经皮肾肿瘤消融后增强超声的临床应用。
Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation.
机构信息
Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No.600 Yishan Road, Shanghai, China.
出版信息
Br J Radiol. 2019 Nov;92(1103):20190183. doi: 10.1259/bjr.20190183. Epub 2019 Oct 1.
OBJECTIVE
To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA).
METHODS
31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors.
RESULTS
The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor ( = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%.
CONCLUSION
After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI.
ADVANCES IN KNOWLEDGE
In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.
目的
评估超声造影（CEUS）在经皮射频消融（RFA）后检测肾肿瘤不完全消融和局部复发的有效性。
方法
31 例患者接受 RFA 治疗，并在 RFA 后进行 CEUS 检查，观察消融区域的消融区和对比剂分布，将 CEUS 图像与增强 CT/MRI 图像进行比较，以确定肾肿瘤的残留肿瘤和局部复发。
结果
首次 RFA 后肿瘤和消融区的平均最大直径分别为 32.3±14.7mm 和 35.9±12.2mm。如果消融区大于原发性肿瘤，完全肿瘤消融的比例更高（=0.026）。RFA 后 1 个月内，增强 CT/MRI 检查显示 31 例患者中有 9 例（29.0%）不完全消融，而 CEUS 显示 31 例患者中有 8 例（25.8%）不完全消融。CEUS 评估肾肿瘤完全消融的灵敏度、特异度、阳性预测值和阴性预测值分别为 88.9%、100%、100%、95.7%。在随访期间，27 例完全肿瘤消融患者中有 2 例（7.4%）报告局部复发。这两名患者的肿瘤复发征象均通过 CEUS 和增强 CT/MRI 识别。因此，CEUS 评估肿瘤复发的灵敏度和特异度均为 100%。
结论
经皮肾肿瘤 RFA 后，CEUS 对残留和复发性肿瘤的随访评估效果基本与增强 CT/MRI 相同。
知识进展
在本研究中，我们评估了 CEUS 在 RFA 后评估残留和复发性肿瘤的随访中的有效性，其效果基本与增强 CT/MRI 相同。结合多种随访方法可能会提高残留或复发性肿瘤的检出率。
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