Ricci P, Cantisani V, Drudi F, Pagliara E, Bezzi M, Meloni F, Calliada F, Erturk S M, D'Andrea V, D'Ambrosio U, Passariello R
Department of Radiology, University La Sapienza, Rome, Italy.
Ultraschall Med. 2009 Jun;30(3):252-8. doi: 10.1055/s-2008-1027727. Epub 2009 Mar 11.
The present study was conducted to assess the efficacy of contrast-enhanced ultrasound with low mechanical index in evaluating the response of percutaneous radiofrequency ablation treatment of hepatocellular carcinoma by comparing it with 4-row spiral computed tomography.
100 consecutive patients (65 men and 35 women; age range: 62 - 76 years) with solitary hepatocellular carcinomas (mean lesion diameter: 3.7 cm +/- 1.1 cm SD) underwent internally cooled radiofrequency ablation. Therapeutic response was evaluated at one month after the treatment with triple-phasic contrast-enhanced spiral CT and low-mechanical index contrast-enhanced ultrasound following bolus injection of 2.4 ml of Sonovue (Bracco, Milan). 60 out of 100 patients were followed up for another 3 months. Contrast-enhanced sonographic studies were reviewed by two blinded radiologists in consensus. Sensitivity, specificity, NPV and PPV of contrast-enhanced ultrasound examination were determined.
After treatment, contrast-enhanced ultrasound identified persistent signal enhancement in 24 patients (24 %), whereas no intratumoral enhancement was detected in the remaining 76 patients (76 %). Using CT imaging as gold standard, the sensitivity, specificity, NPV, and PPV of contrast enhanced ultrasound were 92.3 % (95 % CI = 75.9 - 97.9 %), 100 % (95 % CI = 95.2 - 100 %), 97.4 % (95 % CI = 91.1 - 99.3 %), and 100 % (95 % CI = 86.2 - 100 %).
Contrast-enhanced ultrasound with low mechanical index using Sonovue is a feasible tool in evaluating the response of hepatocellular carcinoma to radiofrequency ablation. Accuracy is comparable to 4-row spiral CT.
本研究旨在通过将低机械指数超声造影与4排螺旋计算机断层扫描相比较，评估其在评价经皮射频消融治疗肝细胞癌疗效方面的作用。
100例连续的肝细胞癌患者（65例男性，35例女性；年龄范围：62 - 76岁），均为单发肝细胞癌（平均病灶直径：3.7 cm ± 1.1 cm标准差），接受了水冷式射频消融治疗。治疗后1个月，采用团注2.4 ml声诺维（意大利博莱科公司，米兰）后的三相增强螺旋CT及低机械指数超声造影评估治疗反应。100例患者中的60例又进行了3个月的随访。两名不知情的放射科医生共同对超声造影研究结果进行回顾。确定超声造影检查的敏感性、特异性、阴性预测值和阳性预测值。
治疗后，超声造影显示24例患者（24%）有持续信号增强，其余76例患者（76%）未检测到瘤内增强。以CT成像作为金标准，超声造影的敏感性、特异性、阴性预测值和阳性预测值分别为92.3%（95%可信区间 = 75.9 - 97.9%）、100%（95%可信区间 = 95.2 - 100%）、97.4%（95%可信区间 = 91.1 - 99.3%）和100%（95%可信区间 = 86.2 - 100%）。
使用声诺维的低机械指数超声造影是评估肝细胞癌射频消融疗效的一种可行工具。其准确性与4排螺旋CT相当。
