摘要:
Objective To explore the clinical significance of dynamic 3-dimensional contrast-enhanced ultrasound (D-3D-CEUS) in assessing the efficacy of microwave ablation (MWA) therapy of hepatocellular carcinoma (HCC). Methods Two hundred and fifty-one HCC lesions from 185 patients undergoing ultrasound-guided percutaneous MWA were studied by D-3D-CEUS and contrast-enhanced computed tomography(CECT) one month after ablation.Imaging results from two imaging modalities were evaluated independently to determine whether the treated lesions were ablated incompletely (residual lesion) or completely.The final diagnosis standard was biopsy pathology or clinical follow-up results.Results One hundred and eighty-five patients were successfully ablated completely.There was no serious complication observed.The final diagnosis standard identified 93.2% (234/251) of ablated lesions as complete ablation and 6.8% (17/251) as incomplete. With the final diagnosis as the reference standard,the sensitivity, specificity,positive predictive value,negative predictive value,and accuracy of D-3D-CEUS and CECT were 82.4% (14/17) vs 88.2% (15/17),98.3% (230/234) vs 97.4% (228/234),77.8% (14/18) vs 71.4%(15/21),98.7% (230/233) vs 99.1% (228/230),97.2% (244/251) vs 96.8% (243/251),respectively. The difference between the D-3D-CEUS and CECT was not statistically significant(χ2=0.14,P =1.00).The consistency analysis showed that D-3D-CEUS and CECT were highly consistent with the final diagnosis standard (Kappa=0.81,P =0.00).Conclusions D-3D-CEUS imaging can be used for assessment of HCC MWA and be used as a useful supplement for CECT.%目的 探讨动态三维超声造影(dynamic three-dimensional contrast-enhanced ultrasound, D-3D-CEUS)在肝细胞癌(hepatocellular carcinoma,HCC)经皮微波消融(microwave ablation, MWA)后残癌诊断中的应用价值.方法 对185例经病理证实的HCC患者(共251个肿瘤结节)行超声引导下经皮 MWA 治疗.治疗结束1个月后,所有患者分别行 D-3D-CEUS 及增强 CT(contrast-enhanced computed tomography,CECT)检查判定局部疗效,比较两种检查方法对 HCC MWA 后局部残癌的诊断能力.最终诊断标准为穿刺活检病理及临床随访结果.结果 185例患者均成功完成经皮MWA,未出现严重并发症.全部251个结节,经最终诊断标准评估为93.2% (234/251)消融完全, 6.8%(17/251)局部残留.以最终诊断为标准,D-3D-CEUS及CECT 诊断MWA后癌灶残留的敏感性分别为82.4%(14/17)、88.2%(15/17),特异性分别为98.3%(230/234)、97.4%(228/234),阳性预测值分别为77.8%(14/18)、71.4%(15/21),阴性预测值分别为98.7%(230/233)、99.1%(228/230),准确性分别为97.2%(244/251)、96.8%(243/251).两种检查方法的诊断结果比较,差异无统计学意义(χ2=0.14,P = 1.00).两种检查方法诊断结果之间具有高度一致性(Kappa= 0.81,P =0.00).结论 D-3D-CEUS可以用于评估 HCC MWA后疗效,可以作为CECT的有益补充.