一种基于三维对比增强超声的新型单模态融合成像方法用于评估肝细胞癌微波消融术后的消融边缘。
A novel mono-modality fusion imaging method based on three-dimensional contrast-enhanced ultrasound for the evaluation of ablation margins after microwave ablation of hepatocellular carcinoma.
作者信息
Ding Jianmin, Wang Dong, Zhou Yan, Zhao Lin, Zhou Hongyu, Jing Xiang, Wang Yandong
机构信息
Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China.
The Third Central Clinical College of Tianjin Medical University, Tianjin, China.
出版信息
J Gastrointest Oncol. 2021 Feb;12(1):184-195. doi: 10.21037/jgo-21-46.
BACKGROUND
To investigate the feasibility and accuracy of using preoperative and postoperative three-dimensional contrast-enhanced ultrasound (3D CEUS) fusion imaging in the evaluation of safety margins after thermal ablation of hepatocellular carcinoma (HCC).
METHODS
A total of the 24 patients with HCC who underwent microwave ablation (MWA) between June 2020 and December 2020 were enrolled in this study. All patients received preoperative and postoperative 3D CEUS. The preoperative and postoperative 3D CEUS images were then fused. The success rate and evaluation time were recorded. The ablation margin and whether or not the safety margin was reached were calculated and recorded. If the ablation safety margin was not reached, the residual ablation volume needed to cover the safety margin was calculated automatically. The agreement between contrast-enhanced computed tomography(CECT) and 3D CEUS fusion imaging in the evaluation of ablation margins was explored using the kappa coefficient.
RESULTS
The 3D CEUS fusion success rate was 95.8% (23/24), with a mean fusion time of (4.1±1.8) minutes. Twenty-three tumors were completely ablated, and the safety margin was achieved for 9 tumors. The ablation margin of 14 tumors was <5 mm. The mean uncovered safety margin volume was (2.27±2.11) mL, and the mean proportion of the uncovered safety margin to the whole safety margin was 16.8%. According to the results of preoperative and postoperative CECT fusion imaging, the ablation margin of 13 tumors was <5 mm, and the ablation margin of 10 tumors was >5 mm. The 2 methods showed excellent consistency, with a Kappa value of 0.911 (P=0.000012).
CONCLUSIONS
This study has presented a novel mono-modality fusion imaging method based on CEUS. We demonstrated that 3D CEUS fusion has a short fusion time and a high success rate, as well as good consistency with enhanced CT fusion. Therefore, 3D CEUS fusion is a feasible and accurate tool for evaluating the immediate efficacy of thermal ablation of HCC.
背景
探讨术前及术后三维对比增强超声（3D CEUS）融合成像在评估肝细胞癌（HCC）热消融术后安全切缘中的可行性及准确性。
方法
选取2020年6月至2020年12月期间24例行微波消融（MWA）的HCC患者纳入本研究。所有患者均接受术前及术后3D CEUS检查。然后将术前及术后3D CEUS图像进行融合。记录成功率及评估时间。计算并记录消融切缘及是否达到安全切缘。若未达到消融安全切缘，则自动计算覆盖安全切缘所需的残余消融体积。采用kappa系数探讨对比增强计算机断层扫描（CECT）与3D CEUS融合成像在评估消融切缘方面的一致性。
结果
3D CEUS融合成功率为95.8%（23/24），平均融合时间为（4.1±1.8）分钟。23个肿瘤完全消融，9个肿瘤达到安全切缘。14个肿瘤的消融切缘<5 mm。未覆盖的安全切缘平均体积为（2.27±2.11）mL，未覆盖的安全切缘占整个安全切缘的平均比例为16.8%。根据术前及术后CECT融合成像结果，13个肿瘤的消融切缘<5 mm，10个肿瘤的消融切缘>5 mm。两种方法显示出极佳的一致性，Kappa值为0.911（P = 0.000012）。
结论
本研究提出了一种基于CEUS的新型单模态融合成像方法。我们证明3D CEUS融合具有融合时间短、成功率高以及与增强CT融合一致性好的特点。因此，3D CEUS融合是评估HCC热消融即时疗效的一种可行且准确的工具。
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