Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA, 90033, USA.
Department of Radiology, Keck School of Medicine, University of Southern California, 2001 North Soto Street, Soto Building 210B, Los Angeles, 90089, USA.
Abdom Radiol (NY). 2016 Aug;41(8):1511-21. doi: 10.1007/s00261-016-0700-4.
Thermal ablation has emerged as a mainstay therapy for primary and metastatic liver malignancy. Percutaneous thermal ablation is usually performed under CT and/or ultrasound guidance. CT guidance frequently utilizes iodinated contrast for tumor targeting, with additional radiation and contrast required at the end of the procedure to ensure satisfactory ablation margins. Contrast-enhanced ultrasound (CEUS) is an imaging technique utilizing microbubble contrast agents to demonstrate blood flow and tissue perfusion. In this study, we performed a retrospective review to assess the utility of CEUS in the immediate post ablation detection of residual tumor.
Sixty-four ablations were retrospectively reviewed. 6/64 ablations (9.4%) had residual tumor on the first follow-up imaging after thermal ablation. There were two groups of patients. Group 1 underwent standard protocol thermal ablation with CT and/or ultrasound guidance. Group 2 not only had thermal ablation with a protocol identical to group 1, but also had CEUS assessment at the conclusion of the procedure to ensure satisfactory ablation zone.
The residual tumor rate in group 1 was 16.7% and the residual tumor rate in group 2 was 0%. The difference between the groups was statistically significant with a p value of 0.023. The results suggest that using CEUS assessment immediately after the ablation procedure reduces the rate of residual tumor after thermal ablation.
CEUS evaluation at the end of an ablation procedure is a powerful technique providing critical information to the treating interventional radiologist, without additional nephrotoxic contrast or ionizing radiation.
热消融已成为原发性和转移性肝恶性肿瘤的主要治疗方法。经皮热消融通常在 CT 和/或超声引导下进行。CT 引导常使用碘造影剂进行肿瘤靶向，在手术结束时需要额外的辐射和造影剂以确保满意的消融边界。对比增强超声（CEUS）是一种利用微泡造影剂显示血流和组织灌注的成像技术。在这项研究中，我们进行了回顾性研究，以评估 CEUS 在热消融后即刻检测残留肿瘤中的应用价值。
回顾性分析了 64 例消融术。64 例消融术中有 6 例（9.4%）在热消融后首次随访影像学检查中发现残留肿瘤。患者分为两组。第 1 组接受标准方案 CT 和/或超声引导下热消融。第 2 组不仅采用与第 1 组相同的方案进行热消融，而且在手术结束时进行 CEUS 评估，以确保满意的消融区域。
第 1 组的残留肿瘤率为 16.7%，第 2 组的残留肿瘤率为 0%。两组之间的差异具有统计学意义（p 值为 0.023）。结果表明，在消融术后立即进行 CEUS 评估可降低热消融后残留肿瘤的发生率。
在消融手术结束时进行 CEUS 评估是一种强大的技术，可为治疗性介入放射科医生提供关键信息，而无需额外的肾毒性造影剂或电离辐射。
