聲脈沖輻射力成像技術(shù)評(píng)價(jià)肝癌射頻消融效果的初步研究
發(fā)布時(shí)間：2019-03-01 16:47
【摘要】：目的： 觀察肝臟惡性腫瘤射頻消融術(shù)后消融區(qū)及其邊緣和周邊肝實(shí)質(zhì)在聲輻射力脈沖成像(acoustic radiation force impulse, ARFI)(包括聲觸診組織彈性成像(virtual touch tissue imaging, VTI)和聲觸診組織量化(virtual touch tissue quantification,VTQ)中的表現(xiàn)及變化,探討ARFI在肝臟惡性腫瘤射頻消融術(shù)中的臨床應(yīng)用價(jià)值。 資料和方法： 對(duì)擬行超聲引導(dǎo)下經(jīng)皮射頻消融治療的38例肝臟惡性腫瘤患者的38個(gè)肝癌結(jié)節(jié)行常規(guī)超聲和ARFI成像檢查。術(shù)后定期隨訪,并對(duì)可疑有殘余癌或原位復(fù)發(fā)者做增強(qiáng)MRI檢查,并行穿刺活檢確診。比較治療前病灶與其周邊肝實(shí)質(zhì)的硬度差異,對(duì)比消融區(qū)在VTI、常規(guī)超聲上顯示的大小。觀察消融區(qū)內(nèi)及其邊緣充血帶的硬度變化。 結(jié)果： 1.射頻消融術(shù)前,38例肝臟惡性腫瘤患者中,26例原發(fā)性肝癌患者(A組)病灶內(nèi)VTQ值(1.77±0.82)m/s與周邊肝實(shí)質(zhì)VTQ值(2.25±0.58)m/s,12例轉(zhuǎn)移性肝癌(B組)患者病灶內(nèi)VTQ值(2.16±1.35)m/s與周邊肝實(shí)質(zhì)VTQ值(1.43±0.72)m/s,兩組病灶內(nèi)VTQ值差異無(wú)顯著統(tǒng)計(jì)學(xué)意義(P=0.516),兩組肝實(shí)質(zhì)VTQ值差異有顯著統(tǒng)計(jì)學(xué)意義(P=0.000)。 2.消融區(qū)的VTQ值：2例原發(fā)性肝癌消融區(qū)內(nèi)可測(cè)得數(shù)值,其余24例均為x.xxm/s,4例轉(zhuǎn)移性肝癌消融區(qū)內(nèi)可測(cè)得數(shù)值,其余8例均為x.xx m/s;VTI成像范圍大于常規(guī)超聲的范圍,且兩者的差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。 3.射頻消融術(shù)后,消融區(qū)邊緣的VTQ值大于消融區(qū)周邊肝實(shí)質(zhì)的VTQ值,且在各個(gè)時(shí)間段兩者之間的差異均有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。 4.射頻消融術(shù)后7天、1個(gè)月、2個(gè)月、3個(gè)月,消融區(qū)邊緣隨著時(shí)間的推移VTQ值呈逐漸減小趨勢(shì),但是差異無(wú)顯著統(tǒng)計(jì)學(xué)意義(P0.05)。 5.隨訪期間1例MLC患者出現(xiàn)原位復(fù)發(fā)。 結(jié)論： ARFI成像技術(shù)能夠反復(fù)、無(wú)創(chuàng)地觀察肝臟惡性腫瘤射頻消融治療后短期內(nèi)腫瘤凝固壞死的形態(tài)和范圍及消融區(qū)周邊組織的硬度變化,對(duì)原位復(fù)發(fā)病灶有潛在診斷價(jià)值,有望成為有效評(píng)估肝腫瘤射頻消融療效的方法之一。
[Abstract]:Objective: to observe the radiative power pulse imaging (acoustic radiation force impulse, ARFI) () including acoustic palpation tissue elastography (virtual touch tissue imaging,) in the ablation area, margin and peripheral liver parenchyma after radiofrequency ablation for malignant liver tumors. To explore the clinical value of ARFI in radiofrequency ablation of liver malignant tumor. VTI) and quantitative (virtual touch tissue quantification,VTQ (acoustic palpation tissue) were used to evaluate the clinical value of MRI in radiofrequency ablation of liver malignant tumor. Materials and methods: 38 HCC nodules in 38 patients with hepatic malignant tumor were examined by conventional ultrasound and ARFI. The patients with suspected residual carcinoma or recurrence in situ were examined by enhanced MRI and confirmed by puncture biopsy. The hardness difference between the lesion and the surrounding hepatic parenchyma before treatment was compared, and the size of the ablation area on VTI, conventional ultrasound was compared. The hardness changes of the hyperemia zone in the ablation zone and its edge were observed. Results: 1. Before radiofrequency ablation, in 26 patients with primary liver cancer (group A), the VTQ value was (1.77 鹵0.82) mm2 in the lesion and (2.25 鹵0.58) mm2 in the peripheral hepatic parenchyma, among 38 patients with liver malignant tumor, the VTQ value in the lesion was (1.77 鹵0.82) mm2 in the patients with primary liver cancer (group A). The VTQ values in 12 patients with metastatic liver cancer (group B) were (2.16 鹵1.35) m / s and (1.43 鹵0.72) m / s in peripheral hepatic parenchyma. There was no significant difference in VTQ values between the two groups (P < 0. 516), but there was no significant difference in VTQ values between the two groups (P > 0. 516). There was a significant difference in VTQ between the two groups (P < 0. 000). 2. The values of VTQ in the ablation area were measured in 2 cases of primary liver cancer, the rest 24 cases were x.xxmm2, 4 cases of metastatic liver cancer were measured in ablation area, and 8 cases of x.xxm/s were detected in the ablation area of primary liver cancer, the other 24 cases were measured in the ablation area of HCC, the other 8 cases were VTQ in the ablation area of metastatic HCC. The range of VTI imaging was larger than that of conventional ultrasound, and the difference was statistically significant (P0.05). 3. After radiofrequency ablation, the VTQ value at the edge of the ablation area was higher than that of the hepatic parenchyma around the ablation area, and the difference between the two groups was statistically significant (P0.05). 4. 7 days, 1 month, 2 months, 3 months after radiofrequency ablation, the VTQ value of the edge of the ablation area decreased gradually with the passage of time, but there was no significant difference (P0.05). 5. One patient with MLC recurred in situ during the follow-up period. Conclusion: ARFI imaging can repeatedly and non-invasively observe the shape and extent of tumor coagulation and necrosis after radiofrequency ablation (RFCA) and the hardness changes of the surrounding tissue in the ablation area after radiofrequency ablation (RFCA), which may be of potential value in the diagnosis of recurrent lesions in situ. It is expected to be one of the effective methods to evaluate the efficacy of radiofrequency ablation of liver tumors.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R735.7
本文編號(hào)：2432616
[Abstract]:Objective: to observe the radiative power pulse imaging (acoustic radiation force impulse, ARFI) () including acoustic palpation tissue elastography (virtual touch tissue imaging,) in the ablation area, margin and peripheral liver parenchyma after radiofrequency ablation for malignant liver tumors. To explore the clinical value of ARFI in radiofrequency ablation of liver malignant tumor. VTI) and quantitative (virtual touch tissue quantification,VTQ (acoustic palpation tissue) were used to evaluate the clinical value of MRI in radiofrequency ablation of liver malignant tumor. Materials and methods: 38 HCC nodules in 38 patients with hepatic malignant tumor were examined by conventional ultrasound and ARFI. The patients with suspected residual carcinoma or recurrence in situ were examined by enhanced MRI and confirmed by puncture biopsy. The hardness difference between the lesion and the surrounding hepatic parenchyma before treatment was compared, and the size of the ablation area on VTI, conventional ultrasound was compared. The hardness changes of the hyperemia zone in the ablation zone and its edge were observed. Results: 1. Before radiofrequency ablation, in 26 patients with primary liver cancer (group A), the VTQ value was (1.77 鹵0.82) mm2 in the lesion and (2.25 鹵0.58) mm2 in the peripheral hepatic parenchyma, among 38 patients with liver malignant tumor, the VTQ value in the lesion was (1.77 鹵0.82) mm2 in the patients with primary liver cancer (group A). The VTQ values in 12 patients with metastatic liver cancer (group B) were (2.16 鹵1.35) m / s and (1.43 鹵0.72) m / s in peripheral hepatic parenchyma. There was no significant difference in VTQ values between the two groups (P < 0. 516), but there was no significant difference in VTQ values between the two groups (P > 0. 516). There was a significant difference in VTQ between the two groups (P < 0. 000). 2. The values of VTQ in the ablation area were measured in 2 cases of primary liver cancer, the rest 24 cases were x.xxmm2, 4 cases of metastatic liver cancer were measured in ablation area, and 8 cases of x.xxm/s were detected in the ablation area of primary liver cancer, the other 24 cases were measured in the ablation area of HCC, the other 8 cases were VTQ in the ablation area of metastatic HCC. The range of VTI imaging was larger than that of conventional ultrasound, and the difference was statistically significant (P0.05). 3. After radiofrequency ablation, the VTQ value at the edge of the ablation area was higher than that of the hepatic parenchyma around the ablation area, and the difference between the two groups was statistically significant (P0.05). 4. 7 days, 1 month, 2 months, 3 months after radiofrequency ablation, the VTQ value of the edge of the ablation area decreased gradually with the passage of time, but there was no significant difference (P0.05). 5. One patient with MLC recurred in situ during the follow-up period. Conclusion: ARFI imaging can repeatedly and non-invasively observe the shape and extent of tumor coagulation and necrosis after radiofrequency ablation (RFCA) and the hardness changes of the surrounding tissue in the ablation area after radiofrequency ablation (RFCA), which may be of potential value in the diagnosis of recurrent lesions in situ. It is expected to be one of the effective methods to evaluate the efficacy of radiofrequency ablation of liver tumors.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R735.7
【共引文獻(xiàn)】
相關(guān)碩士學(xué)位論文 前1條
1 何石林;腹腔鏡與開(kāi)腹肝切除術(shù)治療肝硬化肝癌的安全性及預(yù)后分析[D];浙江大學(xué);2014年
，本文編號(hào)：2432616
本文鏈接：http://sikaile.net/yixuelunwen/fangshe/2432616.html
最近更新
教材專著
