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目的探讨融合成像在原发性肝癌(肝癌)热消融治疗术中即时疗效评价中的应用价值。方法本前瞻性研究对象为2014年12月至2015年3月在中山大学附属第三医院接受超声引导下肝癌热消融治疗的46例肝癌患者,共计71个病灶。其中男42例,女4例;年龄36~82岁,中位年龄54岁。所有患者均签署知情同意书,符合医学伦理学规定。所有肝癌病灶完成热消融后优先采用超声造影-CT/MRI融合成像技术进行疗效评价,当无法完成时则采用单纯超声造影评价。根据评价方法分为融合成像组和超声造影组。观察指标包括两组病灶的大小、补充消融率、完全消融率。两组病灶直径的比较采用Z检验,率的比较采用χ2检验或Fisher确切概率法。结果本研究中25例患者共31个病灶采用融合成像即时疗效评价,26例患者共40个病灶采用单纯超声造影评价。以病灶直径≥20 mm作为界值,融合成像组占58%(18/31),明显高于超声造影组的30%(12/40)(χ2=5.638,P<0.05)。融合成像组的补充消融率为52%(16/31),明显高于超声造影组的22%(9/40)(χ2=6.489,P<0.05)。融合成像组的完全消融率为100%(31/31),超声造影组为95%(38/40),差异无统计学意义(P=0.501)。结论融合成像与单纯超声造影均为术中即时疗效评价的重要方法,融合成像对于较大病灶能够更精准地进行即时疗效评价,有助于提高完全消融率。
Objective To investigate the value of fusion imaging in the evaluation of immediate curative effect of thermal ablation of primary liver cancer (HCC). Methods This prospective study was conducted in 46 patients with HCC undergoing ultrasound-guided thermal ablation of liver cancer at the Third Affiliated Hospital of Sun Yat-sen University from December 2014 to March 2015, for a total of 71 lesions. There were 42 males and 4 females, aged from 36 to 82 years, with a median age of 54 years. All patients signed informed consent, in line with medical ethics rules. All liver cancer lesions after the completion of thermal ablation precede the use of ultrasound contrast-CT / MRI fusion imaging for evaluation of efficacy, when not completed when the use of simple ultrasound contrast evaluation. According to the evaluation method is divided into fusion imaging group and ultrasound contrast group. Observations include the size of the two groups of lesions, additional ablation rate, complete ablation rate. Z-test was used to compare the diameters of two lesions, and the rates were compared using Chi-square test or Fisher’s exact test. Results Totally 31 lesions of 25 patients in this study were evaluated by fusion imaging. The lesions of 26 patients were evaluated by simple contrast-enhanced ultrasound. The fusion imaging group accounted for 58% (18/31), which was significantly higher than that of ultrasound contrast group (12/40) (χ2 = 5.638, P <0.05). The fusion ablation rate was 52% (16/31) in the fusion group, which was significantly higher than that in the contrast group (22%, 9/40) (χ2 = 6.489, P <0.05). The complete ablation rate was 100% (31/31) in the fusion group and 95% (38/40) in the CEUS group, with no significant difference (P = 0.501). Conclusion Both fusion imaging and simple contrast-enhanced ultrasound are important methods for immediate assessment of intraoperative efficacy. Fusion imaging can be used to evaluate the immediate effect more accurately for larger lesions and improve the complete ablation rate.