Kim Eui Joo, Kim Yun Soo, Shin Seung Kak, Kwon Oh Sang, Choi Duck Joo, Kim Ju Hyun
Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Turk J Gastroenterol. 2017 Nov;28(6):446-452. doi: 10.5152/tjg.2017.17104. Epub 2017 Oct 25.
BACKGROUND/AIMS: B-mode ultrasound (US) has difficulty targeting small hepatocellular carcinomas (HCCs) with poor conspicuity during radiofrequency ablation (RFA). Contrast-enhanced ultrasound (CEUS) can improve visualization of small or inconspicuous HCCs. This study was conducted to evaluate the effectiveness of CEUS-guided RFA electrode insertion during the arterial phase in inconspicuous HCCs.
Ninety-three treatment-naïve HCCs from 80 patients treated with RFA from August 2012 to December 2014 were retrospectively reviewed. Seventy-five HCCs from 65 patients underwent B-mode US-guided RFA, and 15 HCCs from 14 patients that were inconspicuous on B-mode US underwent CEUS-guided RFA during the arterial phase after injection of sulfur hexafluoride microbubbles (SonoVue®). Technical success was assessed by contrast-enhanced computed tomography within 1 week and 3 months after the procedure.
The mean size of HCCs treated with CEUS-guided RFA was smaller than that of HCCs treated with B-mode US-guided RFA (1.17±0.36 vs. 1.63±0.55 cm, p=0.003). Technical success rates of CEUS-guided RFA within 1 week and 3 months were 100% (15/15) and 93.3% (14/15), respectively. Technical success rates of B-mode US-guided RFA were 97.3% (73/75) and 94.5% (69/73), respectively.
CEUS-guided RFA is highly efficacious for ablation of very small and inconspicuous HCCs.
背景/目的：B 型超声（US）在射频消融（RFA）过程中难以靶向显影不佳的小肝细胞癌（HCC）。超声造影（CEUS）可改善小的或不显影的 HCC 的可视化。本研究旨在评估 CEUS 引导下在动脉期将 RFA 电极插入不显影的 HCC 中的有效性。
回顾性分析 2012 年 8 月至 2014 年 12 月期间接受 RFA 治疗的 80 例患者的 93 个未经治疗的 HCC。65 例患者的 75 个 HCC 接受 B 型超声引导下的 RFA，14 例患者的 15 个在 B 型超声上不显影的 HCC 在注射六氟化硫微泡（声诺维®）后的动脉期接受 CEUS 引导下的 RFA。在术后 1 周和 3 个月内通过对比增强计算机断层扫描评估技术成功率。
CEUS 引导下 RFA 治疗的 HCC 的平均大小小于 B 型超声引导下 RFA 治疗的 HCC（1.17±0.36 对 1.63±0.55 cm，p = 0.003）。CEUS 引导下 RFA 在 1 周和 3 个月内的技术成功率分别为 100%（15/15）和 93.3%（14/15）。B 型超声引导下 RFA 的技术成功率分别为 97.3%（73/75）和 94.5%（69/73）。
CEUS 引导下的 RFA 对消融非常小的和不显影的 HCC 非常有效。
