Dill-Macky Marcus J, Asch Murray, Burns Peter, Wilson Stephanie
Department of Medical Imaging, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.
AJR Am J Roentgenol. 2006 May;186(5 Suppl):S287-95. doi: 10.2214/AJR.04.1916.
This pilot study compared the utility of immediate postprocedural contrast-enhanced sonography with that of delayed enhanced sonography and CT or MRI in assessing the success of radiofrequency ablation of hepatocellular carcinoma.
Twenty-two lesions (1.5-3.7 cm) were studied in 19 patients. Enhanced sonography was performed before and within 1 hr after radiofrequency ablation. At routine 2-week follow-up CT or MRI, additional enhanced sonography was performed. The findings of preablation CT or MRI and enhanced sonography were compared with those of postprocedural and follow-up enhanced sonography by three radiologists experienced in these techniques. The reviewers were unaware of the follow-up CT or MRI results (reference standard). Technical adequacy, ablation zone targeting, and identification of residual disease were assessed by each reviewer, and the results were analyzed by consensus.
One postprocedural sonographic study was considered technically inadequate. Postprocedural sonography predicted the follow-up CT or MRI results in 76% (16/21) of subjects (sensitivity, 88%; specificity, 40%; positive predictive value [PPV], 82%; negative predictive value, [NPV] 50%). Follow-up CT or MRI identified accurate targeting in 17 of 22 subjects. Follow-up sonography agreed with CT or MRI in 82% (18/22) of subjects (sensitivity, 88%; specificity, 67%; PPV, 88%; NPV, 67%). Postprocedural sonography predicted the follow-up CT or MRI results in 81% (17/21) of subjects (sensitivity, 40%; specificity, 94%; PPV, 66%; NPV, 83%). Follow-up CT or MRI detected residual disease in six subjects. Follow-up sonography agreed with CT or MRI in 91% (20/22) of subjects (sensitivity, 83%; specificity, 94%; PPV, 83%; NPV, 94%).
Postprocedural enhanced sonography has the potential to guide completion of radiofrequency ablation at the time of initial therapy when residual disease is detected. The procedure is less accurate in detection of residual disease than is either delayed enhanced sonography or CT or MRI.
本初步研究比较了术后即刻对比增强超声检查与延迟增强超声检查以及CT或MRI在评估肝细胞癌射频消融成功率方面的效用。
对19例患者的22个病灶（1.5 - 3.7厘米）进行研究。在射频消融术前及术后1小时内进行增强超声检查。在常规2周随访CT或MRI时，额外进行增强超声检查。由三位精通这些技术的放射科医生将消融术前CT或MRI及增强超声检查结果与术后及随访增强超声检查结果进行比较。评估者不知晓随访CT或MRI结果（参考标准）。每位评估者评估技术充分性、消融区靶向性及残余疾病的识别情况，并通过共识分析结果。
一项术后超声检查被认为技术不充分。术后超声检查在76%（16/21）的受试者中预测了随访CT或MRI结果（敏感性88%；特异性40%；阳性预测值[PPV]82%；阴性预测值[NPV]50%）。随访CT或MRI在22例受试者中的17例中确定了准确靶向。随访超声检查在82%（18/22）的受试者中与CT或MRI结果一致（敏感性88%；特异性67%；PPV88%；NPV67%）。术后超声检查在81%（17/21）的受试者中预测了随访CT或MRI结果（敏感性40%；特异性94%；PPV66%；NPV83%）。随访CT或MRI在6例受试者中检测到残余疾病。随访超声检查在91%（20/22）的受试者中与CT或MRI结果一致（敏感性83%；特异性94%；PPV83%；NPV94%）。
术后增强超声检查在检测到残余疾病时，有可能在初始治疗时指导射频消融的完成。该检查在检测残余疾病方面不如延迟增强超声检查或CT或MRI准确。
