Department of Surgery, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
HPB (Oxford). 2010 Dec;12(10):717-23. doi: 10.1111/j.1477-2574.2010.00247.x.
Thermal ablation is an accepted therapy for selected hepatic malignancies. However, the reliability of thermal ablation is limited by the inability to accurately monitor and confirm completeness of tumour destruction in real time. We investigated the ability of ultrasound elasticity imaging (USEI) to monitor thermal ablation.
Capitalizing on the known increased stiffness that occurs with protein denaturation and dehydration during thermal therapy, we sought to investigate the feasibility and accuracy of USEI for monitoring of liver tumour ablation.
A model for hepatic tumours was developed and elasticity images of liver ablation were acquired in in vivo animal studies, comparing the elasticity images to gross specimens. A clinical pilot study was conducted using USEI in nine patients undergoing open radiofrequency ablation for hepatic malignancies. The size and shape of thermal lesions on USEI were compared to B-mode ultrasound and post-ablation computed tomography (CT).
In both in vivo animal studies and in the clinical trial, the boundary of thermal lesions was significantly more conspicuous on USEI when compared with B-mode imaging. Animal studies demonstrated good correlation between the diameter of ablated lesions on USEI and the gross specimen (r = 0.81). Moreover, high-quality strain images were generated in real time during therapy. In patients undergoing tumour ablation, a good size correlation was observed between USEI and post-operative CT (r = 0.80).
USEI can be a valuable tool for the accurate monitoring and real-time verification of successful thermal ablation of liver tumours.
热消融是治疗选定的肝恶性肿瘤的一种公认的治疗方法。然而，热消融的可靠性受到限制，因为无法实时准确监测和确认肿瘤破坏的完整性。我们研究了超声弹性成像（USEI）监测热消融的能力。
利用在热疗过程中蛋白质变性和脱水导致的已知的增加的硬度，我们试图研究 USEI 监测肝肿瘤消融的可行性和准确性。
建立了肝脏肿瘤模型，并在体内动物研究中获取了肝消融的弹性图像，将弹性图像与大体标本进行比较。在 9 例接受开放射频消融治疗肝恶性肿瘤的患者中进行了 USEI 的临床初步研究。将 USEI 上的热损伤的大小和形状与 B 型超声和消融后的计算机断层扫描（CT）进行比较。
在体内动物研究和临床试验中，与 B 型成像相比，USEI 上热损伤的边界明显更明显。动物研究显示 USEI 上消融病变的直径与大体标本有很好的相关性（r = 0.81）。此外，在治疗过程中实时生成了高质量的应变图像。在接受肿瘤消融的患者中，USEI 与术后 CT 之间观察到很好的大小相关性（r = 0.80）。
USEI 可以成为准确监测和实时验证肝肿瘤热消融成功的有价值的工具。
