of residual tumor checked after the initial ablation. No severe complications occurred in the present study. One-month after ablation,all patients showed complete ablation by further CT/MRI examinations.Conclusion Virtual navigation sonography can precisely target small liver tumors which are undetected by conventional sonography.Evaluation of lesions and ablation efficacy can be performed with the help of virtual navigation contrast enhanced sonography during the ablation period,which have shown satisfactory clinical efficacy.%目的 探讨虚拟导航超声造影在常规超声不能检出的肝脏小占位病灶中进行微波消融治疗的精准定位中的应用价值.方法 选取南方医院2015年1月至2017年3月期间的23例患者共28个常规超声不能检出而由CT/MRI提示的肝脏小占位,借助实时虚拟导航超声造影系统对其进行微波消融治疗.融合了超声和CT/MRI图像后,在实时超声监控下对病灶进行微波消融治疗,并于术后使用虚拟导航超声造影评价消融效果.术后1个月对所有患者进行CT/MRI检查评价微波消融的疗效.结果 所有病灶经过虚拟导航系统均可达到超声与CT/MRI图像融合.所有病例在虚拟导航超声造影系统的监测下进行了微波消融治疗,只有1例患者消融后发现少许残留,需即时再次行消融治疗.本组患者均无发生严重并发症.术后1个月的CT/MRI检查显示所有患者均达到完全消融.结论 虚拟导航超声系统可以精准定位常规超声不能检出的肝脏小占位,并利用虚拟导航超声造影在围手术期评估病灶性质和消融疗效,具有良好的临床应用价值.