| 摘要: |
| 目的：比较动态三维超声造影(D-3D-CEUS)与增强CT(CECT)肝细胞癌诊断及微波消融后疗效评价作用,探讨两者对肝细胞癌诊断及疗效评价效果。方法：选择2017年10月-2019年1月我院行微波消融治疗的肝细胞癌患者80例,所有患者均进行D-3D-CEUS与CECT检查,比较两种方法对肝细胞癌的诊断情况、动脉期肿瘤内部显示、肿瘤供血血管情况及肿瘤边界情况,所有患者随访1年,以临床随访的最终诊断结果为金标准,对肝细胞癌微波消融后的评价情况及诊断效能进行评价。结果：80例患者经D-3D-CEUS诊断均为肝细胞癌,其中肝细胞癌直径<3cm 55例,肝细胞癌直径≥3cm 25例,肿瘤有内部坏死21例；CECT表诊断均为肝细胞癌,其中肝细胞癌直径<3cm 53例,肝细胞癌直径≥3cm 27例,肿瘤有内部坏死22例,两者对肝细胞癌的直径及内部坏死诊断效能相比,差异无统计学意义(P>0.05)。D-3D-CEUS对肝细胞癌肿瘤供血血管清晰度优于CECT,CECT对肿瘤边界清晰度优于D-3D-CEUS,比较有统计学差异(P<0.05),两种检查方式下动脉期肿瘤内部显示比较无统计学差异(P>0.05)。80例患者经过临床随访最终诊断为局部残留11例,消融完全69例,D-3D-CEUS疗效评价准确率为91.25%(73/80),CECT疗效评价准确率为90.00%(72/80),两种检查方式评价疗效的准确率比较无统计学差异(P>0.05),D-3D-CEUS与CECT对肝细胞癌微波消融后的疗效评价的敏感性、特异性、阴性预测值和阳性预测值分别为94.20%、91.30%、72.73%、81.82%、66.67%、60.00%、95.59%、96.92%,两种检查方式评价疗效的敏感性、特异性、阴性预测值和阳性预测值比较无统计学差异(P>0.05)。结论：D-3D-CEUS在对肝细胞癌肿瘤供血血管清晰度优于CECT,CECT对肿瘤边界清晰度优于D-3D-CEUS,两者对肝细胞癌微波消融后疗效评价均具有较好效果。 |
| 关键词: 动态三维超声造影 增强CT 肝细胞癌 微波消融 疗效评价 |
| DOI： |
| 投稿时间：2020-07-23修订日期：2020-08-24 |
| 基金项目:北京市自然科学基金拟资助项目,编号：7203263 |
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| A comparative study of dynamic three-dimensional contrast-enhanced ultrasound and enhanced CT in the diagnosis of hepatocellular carcinoma and the evaluation of therapeutic effect after microwave ablation |
| Cui Jin,Zhu Shuang-li |
| () |
| Abstract: |
| Objective: To compare the effect of dynamic three-dimensional contrast-enhanced ultrasound (D-3D-CEUS) and enhanced CT (CECT) in the diagnosis of hepatocellular carcinoma and the evaluation of therapeutic effect after microwave ablation, and to explore the effect of both in the diagnosis and evaluation of therapeutic effect of hepatocellular carcinoma. Methods: 80 patients with hepatocellular carcinoma underwent microwave ablation in our hospital from October 2017 to January 2019 were selected. All patients were inspected by D-3D-CEUS and CECT. The diagnosis, the internal display of the arterial phase tumor, the blood supply vessels of the tumor and the tumor boundary of hepatocellular carcinoma of the two methods were compared. All patients were followed up for one year, based on the final results of clinical follow-up as the gold standard, the evaluation and diagnostic efficacy of microwave ablation for hepatocellular carcinoma were evaluated. Results: 80 patients were diagnosed as hepatocellular carcinoma by D-3D-CEUS, among them, there were 55 cases with the diameter of hepatocellular carcinoma <3cm, and 25 cases with the diameter of hepatocellular carcinoma ≥ 3cm, 21 cases with internal necrosis, there were no statistically significant differences between the two in the diagnostic efficacy of diameter and internal necrosis in hepatocellular carcinoma (P>0.05). The clarity of D-3D-CEUS in the blood supply vessels of hepatocellular carcinoma was better than that of CECT, and the clarity of tumor boundary of CECT was better than that of D-3D-CEUS, which had showed a statistical difference (P<0.05). There was no statistical difference between the two groups in the internal display of arterial tumors (P>0.05). After clinical follow-up, 11 patients were finally diagnosed as local residual, 69 patients were completely ablated, the accuracy rate of D-3D-CEUS efficacy evaluation was 91.25% (73/80), the accuracy rate of CECT efficacy evaluation was 90.00% (72/80), there was no statistical difference in the accuracy of the two methods (P>0.05). The sensitivity, specificity, negative predictive value and positive predictive value of D-3D-CEUS and CECT were 94.20%, 91.30%, 72.73%, 81.82%, 66.67%, 60.00%, 95.59% and 96.92% respectively. There were no significant differences in the sensitivity, specificity, negative predictive value and positive predictive value between the two methods (P>0.05).Conclusion: D-3D-CEUS is superior to CECT in the clarity of blood supply vessels of hepatocellular carcinoma, and CECT is superior to D-3D-CEUS in the clarity of tumor boundary. Both of them have good effect on the efficacy evaluation of hepatocellular carcinoma after microwave ablation. |
| Key words: Dynamic three-dimensional contrast-enhanced ultrasound Enhanced CT Hepatocellular carcinoma Microwave ablation Efficacy evaluation |
