Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.
Improvement of ablative margins by the intraoperative use of CEUS-CT/MR image fusion in hepatocellular carcinoma.
复制标题
术中使用CEUS-CT/MR图像融合治疗肝细胞癌改善消融切缘
DOI：
10.1186/s12885-016-2306-1
复制
发表时间：
2016-04-18
期刊：
影响因子：
3.8
通讯作者：
Zheng RQ
中科院分区：
文献类型：
--
作者：
Li K;Su ZZ;Xu EJ;Ju JX;Meng XC;Zheng RQ
BackgroundTo评估是否术中使用对比增强超声（CEUS）-CT/MR图像融合可以准确地评估消融边缘（AM），并指导补充消融，以改善AM后，肝细胞癌（HCC）ablation.Methods98例患者126 HCCs指定接受热消融治疗在这项前瞻性研究。术中进行CEUS-CT/MR图像融合，以评估消融区域是否覆盖5 mm AM。如果可能，在AM不足的部位进行补充消融。记录CEUS图像质量、CEUS-CT/MR图像融合所用时间及图像融合成功率。随访期间观察到局部肿瘤进展（LTP）。结果图像融合成功率为96.2%（126/131），图像融合时间为4.9 ± 2.0（3-13）min，CEUS图像质量良好者占36.1%（53/147），中等者占63.9%（94/147）。通过补充消融，21.8%（12/55）的AM不足的病变变为AM充足。随访期间，AM不足的病变中有5例LTP，AM充足的病变中有1例LTP。多因素分析显示AM是LTP的唯一独立危险因素（危险比，9.167; 95%可信区间，1.070-78.571;p= 0.043）。结论CEUS-CT/MR图像融合技术在术中应用是可行的，可作为评估AM的准确方法，并可指导辅助消融以降低不充分的AM。
BackgroundTo assess whether intraoperative use of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion can accurately evaluate ablative margin (AM) and guide supplementary ablation to improve AM after hepatocellular carcinoma (HCC) ablation.MethodsNinety-eight patients with 126 HCCs designated to undergo thermal ablation treatment were enrolled in this prospective study. CEUS-CT/MR image fusion was performed intraoperatively to evaluate whether 5-mm AM was covered by the ablative area. If possible, supplementary ablation was applied at the site of inadequate AM. The CEUS image quality, the time used for CEUS-CT/MR image fusion and the success rate of image fusion were recorded. Local tumor progression (LTP) was observed during follow-up. Clinical factors including AM were examined to identify risk factors for LTP.ResultsThe success rate of image fusion was 96.2 % (126/131), and the duration required for image fusion was 4.9 ± 2.0 (3–13) min. The CEUS image quality was good in 36.1 % (53/147) and medium in 63.9 % (94/147) of the cases. By supplementary ablation, 21.8 % (12/55) of lesions with inadequate AMs became adequate AMs. During follow-up, there were 5 LTPs in lesions with inadequate AMs and 1 LTP in lesions with adequate AMs. Multivariate analysis showed that AM was the only independent risk factor for LTP (hazard ratio, 9.167; 95 % confidence interval, 1.070–78.571;p= 0.043).ConclusionCEUS-CT/MR image fusion is feasible for intraoperative use and can serve as an accurate method to evaluate AMs and guide supplementary ablation to lower inadequate AMs.