Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers
Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers
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DOI：
10.1259/bjr.20160379
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发表时间：
2016-01-01
影响因子：
2.6
通讯作者：
Zhang, Kun
中科院分区：
文献类型：
--
作者：
Bo, Xiao-Wan;Xu, Hui-Xiong;Zhang, Kun
目的：探讨超声造影（CEUS）和CECT/CEMRI融合成像在经皮超声引导射频消融（RFA）治疗肝癌前的有效性。方法：2013年3月至2015年10月，连续纳入45例患者的70个肝脏病灶，所有病灶在纳入研究前均在CEMRI/CECT上识别。在同一个疗程中，使用常规超声、超声-CECT/CEMRI和CEUS以及CECT/CEMRI融合成像进行经皮RFA的计划超声。记录超声和融合成像上明显病灶的数目。根据融合成像结果行RFA。结果：70个病灶中，常规超声显示明显病灶25个（35.7%），不明显病灶45个（64.3%）。超声-CECT/CEMRI融合成像检测到额外的24个病灶，从而将明显病灶的数量增加到49个（70.0%）（70.0% vs 35.7%;与常规超声相比p < 0.001）。使用CEUS和CECT/CEMRI融合成像，明显病变的数量进一步增加至67个（95.7%，67/70）（95.7% vs 70.0%，95.7% vs 35.7%;与超声和超声-CECT/CEMRI融合成像相比，p均<0.001）。在CEUS和CECT/CEMRI融合成像的辅助下，术者进行RFA的置信水平在靶病变可视化方面显著提高（p = 0.001）。1个月后复查CECT/CEMRI，完全缓解率为97.0%（64/66）。结论：CEUS与CECT/CEMRI融合可提高常规超声对不明显病变的显示率。知识的进步：CEUS和CECT/CEMRI融合成像在病灶可视化方面优于常规超声和超声-CECT/CEMRI融合成像，提高了操作者的信心，因此应推荐作为超声引导经皮射频消融治疗肝癌的常规方法。
Objective: To investigate the usefulness of fusion imaging of contrast-enhanced ultrasound (CEUS) and CECT/CEMRI before percutaneous ultrasound-guided radiofre-quency ablation (RFA) for liver cancers.Methods: 45 consecutive patients with 70 liver lesions were included between March 2013 and October 2015, and all the lesions were identified on CEMRI/CECT prior to inclusion in the study. Planning ultrasound for percutaneous RFA was performed using conventional ultrasound, ultrasound-CECT/CEMRI and CEUS and CECT/CEMRI fusion imaging during the same session. The numbers of the conspicuous lesions on ultrasound and fusion imaging were recorded. RFA was performed according to the results of fusion imaging. Complete response (CR) rate was calculated and the complications were recorded.Results: On conventional ultrasound, 25 (35.7%) of the 70 lesions were conspicuous, whereas 45 (64.3%) were inconspicuous. Ultrasound-CECT/CEMRI fusion imaging detected additional 24 lesions thus increased the number of the conspicuous lesions to 49 (70.0%) (70.0% vs 35.7%; p < 0.001 in comparison with conventional ultrasound). With the use of CEUS and CECT/CEMRI fusion imaging, the number of the conspicuous lesions further increased to 67 (95.7%, 67/70) (95.7% vs 70.0%, 95.7% vs 35.7%; both p, 0.001 in comparison with ultrasound and ultrasound-CECT/CEMRI fusion imaging, respectively). With the assistance of CEUS and CECT/CEMRI fusion imaging, the confidence level of the operator for performing RFA improved significantly with regard to visualization of the target lesions (p = 0.001). The CR rate for RFA was 97.0% (64/66) in accordance to the CECT/CEMRI results 1 month later. No procedure-related deaths and major complications occurred during and after RFA.Conclusion: Fusion of CEUS and CECT/CEMRI improves the visualization of those inconspicuous lesions on conventional ultrasound. It also facilitates improvement in the RFA operators' confidence and CR of RFA.Advances in knowledge: CEUS and CECT/CEMRI fusion imaging is better than both conventional ultrasound and ultrasound-CECT/CEMRI fusion imaging for lesion visualization and improves the operator confidence, thus it should be recommended to be used as a routine in ultrasound-guided percutaneous RFA procedures for liver cancer.