Integrating contrast-enhanced sonography in the follow-up algorithm of hepatocellular carcinoma treated with radiofrequency ablation: single cancer center experience
Integrating contrast-enhanced sonography in the follow-up algorithm of hepatocellular carcinoma treated with radiofrequency ablation: single cancer center experience
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DOI：
10.1177/0284185114521108
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发表时间：
2015-02-01
期刊：
影响因子：
1.3
通讯作者：
Petrillo, Antonella
中科院分区：
文献类型：
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作者：
Catalano, Orlando;Izzo, Francesco;Petrillo, Antonella
背景资料：经皮消融治疗的肝细胞癌（HCC）患者需要密切随访，以早期发现和治疗肿瘤复发。目的：说明我们使用超声造影（CEUS）作为与计算机断层扫描（CT）交替的随访工具的单中心前瞻性经验。材料和方法：在7年的时间里，588例1 - 3例HCC患者接受了射频消融（单独或联合乙醇注射）治疗。对1个月CT扫描时肿瘤完全消融的患者进行连续随访，每3个月进行一次CEUS（每叶注射一次微泡）和CT，持续2年。在少数情况下，使用磁共振成像（MRI）代替或补充CT。考虑了以下复发模式：A，病灶内组织增强; B，病灶粘附组织增强; C，治疗结节同一肝段内组织增强; D，不同肝段内组织增强。CEUS阳性的患者进行了验证性CT/MRI（标准参考）。结果：中位随访时间为19个月。复发221例。A型复发3例（CEUS检出2例，CT检出1例），B型复发86例（CEUS检出44例，CT检出42例），C型复发70例（CEUS检出32例，CT检出38例），D型复发62例（CEUS检出23例，CT检出39例）。101例CEUS阳性患者中，CT检出16例额外结节。结论：对肝癌患者行消融术后进行CEUS随访是可行的。由于72%的复发发生在坏死结节的同一节段，因此CEUS被证明是有效的，尽管与CT和MRI相比，在动脉期对整个肝脏的可视化较小。在患者随访中纳入CEUS可能会减少CT和MRI检查的数量。
Background: Hepatocellular carcinoma (HCC) patients treated with percutaneous ablation require close follow-up for early detecting and treating tumor recurrence.Purpose: To illustrate our single-center prospective experience on using contrast-enhanced ultrasound (CEUS) as a follow-up tool alternated with computed tomography (CT).Material and Methods: In a 7-year period 588 patients with one to three HCCs were treated with radiofrequency ablation (alone or combined with ethanol injection). Patients with completely ablated tumors at 1-month CT scan were followed up serially, using alternated CEUS (one microbubbles injection per lobe) and CTevery 3 months for 2 years. In few cases magnetic resonance imaging (MRI) was employed instead of or in addition to CT. The following patterns of recurrence were considered: A, enhancing tissue within the lesion; B, enhancing tissue adherent to the lesion; C, enhancing tissue within the same liver segment of the treated nodule; and D, enhancing tissue within a different segment. Patients with positive CEUS underwent confirmatory CT/MRI (standard reference).Results: Median follow-up was 19 months. There were 221 recurrences. Three pattern A recurrences (2 detected by CEUS and 1 by CT), 86 pattern B recurrences (44 detected by CEUS and 42 by CT), 70 pattern C recurrences (32 detected by CEUS and 38 by CT), and 62 pattern D recurrences (23 detected by CEUS and 39 by CT). CT detected additional nodules in 16/101 patients with positive CEUS.Conclusion: CEUS follow-up of HCC patients after ablation is feasible. Since 72% recurrences develop in the same segment of the necrotic nodule, CEUS proves to be effective despite the minor visualization of the entire liver during the arterial phase when compared to CT and MRI. Including CEUS in patient follow-up may reduce the number of CT and MRI examinations.