超声造影对肝癌射频消融后继发性肝动脉-门静脉瘘的诊断价值
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摘要
目的探讨肝细胞肝癌(HCC)射频消融(RFA)治疗后继发性肝动脉-门静脉瘘(APF)的超声造影(CEUS)灌注特征,并与异位复发HCC超声造影灌注特征进行比较。方法回顾性分析2010年01月～2016年10月我院就诊HCC患者RFA治疗后经数字减影血管造影(DSA)确诊为继发性APF29例(共31个病灶),作为APF组;选取同时期经手术病理或临床确诊为异位复发HCC患者30例(共34个病灶),作为HCC组。比较两组患者CEUS灌注特征,包括动脉期增强形态,各时期增强水平。两组动脉期增强形态、各时期增强水平的比较采用Fisher精确检验。结果 APF组CEUS表现为动脉期楔形增强27个病灶(87.1%);HCC组CEUS表现为动脉期球形增强30个病灶(88.2%);两组患者CEUS在动脉期增强形态方面比较,差异具有统计学意义(P<0.05)。APF组门静脉期等增强28个病灶(90.3%),延迟期等增强25个病灶(80.6%);HCC组门静脉期低增强21个病灶(61.8%),延迟期低增强28个病灶(82.4%);两组比较差异均有统计学意义(P值均<0.05)。APF组动脉期高增强27个病灶(87.1%);HCC组动脉期高增强33个病灶(97.1%);两组比较差异无统计学意义(P>0.05)。结论 HCC患者RFA治疗后继发性APF的CEUS具有特征性表现,认识这一点有助于与异位复发HCC鉴别。
Objective To explore the perfusion features of contrast-enhanced ultrasound(CEUS) at secondary arterio-portal fistula(APF) after the radio-frequency ablation(RFA) of hepatocellular carcinoma(HCC) and to compare the difference between them with the CEUS perfusion pattens of ectopic recurrent HCC. Methods From Jan 2010 to Oct 2016, tmenty-nine cases(31 lesions) of HCC were visited lishni center hospital, we retrospectively analyzed those patients treated with RFA, who were confirmed as secondary AFP by dirital substraction angiography(DSA), selccted as APF group. Thirty cases(34 lesions) were selected from the same period, by surgery pathology or clinical in the diagnosis of ectopic recurrent HCC patients as HCC group. The CEUS features includes enhancement shape at arterial phase and enhancement extent at different phases. The enhancement shape at arterial phase and the enhancement extent at different phases of APF group and HCC group were compared with Fisher's exact test. Results Twenty-seven(87.1%) cases of APF group after the RFA showed wedgelike and thirty(88.2%) cases of HCC group showed global enhancement during arterial phase. The differences of enhancesment shape at arterial phase had statistically significant. The features of CEUS of APF group after the RFA were twenty-eight cases(90.3%), showing iso-enhancement during portal phase and twenty-five(80.6%) cases showing iso-enhancementduring delayed phase. Twenty-one(61.8%) cases of HCC group showed hypo-enhancement during portal phase and Twenty-eight(82.4%) cases showed hypo-enhancement during delayed phase. The differences between the two groups had statistically significant. Twenty-seven(87.1%) cases of APF group showed hyper-enhancement during arterial phase and thirty-three(97.1%) cases of HCC group showed hyper-enhancement during arterial phase. No significant differences existed between the two groups. Conclusion The CEUS of secondary APF after the RFA on HCC has distinct characteristics which could help to be discriminate from the intrahepatic recurrent HCC.
Objective To explore the perfusion features of contrast-enhanced ultrasound(CEUS) at secondary arterio-portal fistula(APF) after the radio-frequency ablation(RFA) of hepatocellular carcinoma(HCC) and to compare the difference between them with the CEUS perfusion pattens of ectopic recurrent HCC. Methods From Jan 2010 to Oct 2016, tmenty-nine cases(31 lesions) of HCC were visited lishni center hospital, we retrospectively analyzed those patients treated with RFA, who were confirmed as secondary AFP by dirital substraction angiography(DSA), selccted as APF group. Thirty cases(34 lesions) were selected from the same period, by surgery pathology or clinical in the diagnosis of ectopic recurrent HCC patients as HCC group. The CEUS features includes enhancement shape at arterial phase and enhancement extent at different phases. The enhancement shape at arterial phase and the enhancement extent at different phases of APF group and HCC group were compared with Fisher's exact test. Results Twenty-seven(87.1%) cases of APF group after the RFA showed wedgelike and thirty(88.2%) cases of HCC group showed global enhancement during arterial phase. The differences of enhancesment shape at arterial phase had statistically significant. The features of CEUS of APF group after the RFA were twenty-eight cases(90.3%), showing iso-enhancement during portal phase and twenty-five(80.6%) cases showing iso-enhancementduring delayed phase. Twenty-one(61.8%) cases of HCC group showed hypo-enhancement during portal phase and Twenty-eight(82.4%) cases showed hypo-enhancement during delayed phase. The differences between the two groups had statistically significant. Twenty-seven(87.1%) cases of APF group showed hyper-enhancement during arterial phase and thirty-three(97.1%) cases of HCC group showed hyper-enhancement during arterial phase. No significant differences existed between the two groups. Conclusion The CEUS of secondary APF after the RFA on HCC has distinct characteristics which could help to be discriminate from the intrahepatic recurrent HCC.
引文
[1] 沈立杰,严鹏,张娟娜,等.CT引导下氩氦冷冻、射频消融和微波消融治疗肝癌的疗效对比[J].医学影像学杂志,2015,25(10):1836-1839.
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[6] Ibnmaidoubhassani K, Mohsine R, Belkouehi A, et al. Post-traumatic arteriovenous fistula of the hepatic pedicle [J]. J Visesurg, 2010, 147(5): 333-336.
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[9] Lim HK, Choi D, Lee WJ, et al. Hepatocellularcarcinomatreated with percutaneousradio-frequency ablation: evaluation with follow-upmultiphase helical CT [J]. Radiology, 2001, 221(2): 447-454.
[10] Nicoli N, Casaril A, Abu Hilal M, et al. A ease of rapid intrahepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation [J]. Am J Surg, 2004, 188(2): 165-167.
[11] Yon HA, Vogt C, Willers R, et al. Real-time imaging with the sonographic contrast agent sonovue: differentiationbetween benign and malignant hepatic lesions [J]. J Ultrasound Med, 2004,23(12): 1557-1568.
[12] 郑汉朋, 项剑瑜, 邱乾德,等.原发性巨块型肝癌CT表现与肿瘤细胞分化程度对照分析[J]. 医学影像学杂志, 2013, 23(4): 536-538.
[13] 李春霞, 兰春慧. 肝动脉-门静脉瘘的研究进展[J]. 国际消化病杂志, 2014, 34(4): 238-240.
[14] 陈敏华, 戴莹, 严昆, 等. 超声造影对肝硬化合并小肝癌的早期诊断价值[J]. 中华超声影像学杂志, 2005, 14(2): 116-120.
[15] 王文平, 魏瑞雪, 李超伦, 等. 超声造影诊断复发性肝细胞肝癌的研究[J]. 中华医学超声杂志: 电子版, 2010, 7(1):10-14.
[2] 钱纪江,朱锦龙,章瑾,等.超声引导经皮射频消融治疗肝癌的临床疗效分析[J].医学影像学杂志,2014,24(10):1849-1851.
[3] 陈敏华,严昆,杨薇,等.射频消融治疗方案对肝大肿瘤的临床应用价值[J].中华超声影像学杂志,2004,13(3):190-194.
[4] 顾乐锋,陈伟建,郑汉朋, 等.多层螺旋CT多期动态扫描结合CT血管造影诊断单纯性肝动脉-门静脉瘘[J].中华肝胆外科杂志, 2015,21(6): 369-372.
[5] Claudon M, Dietrich CF, Choi BL, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver-update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS[J]. Ultrasound in Medicine & Biology, 2013, 39(2): 187-210.
[6] Ibnmaidoubhassani K, Mohsine R, Belkouehi A, et al. Post-traumatic arteriovenous fistula of the hepatic pedicle [J]. J Visesurg, 2010, 147(5): 333-336.
[7] 张羲娥, 宋彬, 袁放, 等. 特发性肝动脉静脉畸形的影像学表现[J]. 中国普外基础与临床杂志, 2010, 17(11): 1207-1212.
[8] 吴春, 姜在波, 李名安, 等. 肝脏特发性肝动脉-门静脉畸形1例[J]. 当代医学, 2009, 15(13): 251-252.
[9] Lim HK, Choi D, Lee WJ, et al. Hepatocellularcarcinomatreated with percutaneousradio-frequency ablation: evaluation with follow-upmultiphase helical CT [J]. Radiology, 2001, 221(2): 447-454.
[10] Nicoli N, Casaril A, Abu Hilal M, et al. A ease of rapid intrahepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation [J]. Am J Surg, 2004, 188(2): 165-167.
[11] Yon HA, Vogt C, Willers R, et al. Real-time imaging with the sonographic contrast agent sonovue: differentiationbetween benign and malignant hepatic lesions [J]. J Ultrasound Med, 2004,23(12): 1557-1568.
[12] 郑汉朋, 项剑瑜, 邱乾德,等.原发性巨块型肝癌CT表现与肿瘤细胞分化程度对照分析[J]. 医学影像学杂志, 2013, 23(4): 536-538.
[13] 李春霞, 兰春慧. 肝动脉-门静脉瘘的研究进展[J]. 国际消化病杂志, 2014, 34(4): 238-240.
[14] 陈敏华, 戴莹, 严昆, 等. 超声造影对肝硬化合并小肝癌的早期诊断价值[J]. 中华超声影像学杂志, 2005, 14(2): 116-120.
[15] 王文平, 魏瑞雪, 李超伦, 等. 超声造影诊断复发性肝细胞肝癌的研究[J]. 中华医学超声杂志: 电子版, 2010, 7(1):10-14.