超声造影对射频消融阻断肝癌血供的评价及应用价值

目的探讨超声造影（CEUS）评价经皮射频消融（RFA）阻断肝癌血供的效果以及指导RFA治疗的应用价值。方法选择2006年1月至2007年6月北京大学肿瘤医院就诊的71例肝癌患者共75个病灶,均为富血供肝癌,均因不宜行动脉栓塞化疗术（TACE）或TACE疗效不佳拟行RFA。所有患者均经超声引导下穿刺活检病理证实。71例患者随机分为经皮消融阻断荷瘤血管（PAA）＋褂1A组与单纯RFA组2组。PAA＋RFA组38例患者共39个病灶,首先行CEuS确认肿瘤荷瘤血管及浸润范围,并在彩色多普勒超声引导下进行PAA;即刻行CEUS评估肿瘤区域灌注及荷瘤血管阻断程度,并指导沿肿瘤外周区域及血供区域行肿瘤整体消融。单纯RFA组33例患者共36个病灶,于常规超声引导下进行消融,按计算方案及定位模式治疗,先消融肿瘤深部或临近其他脏器区域。治疗后1、3、6个月对2组患者行增强CT评价疗效。应用t检验比较2组患者消融病灶个数差异,应用矿检验比较2组患者治疗后1、6个月肿瘤病灶灭活率差异。结果PAA＋RFA组患者PAA后即刻CEUS显示31个病灶（79．5％,31／39）瘤内灌注缺失范围超过70％,其中13个病灶（33．3％,13／39）显示肿瘤整体灌注缺失呈边界清晰规整的“日全食”征;8个病灶（20．5％,8／39）灌注缺失范围达40％～70％。PAA＋RFA组38例患者共39个病灶PAA前彩色多普勒超声检查示42支主荷瘤血管良好显示;PAA后即刻彩色多普勒血流成像显示35支（83．3％,35／42）荷瘤血管被阻断,3支（7．1％,3／42）血管血流信号明显减少。PAA＋RFA组每个肿瘤平均消融（3．18±1．42）个球灶,较单纯RFA组每个肿瘤平均消融（4．32±1．56）个球灶少,且差异有统计学意义（t=-2．524,P=0．015）。治疗后1个月PAA＋RFA组肿瘤病灶灭活率为92．3％（36／39）,高于单纯RFA组的66．7％（24／35）,且差异有统计学意义（x^2=8．264,P=0．001）。结论CEUS证实PAA可成功阻断或减少荷瘤血供,增大射频凝固坏死区,有效降低富血供大肿瘤RFA复发率;重视CEUS指导PAA下RFA治疗,可减少消融病灶数目,有较高的应用价值。     

The role of CEUS in the characterization of hepatocellular nodules detected during the US surveillance program--current practices in Europe

The basic pathological feature for the differential diagnosis between hepatocellular carcinoma (HCC) and non-malignant hepatocellular nodules in cirrhotic patients detected during ultrasound (US) is the vascular supply to the nodule. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered reference imaging techniques for depicting hepatocellular nodule vascularity in the noninvasive diagnosis of HCC. Contrast-enhanced US (CEUS) improves the diagnostic performance of unenhanced US in the diagnosis of HCC, giving an overall diagnostic accuracy that is similar to that of CT, even for nodules smaller than 2 cm. An additional diagnostic feature of CEUS relative to CT is the possibility to visualize contrast wash-in to hepatic nodules during the arterial phase and contrast washout during the portal venous and late phases. Sensitivity for the diagnosis of HCC with combined assessment of CEUS and CT is higher than for separate assessments of CEUS and CT due to the reduction of false-negative findings. CEUS represents a competitive imaging method from an economic point of view, and is an effective imaging tool for assessing the therapeutic outcome after surgery, ablation therapy, and transarterial chemoembolization (TACE).     

超声造影与增强CT对肝硬化背景下肝内小结节样病灶的诊断比较和误诊分析

目的 比较超声造影(CEUS)与增强螺旋CT(CECT)对肝硬化背景下≤3 cm结节样病灶的诊断效能.方法 对74例84个肝硬化合并肝内小结节样病灶患者行CEUS及CECT检查,评估2种检查方法的诊断效能并分析其误诊原因.结果 CEUS对小结节样病灶的敏感性、特异性、准确性分别为88.6%、87.5%、88.1%,CECT对应值分别为79.5%、95.0%、86.9%(P>0.05).2种检查方法均正确诊断68个结节(33个HCC,35个良性结节),CEUS误诊10个(5个HCC,5个良性结节),CECT误诊10个(8个HCC,2个良性结节),漏诊1个,两者均误诊的有5个结节(3个HCC,2个良性结节).结论 CEUS对肝硬化背景下小结节样病灶的定性诊断价值与CECT相似,对于误诊病例,应予注意.     

Computer-Aided Color Parameter Imaging of Contrast-Enhanced Ultrasound Evaluates Hepatocellular Carcinoma Hemodynamic Features and Predicts Radiofrequency Ablation Outcome

Computer-aided color parameter imaging (CPI) is a novel technique for contrast-enhanced ultrasound (CEUS) that can highlight hemodynamic features of focal lesions. The purpose of the study was to investigate the role of CPI in evaluation of hepatocellular carcinoma (HCC) hemodynamic features and prognosis after radiofrequency ablation (RFA). One hundred twenty-one patients with HCC underwent CEUS with CPI analysis before RFA. Eighty-nine patients had pathologically proven well- to moderately differentiated HCC (WM-HCC), and 32 patients had poorly differentiated or undifferentiated HCC (PU-HCC). Perfusion features of CEUS and contrast-enhanced computed tomography/magnetic resonance imaging were compared with CPI parameters for WM-HCC and PU-HCC. The results indicated that 67.4% of WM-HCC had a centrifugal perfusion CPI pattern, whereas 84.4% of PU-HCC tumors had a centripetal pattern (p < 0.001, odds ratio = 11.2). The specificity, sensitivity and accuracy of the CPI perfusion pattern regarding HCC pathological grade were higher than those with routine CEUS (84.4% vs. 9.4%, p < 0.001; 67.4% vs. 3.4%, p < 0.001; 71.9% vs. 5.0%, p < 0.001). Moreover, multivariable analysis revealed that the CPI perfusion pattern was an independent risk factor for progression-free survival post-RFA (centripetal group: 28.3 ± 4.1 mo vs. centrifugal group: 45.8 ± 4.4 mo, p = 0.002). A novel CPI technique for CEUS could non-invasively provide valuable hemodynamic information and predict prognosis for HCC patients treated by RFA.     

The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy.

OBJECTIVE: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA). METHODS: One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients. RESULTS: In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively). CONCLUSIONS: Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.     

超声造影和增强磁共振在不同大小肝癌肝动脉化疗栓塞术后的疗效评价

目的:探究超声造影(contrast-enhanced ultrasonography,CEUS)、增强磁共振(contrast-enhanced MRI,CE-MRI)在不同大小原发性肝癌TACE(transcatheter arterial chemoembolization)术后疗效评估的价值与意义,以期为原发性肝癌(hepatocellular carcinoma,HCC)患者在TACE后复查中影像学方法的选择提供依据。方法:本研究收集2018年1月至2018年12月在徐州医科大学附属医院介入放射科接受TACE治疗的33例HCC患者(共83个病灶),TACE术后1个月1周内依次行CEUS,CE-MRI,数字减影血管造影(digital subtraction angiography,DSA)检查,如发现病灶再次TACE,以DSA结果为金标准分别对三者的检查结果进行Kappa检验以及Mc Nemar检验,比较三者其对TACE术后肿瘤残存、复发病灶检出的敏感性,特异性,诊断准确性及检查结果的一致性。结果:CEUS和CEM R I的诊断准确性分别为91.6%和100%,CE-MRI的诊断准确性优于CEUS,差异有统计学意义;但CEUS与CE-MRI检查一致性较强(Kappa=0.794);CE-MRI敏感度、特异度比均为100%,CEUS的分别为88.9%,100%;在>3 cm的病灶中,CEUS与CE-MRI的一致性强(Kappa=0.891),CEUS的准确性、敏感度及特异度分别为96.1%,95.0%和100%。在≤3 cm的病灶中,CEUS与CE-MRI的一致性一般(Kappa=0.669),CEUS的准确性、敏感度及特异度分别为84.4%,78.3%和100%。结论:CEUS,CE-MRI与金标准DSA对于原发性肝癌TACE治疗后的诊断一致性相当,CEUS可作为原发性肝癌TACE短期复查的替代影像学检查方法。     

Hepatocellular nodules in liver cirrhosis: contrast-enhanced ultrasound

Contrast-enhanced ultrasound (CEUS) using microbubble contrast agents has expanded the role of US in the diagnosis of liver nodules in high risk patients for hepatocellular carcinoma (HCC). HCC is typically characterized by arterial hypervascularity and later washout (negative enhancement). Washout in the portal phase is often not obvious until late (>90 s). Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial and portal venous phases. However, there are occasional cases with overlap of imaging features between benign and malignant nodules, including hypovascular HCC and hypervascular HCC without washout. CEUS is helpful to characterize potential mimickers of HCC on imaging such as nontumorous arterioportal shunt or hemangioma. CEUS is also useful for a guidance of percutaneous local therapy of HCC and post-procedure monitoring of therapeutic response. CEUS can be effectively used in the diagnostic algorithm of small (1–2 cm) newly detected nodules during HCC surveillance.     

Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC

INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most common cancer-related causes of death worldwide and there is a clear need for further treatment options. In this study, we assessed the efficacy of a combination of lentinan (a fungal extract), transcatheter arterial chemoembolisation (TACE) and radiofrequency ablation (RFA) in HCC patients. METHODS: Seventy-eight patients with HCC confirmed by pathology and iconographical checks were used in this study. A total of 136 tumours with a mean diameter of 6.5 cm were detected (standard deviation [SD]+/-0.7). Subjects were divided into four groups, receiving either TACE only, RFA only, RFA and TACE, or the combination group - receiving lentinan, RFA and TACE. RESULTS: The tumour necrosis was significantly higher in the combination group (88.6%), compared to the TACE group (37.5%), the RFA group (47.8%) and the TACE/RFA group (60.3%; P<0.05). The tumour recurrence rate was significantly lower in the combination group (17.8%), compared to the TACE group (45.8%), the RFA group (34.7%) and the TACE/RFA group (29.0%; P<0.05). Finally, mean survival duration was significantly higher in the combination group (28.2 months; P<0.05). CONCLUSION: Combination therapy involving lentinan, RFA and TACE was beneficial in terms of increasing mean survival duration, tumour necrosis and reducing the recurrence rate. Lentinan may therefore be of benefit to HCC patients.     

Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US,spiral CT,and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

IntroductionThe commercially available Navigator system^© (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator^©). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC).Materials and methodsFrom November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue^© (Bracco, Milan, Italy) as a contrast agent and Technos MPX^© scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15).ResultsDefinitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1–3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (+9 multinodularN and 6 LR), 3 false-negatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9).Conclusions3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.     

肝动脉化疗栓塞联合射频消融治疗直径≥5 cm肝细胞癌患者10年疗效及预后分析

目的探讨经导管肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗直径≥5 cm肝细胞癌（HCC）患者的远期疗效及预后影响因素。 方法选择2006年1月至2015年12月天津第三中心医院收治并接受RFA治疗或RFA联合TACE治疗的HCC患者79例。其中36例HCC患者行单纯RFA治疗（RFA组）,43例HCC患者行TACE联合RFA治疗（TACE联合组）。TACE联合组患者在TACE术后2周内进行RFA治疗。采用χ²检验比较TACE联合组与RFA组患者肿瘤首次完全消融率差异;采用Kaplan-Meier法对2组患者进行生存分析,并采用Log-rank检验比较2组患者的生存率。采用Cox回归分析直径≥5 cm的HCC患者预后的影响因素。 结果TACE联合组患者肿瘤首次完全消融率93.0%（40/43）,RFA组患者肿瘤首次完全消融率为91.7%（33/36）,两者比较差异无统计学意义（χ²=0.051,P=0.821）。TACE联合组及RFA组患者1、3、5、7、10年肿瘤无进展生存率分别为78.8%、56.1%、38.4%、25.2%、16.8%及69.0%、40.0%、20.1%、13.4%、13.4%,两者差异无统计学意义（χ²=3.561,P=0.059）;TACE组患者1、3、5、7、10年总生存率分别为83.4%、57.6%、45.9%、41.3%、31.0%,高于RFA组患者的68.8%、40.2%、24.1%、16.2%、16.2%,且差异有统计学意义（χ²=4.681,P=0.030）。单因素分析结果显示,合并门脉分支瘤栓、肿瘤无假包膜以及甲胎蛋白（AFP）浓度升高是影响直径≥5 cm的HCC患者总生存时间的因素;进一步多因素分析结果显示,合并门脉分支瘤栓及AFP浓度升高是影响直径≥5 cm的HCC患者总生存时间的独立危险因素。 结论TACE联合RFA治疗能延长直径≥5 cm HCC患者的生存时间,改善患者预后;合并门脉分支瘤栓及AFP浓度是影响直径≥5 cm HCC患者预后的独立危险因素。     

Double-contrast magnetic resonance imaging of hepatocellular carcinoma after transarterial chemoembolization

Background The purpose of this study was to assess the accuracy of double-contrast magnetic resonance (MR) imaging for the treatment response evaluation of hepatocellular carcinoma (HCC) in cirrhotic liver after transarterial chemoembolization (TACE). Methods Twenty-two patients with 30 HCC nodules treated by TACE underwent double-contrast MR imaging 1 month after treatment. MR images were obtained before and after the sequential administration of superparamagnetic iron oxide (SPIO) and gadopentetate dimeglumine contrast agent within the same imaging session. Two observers retrospectively assessed all treated nodules for evidence of residual viable tumor after TACE. The diagnostic performance of gadolinium-enhanced, SPIO-enhanced, and double-contrast enhanced images was calculated. Histopathological and angiographical findings served as standard of reference. Receiver operating characteristic curves and areas under the curves (A _z) were calculated. Results Double-contrast technique (A _z = 0.95) was significantly (p = 0.036) more accurate than SPIO-enhanced technique (A _z = 0.92) and gadolinium-enhanced technique (p = 0.005) (A _z = 0.81) in viable tumor detection after TACE. Double-contrast technique was significantly more sensitive (92%) than SPIO-enhanced technique (80%) and gadolinium-enhanced technique (68%). Kappa values for interobserver agreement ranged from 0.67 to 0.87 and were significantly different from zero (all p < 0.001). Conclusions Compared to gadolinium-enhanced and SPIO-enhanced techniques, double-contrast technique significantly improves the detection of viable tumor in HCC after TACE.     

原发性肝癌不同介入方案治疗后生命质量的评价

目的 观察原发性肝癌(HCC)经皮射频消融(RFA)治疗后生命质量的情况. 方法 采用国内肝癌特异性生命质量量表(QOL-LC V2.0),对88 g,l经RFA治疗,72例经动脉插管栓塞化疗(TACE组)以及49例TACE+RFA(联合治疗组)治疗HCC患者,分别进行生命质量评定. 结果 RFA组生命质量总分中位数(167.6)高于TACE组(145.7)(P<0.01);RFA组和联合治疗组在症彤副作用领域的得分中位数47.5、45.0,均优于TACE组的37.2(均P<0.01);RFA组躯体功能领域得分高于TACE组趋势(P=0.047);TACE组和联合治疗组Child-Pugh分级提高的比例均高于RFA组(均P<0.01);TACE组并发症发生率、肿瘤复发/新生率明显高于RFA组(均P<0.05). 结论 RFA作为一种肝癌局部微创治疗方法.多数患者在获得较好疗效的同时,可避免严重副作用,减少躯体功能损伤,有较高的整体生命质量.适当地选择TACE与RFA联合治疗与单纯TACE相比,可减少肝功能损伤,有利于提高原发性肝癌患者的生命质量.     

Detection of hepatocellular carcinoma capsule by contrast-enhanced ultrasound using Levovist: correlations with pathological findings

Purpose To determine the most appropriate therapy for each hepatocellular carcinoma (HCC) nodule, it is important to ascertain whether the tumor has a capsule. The aim of this study was to investigate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in HCC capsule detection by comparing ultrasound findings with histological results from operative specimens. Methods Thirty-six HCC nodules (all smaller than 5 cm) from 36 patients who had undergone hepatectomy were examined by CEUS using Levovist with agent detection imaging. The vascular phase images and time course changes of HCC were observed after a bolus injection of Levovist. We classified the appearance of the tumor artery, tumor enhancement, and washout into several patterns. We grouped HCCs into encapsulated or nonencapsulated on the basis of the histology of the operative specimens, taking into account the effectiveness of transcatheter arterial chemoembolization. Ultrasound and pathological findings were compared to assess the ability of CEUS to detect HCC capsules. Results During the arterial phase, 12 (80.0%) encapsulated and 3 (14.3%) nonencapsulated HCC nodules showed a surrounding artery with branches pattern (P < 0.0001). The sensitivity, specificity, and accuracy of this pattern for HCC capsule detection were 80%, 86%, and 83%, respectively. A branching artery was found in 15 (71.4%) nonencapsulated but in only 3 (20.0%) encapsulated HCC nodules (P < 0.01). The sensitivity, specificity, and accuracy of this branching artery pattern for confirming the absence of a capsule in HCC nodules were 71%, 80%, and 75%, respectively. Almost all HCC nodules showed strong–moderate or weak enhancement and strong–moderate or mild washout. Neither enhancement nor washout pattern correlated with the presence of a capsule. Conclusion The arterial phase of CEUS is very useful for detection of HCC capsules and therefore facilitates selection of the most appropriate treatment method for HCC.     

多电极射频联合肝动脉栓塞化疗治疗不能切除大肝癌的临床观察

目的：探讨多电极射频（RFA）联合肝动脉栓塞化疗（TACE）治疗不能切除大肝癌的临床价值。方法：对23例大肝癌患者的30个结节采用RFA及TACE治疗，肝癌结节大小5．3～12．0cm，平均6．4cm。结果：18例治疗前甲胎球蛋白（AFP）升高的患者，治疗后明显下降。6例治疗后再次活检，呈完全性坏死。1a存活73．7％（14／19），3例生存4a以上，1例至今存活达6a以上。结论：RFA联合TACE治疗不能切除的大肝癌是一种安全有效的治疗方法。     

超声造影与增强螺旋CT诊断肝硬化背景下≤2 cm结节样病灶的比较研究

目的 探讨超声造影(contrast-enhanced ultrasound,CEUS)与增强螺旋CT(contrast-enhanced helical computed tomography,CECT)对肝硬化背景下≤2 cm结节样病灶的诊断效能.方法 对72例81个肝硬化背景下常规超声检查可疑肝内小占化病变者(最大直径≤2 cm)进行CEUS和CECT检查(两者间隔时间≤2周),将两种检查的术前诊断与病理结果进行比较分析,评估两种检查方法的诊断效能.结果 81个病灶53个为肝细胞癌(HCC),26个增生结节,2个血管瘤.53个HCC中,CEUS 51个(96.2%)病灶动脉期呈高增强,CECT 41个(77.4%)病灶动脉期显示强化,CEUS与CECT在显示动脉期血供方面差异有统计学意义(P<0.01).以病灶动脉期呈高增强,门脉期或延迟期消退为低增强作为诊断HCC的标准,CEUS诊断小结节样病灶的敏感性、特异性、准确性分别为86.8%、82.1%、85.2%.CECT分别为73.6%、92.9%、80.2%(P>0.05).结论 CEUS对≤2 cm HCC动脉期血供的显示率高于CECT,CEUS对肝硬化背景下小结节样病灶的诊断能力与CECTT相似.     

肝动脉化疗栓塞序贯射频消融及联合CIK细胞疗法治疗肝细胞癌的临床研究

目的：观察肝动脉化疗栓塞(TACE)序贯射频消融(RFA)及TACE序贯RFA联合CIK细胞疗法治疗原发性肝癌的临床疗效。方法：61例原发性肝细胞癌患者分为TACE序贯RFA后联合CIK细胞治疗27例（研究组），TACE序贯RFA治疗34例（对照组）。于治疗前后检测肿瘤大小、血清甲胎蛋白（AFP）及CD3＋、CD4＋、CD8＋、CD4＋/CD8＋，治疗后评估生命质量。结果：TACE序贯RFA后联合CIK细胞治疗研究组治疗后的缓解率（85.19％）高于对照组（61.76％）（P＜0.05）；研究组AFP降为正常者占84.21％，高于对照组（52.00％）（P＜0.05)；研究组治疗后CD3＋、CD4＋、CD4＋/CD8＋升高程度较对照组更为明显(P<0．01)；研究组生命质量明显优于对照组（P＜0.01)。结论：TACE序贯RFA后联合CIK细胞综合疗法治疗原发性肝癌有较好的临床疗效，优于TACE序贯RFA治疗，提高了患者的生命质量。     

超声造影与增强MRI对高分化肝癌和异型增生结节的诊断

目的探讨超声造影与增强MRI对高分化肝细胞癌和肝异型增生结节（DN）的诊断能力。 方法回顾性收集2012年1月至2018年12月在复旦大学附属中山医院同期行超声造影和增强MRI检查并获病理学证实的39例患者的39个高分化肝细胞癌病灶和7例患者的8个DN病灶，分析其超声造影和增强MRI表现特征。采用χ²检验，计算Kappa值，比较2种检查方法的诊断一致性；绘制不同检查方法的受试者操作特征（ROC）曲线，分析其诊断效能。 结果2种诊断方法中，69.2%（27/39）的高分化肝细胞癌的动脉期表现一致（Kappa=0.482），53.8%（21/39）的高分化肝细胞癌的延迟期表现一致（Kappa=0.168）。DN病灶在超声造影的主要表现呈“等增强-等增强”模式（87.5%，7/8），增强MRI主要表现为“高信号-低信号”模式（62.5%，5/8），所有DN病灶在超声造影延迟期均未出现廓清。超声造影、增强MRI、超声造影联合增强MRI（同时满足或只满足一种）4种检查方法中，超声造影联合增强MRI（只满足一种）诊断高分化肝细胞癌的敏感度（66.7%）和准确性（61.7%）最高，而超声造影诊断高分化肝细胞癌的特异度（100%）和ROC曲线下面积（0.658，95%CI：0.482~0.834）最高。 结论超声造影联合增强MRI有助于高分化肝细胞癌和肝DN的鉴别诊断，而超声造影具有更高的诊断特异度。     

Contrast enhanced ultrasound: Roles in immediate post-procedural and 24-h evaluation of the effectiveness of thermal ablation of liver tumors

PurposeTo retrospectively assess the diagnostic accuracy of immediate post-procedural CEUS, 24-h CEUS, and 24-h CT in verifying the effectiveness of thermal ablation of liver tumors ablation, using the combined results of 3-month post-procedure CEUS and MDCT as the reference standard.Materials and methodsFrom our database, we selected patients who had immediate post-procedural CEUS and 24-h CEUS and MDCT examinations after undergoing thermal ablation of a liver tumor between January 2009 and March 2010. The study population consisted of 53 subjects and 55 tumors (44 HCC and 11 metastasis) were evaluated. Thirty-seven tumors were treated with radiofrequency and 18 with microwave ablation.Post-procedural CEUS, 24-h CEUS and MDCT, and 3-month follow-up CEUS and MDCT images were blindly reviewed by two radiologists, who measured the size of the ablation area on the post-procedural and 24-h studies. They also evaluated the ability of each of these three index tests to predict the outcome (residual tumor vs. no residual tumor) using imaging studies done at the 3-month follow-up as the reference standard.ResultsMean tumor diameter on preablation CEUS (the day before treatment) was 20 ± 9 mm. Mean diameter of the necrotic area was 29 ± 9 mm on post-procedural CEUS, 34 ± 11 mm on 24-h CEUS, and 36 ± 11 mm on 24-h MDCT. Diameters of the necrotic area (mean and maximum) on post-procedural CEUS were significantly smaller than those measured on 24-h CEUS or 24-h MDCT, which were not significantly different. For predicting the presence of residual tumor at the 3-month follow-up, post-procedural CEUS, 24-h CEUS, and 24-h MDCT displayed sensitivity of 33%, 33%, and 42%; specificity of 92%, 97%, and 97%; negative predictive value of 84%, 85%, and 83%. The accuracy parameters of these three imaging modalities were not significantly different from one another.ConclusionsIn patients undergoing thermal ablation for liver tumors, the immediate post-procedural CEUS seems comparable to 24-h CEUS and MDCT in terms of detecting residual disease.     

超声造影成像对TACE综合治疗肝癌疗效的评判价值与螺旋CT对比分析

目的与螺旋CT(HCT)对比分析超声造影成像(CEUS)在评价经导管肝动脉灌注化疗药物及碘油栓塞术(TACE)联合经皮无水乙醇注射(PEI)等微创术治疗肝细胞肝癌(HCC)疗效的价值。方法TACE综合治疗后的25个HCC病灶经CEUS和HCT检查,两者阳性检出率进行McNemer检验,并计算二者的诊断准确率。结果CEUS发现10个阳性,出现动脉期增强,15个阴性;HCT发现4个阳性,21个阴性(P<0.05)。与临床追踪对照,CEUS和HCT的准确率分别是96.0%和72.0%。结论与HCT比较,CEUS不受碘油的干扰,能更客观地揭示TACE术后HCC的残存,是评价TACE疗效敏感而有效的方法。     

超声造影对甲状腺影像报告和数据系统4类结节的诊断价值

目的 探讨超声造影(contrast-enhanced ultrasound, CEUS)对甲状腺影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)4类结节的恶性风险及临床诊断价值。方法 分析226例甲状腺患者的结节特征,依据Kwak制定标准进行分类,其中TI-RADS 4A、4B和4C类结节纳入研究中,所有结节均行CEUS检查。CEUS结果与病理结果对照。结果 226个TI-RADS 4类结节中,CEUS诊断恶性为106个,良性为120个,术后病理诊断恶性110为个,良性为116个,CEUS诊断4类结节的准确性、敏感度、特异度、阳性预测值及阴性预测值,分别为91.15%、89.09%、93.10%、89.91%和89.74%。CEUS诊断4类结节结果和病理结果比较,具有较高的一致性,Kappa值0.823(P＜0.001)。CEUS诊断4A、4B和4C类结节的实际恶性率,分别为14.06%(9/64)、47.53%(48/101)和86.89%(53/61)。 结论 CEUS检查对TI-RADS 4类甲状腺结节具有较高的诊断价值。有助于指导TI-RADS 4类甲状腺可疑结节临床后续决策。