Ishii Tomohiro, Numata Kazushi, Hao Yoshiteru, Doba Nobutaka, Hara Koji, Kondo Masaaki, Tanaka Katsuaki, Maeda Shin
Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
Eur J Radiol. 2017 Apr;89:234-241. doi: 10.1016/j.ejrad.2016.12.018. Epub 2016 Dec 21.
The purpose of this study was to evaluate whether the hypervascularity of hepatocellular carcinomas (HCCs) on contrast-enhanced ultrasonography (CEUS) prior to radiofrequency ablation (RFA) is a significant risk factor for local recurrence after RFA.
Institutional review board approval and informed consent were obtained. Overall, 208 patients (mean age, 71.7 years; range, 50-87 years; 137 men, 71 women) with 282 HCCs treated with RFA were analyzed retrospectively. The mean maximum tumor diameter was 15.7mm. We compared the abilities of CEUS and contrast-enhanced computed tomography (CECT) to detect hypervascularity in HCCs. We then classified the HCCs into two groups according to the arterial-phase CEUS findings: a "hypervascular group" with whole or partial hypervascular areas within the lesions compared with the surrounding liver parenchyma, and a "non-hypervascular group" with isovascular or hypovascular areas within the lesions. We assessed the cumulative rate of local recurrence after RFA, and we also evaluated the risk factors for local recurrence using a univariate analysis.
The detection rate for hypervascular HCCs was significantly higher using CEUS (78%, 221/282) than that using CECT (66%, 186/282) (P<0.001). Using the CEUS findings, the cumulative rate of local recurrence was significantly higher in the hypervascular group (41.2%, 56/221) than in the non-hypervascular group (18.4%, 6/61) (P=0.007). A univariate analysis revealed that hypervascularity on CEUS was an independent risk factor for local recurrence (P=0.010).
Hypervascularity in HCCs as observed using CEUS is a significant risk factor for local recurrence after RFA.
本研究旨在评估在射频消融（RFA）前，经超声造影（CEUS）检测到的肝细胞癌（HCC）的高血供情况是否是RFA后局部复发的重要危险因素。
获得机构审查委员会批准并取得知情同意。本研究对208例（平均年龄71.7岁；范围50 - 87岁；男性137例，女性71例）接受RFA治疗的282个HCC进行了回顾性分析。肿瘤最大平均直径为15.7mm。我们比较了CEUS和对比增强计算机断层扫描（CECT）检测HCC高血供情况的能力。然后根据动脉期CEUS表现将HCC分为两组：与周围肝实质相比，病灶内有全部或部分高血供区域的“高血供组”，以及病灶内血供相等或血供减少区域的“非高血供组”。我们评估了RFA后局部复发的累积发生率，并使用单因素分析评估了局部复发的危险因素。
CEUS检测高血供HCC的比率（78%，221/282）显著高于CECT（66%，186/282）（P<0.001）。根据CEUS表现，高血供组的局部复发累积发生率（41.2%，56/221）显著高于非高血供组（18.4%，6/61）（P = 0.007）。单因素分析显示，CEUS显示的高血供情况是局部复发的独立危险因素（P = 0.010）。
CEUS观察到的HCC高血供情况是RFA后局部复发的重要危险因素。
