CAJ | 학술논문

目的：探讨声脉冲辐射力成像(ARFI)技术在肝癌射频消融中的临床应用价值。方法对原发性肝癌组26例(包括25例肝细胞肝癌、1例肝内胆管细胞癌)和转移性肝癌组12例共38个肝癌结节在行射频消融(RFA)治疗前后分别行常规超声和 ARFI 检查。比较治疗前后病灶在声触诊组织成像(VTI)、常规超声上显示的大小及其与周边肝实质的硬度差异和变化,观察消融区内及其边缘充血带的硬度变化。术后定期随访,观察可疑残余癌或原位复发灶的 ARFI 表现,并行增强 MRI 及穿刺活检证实。结果 VTI 显示病灶范围大于常规超声(P <0.05)。消融区边缘的剪切波速度(SWV)大于消融区周边肝实质(P <0.05),且随着时间的推移呈递减趋势,差异无统计学意义(P >0.05)。随访期间1例转移性肝癌(MLC)患者出现原位复发,VTI 表现为较周边消融灶稍亮的灰色区域。结论 ARFI 技术能够反复、无创地观察肝癌 RFA 治疗后短期内肿瘤凝固坏死的形态和范围及消融区周边组织的硬度变化,对原位复发病灶有潜在的诊断价值。
목적：탐토성맥충복사력성상(ARFI)기술재간암사빈소융중적림상응용개치。방법대원발성간암조26례(포괄25례간세포간암、1례간내담관세포암)화전이성간암조12례공38개간암결절재행사빈소융(RFA)치료전후분별행상규초성화 ARFI 검사。비교치료전후병조재성촉진조직성상(VTI)、상규초성상현시적대소급기여주변간실질적경도차이화변화,관찰소융구내급기변연충혈대적경도변화。술후정기수방,관찰가의잔여암혹원위복발조적 ARFI 표현,병행증강 MRI 급천자활검증실。결과 VTI 현시병조범위대우상규초성(P <0.05)。소융구변연적전절파속도(SWV)대우소융구주변간실질(P <0.05),차수착시간적추이정체감추세,차이무통계학의의(P >0.05)。수방기간1례전이성간암(MLC)환자출현원위복발,VTI 표현위교주변소융조초량적회색구역。결론 ARFI 기술능구반복、무창지관찰간암 RFA 치료후단기내종류응고배사적형태화범위급소융구주변조직적경도변화,대원위복발병조유잠재적진단개치。
Objective To evaluate the clinical value of acoustic radiation force impulse (ARFI) imaging in radiofrequency ablation of hepatic malignancies.Methods Twenty-six patients with primary carcinoma of the liver (including 25 cases of hepatocellular carcinoma and 1 case of intrahepatic cholangiocarcinoma)and 12 patients with metastatic hepatic carcinoma were enrolled and a total of 38 hepatic nodules were studied.All patients underwent ARFI imaging and conventional ultrasound before and after radiofrequency ablation.The sizes of lesions were assessed with virtual touch tissue imaging (VTI)and conventional ultrasound before and after radiofrequency ablation,and the stiffness of lesions,adjacent congestion zone and surrounding parenchyma were assessed with virtual touch tissue quantification (VTQ). Regular follow-up by ARFI was conducted for suspected residual tumor or local recurrence,and enhanced MRI examination or liver biopsy was performed for confirmation.Results The mean size of lesions assessed with VTI was bigger than that on conventional ultrasound (P <0.05).Shear wave velocity (SWV)value at the edge of the ablation zone were higher than that at surrounding parenchyma (P < 0.05 ),and was decreasing with the time passed by,but the difference was not of statistical significance (P > 0.05 ). Recurrence was observed in one metastatic hepatic carcinoma patient during the follow-up,and the lesion was gray which is slightly brighter than the surrounding ablation lesions on VTI.Conclusions ARFI plays a potential role in estimating recurrence by observing the shape and range of coagulation necrosis,and the changes of stiffness in the surrounding parenchyma of ablation zone in a short time after radiofrequency ablation of liver malignancies,and can be used effectively in the assessments of thermal ablation of hepatic malignancies.