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中华医学超声杂志（电子版） ›› 2021, Vol. 18 ›› Issue (01) : 45 -49. doi: 10.3877/cma.j.issn.1672-6448.2021.01.010

所属专题： 文献；

腹部超声影像学

经肝动脉超声造影对经肝动脉栓塞化疗治疗肝细胞癌效果的评价
韩鹏1, 罗渝昆1,†(), 费翔1, 姜波1, 王志军2, 贺崇1   
  1. 1. 100853　北京，中国人民解放军总医院第一医学中心超声诊断科
    2. 100853　北京，中国人民解放军总医院第一医学中心介入放射科
  • 收稿日期:2019-06-21 出版日期:2021-01-01
  • 通信作者: 罗渝昆
  • 基金资助:
    人工智能辅助便捷式超声对腹部实质脏器战创伤自动诊断系统的建立(2H19021)

Clinical value of transhepatic arterial contrast-enhanced ultrasonography in assessing efficacy of transarterial chemoembolization for hepatocellular carcinoma

Peng Han1, Yukun Luo1,†(), Xiang Fei1, Bo Jiang1, Zhijun Wang2, Chong He1   

  1. 1. Department of Ultrasonography, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    2. Department of Interventional Radiology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2019-06-21 Published:2021-01-01
  • Corresponding author: Yukun Luo
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韩鹏, 罗渝昆, 费翔, 姜波, 王志军, 贺崇. 经肝动脉超声造影对经肝动脉栓塞化疗治疗肝细胞癌效果的评价[J/OL]. 中华医学超声杂志（电子版）, 2021, 18(01): 45-49.

Peng Han, Yukun Luo, Xiang Fei, Bo Jiang, Zhijun Wang, Chong He. Clinical value of transhepatic arterial contrast-enhanced ultrasonography in assessing efficacy of transarterial chemoembolization for hepatocellular carcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(01): 45-49.

目的

探讨经肝动脉超声造影评价经肝动脉栓塞化疗（TACE）治疗肝细胞癌（HCC）效果的临床应用价值。

方法

选取解放军总医院第一医学中心2018年9月至2019年2月因肝肿瘤行TACE治疗的38例HCC患者（共48个病灶），分别行术前及术后即刻经肝动脉超声造影，通过观察肿瘤内及引流区是否增强评估疗效，并与TACE术后1个月的MRI结果进行对比。患者经肝动脉超声造影与MRI结果采用配对资料的χ2检验，采用Kappa检验评价经肝动脉超声造影与MRI结果的一致性，并评价其诊断效能。

结果

术后即刻仅观察瘤内是否增强判断栓塞疗效与术后1个月MRI相比差异无统计学意义（P=0.289），同时观察肿瘤内及引流区是否增强判断疗效与术后1个月MRI相比差异无统计学意义（P=1.000），同时观察瘤内及引流区的评估结果一致性高于仅观察瘤内的评估结果（Kappa值：0.780 vs 0.664；P＜0.001）。同时观察瘤内及引流区的评估结果特异度为84.2%、敏感度为93.1%、准确性为89.5%，均高于仅观察瘤内的评估结果（79.3%、89.4%、83.3%）。

结论

采用经肝动脉超声造影观察HCC瘤内及引流区是否增强可以术后即刻且准确地评价TACE治疗疗效，具有较高的临床价值。

关键词: 经肝动脉超声造影, 引流区, 经肝动脉栓塞化疗, 肝细胞癌
Objective

To assess the clinical application value of transhepatic arterial contrast-enhanced ultrasonography in evaluating the therapeutic effect of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

Methods

Thirty-eight patients with 48 lesions of HCC underwent TACE at the First Medical Center of Chinese PLA General Hospital from September 2018 to February 2019. All of them underwent preoperative and postoperative transhepatic arterial contrast-enhanced ultrasonography to evaluate the therapeutic effect by observing the enhancement in tumor and drainage area. The outcomes of magnetic resonance imaging (MRI) one month after TACE were used for comparison. The results of transhepatic arterial contrast-enhanced ultrasonography and MRI were compared by the χ2 test, and the Kappa test was used to evaluate the consistency of the results of transhepatic arterial contrast-enhanced ultrasonography and MRI.

Results

The enhancement in tumor immediately after TACE was not different from the result of magnetic resonance imaging (MRI) one month after TACE (P=0.289). The enhancement in tumor and drainage area immediately after TACE was not different from the outcomes of magnetic resonance imaging (MRI) one month after TACE (P=1.000). The Kappa in observing the enhancement in tumor and drainage area was higher than that in observing the enhancement in tumor (0.780 vs 0.664, P＜0.001). The specificity, sensitivity, and accuracy in observing the enhancement in both tumor and drainage area were 84.2%, 93.1%, and 89.5%, respectively, which were higher than those in observing the enhancement in tumor alone (79.3%, 89.4%, and 83.3%).

Conclusion

Transhepattic arterial contrast-enhanced ultrasonography could observe the enhancement in tumor and drainage area immediately after TACE, and has high clinical value in evaluating the therapeutic effect of TACE.

Key words: Transhepatic arterial contrast-enhanced ultrasonography, Drainage area, Transarterial chemoembolization, Carcinoma, hepatocellular
图1 肝细胞癌患者术前及术后即刻经肝动脉超声造影图像。经肝动脉栓塞化疗（TACE）术前（图a~d）：肝右叶近被膜处可见一偏高回声结节（图a标尺处）；彩色多普勒检查示其周边部可见血流信号（图b箭头处）；经肝动脉超声造影提示5 s时结节呈均匀高增强（图c）；48 s时结节周边部可见引流区（图d箭头示）。TACE术后（图e~h）：术后即刻结节内由于栓塞剂沉积呈不均匀高增强（图e标尺处）；术后即刻经肝动脉超声造影提示4 s时结节周边部可见少量点状强化（图f箭头处）；5 s时病灶周围肝呈不均匀强化（箭头处），灌注速度较前减慢（图gΔ处）；60 s时结节周边可见引流区部分残留（图h箭头处）
图2 同一肝细胞癌患者术后1个月MRI图像。术后1个月MRI显示动脉期病灶内可见强化（图a），延迟期强化消退（图b），提示病灶仍存在活性（箭头处为目标病灶）
表1 经肝动脉超声造影仅观察瘤内和同时观察瘤内与引流区评估结果与MRI结果对比
超声造影观察范围 MRI 总计
有残留 无残留
瘤内

有残留

 23 2 25

无残留

 6 17 23
瘤内与引流区

有残留

 27 3 30

无残留

 2 16 18
合计 29 19
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