| ObjectiveCombining conventional ultrasound and contrast-enhanced ultrasonography(CE-US)mainly to observe the numbers,shape,size and blood supply of hepatocellular carcinoma lesions,master the basic situation of the patients,guide microwave ablation and evaluate curative effect.MethodsBetween November 2014 and December 2016,45 patients with hepatocellular carcinoma who were confirmed by more than two kinds of imaging diagnosis and biopsy pathology were enrolled in the study(males 32,females 13,age from 31 to 79 years old,mean age was 54±6.08 years).All patients were treated with microwave ablation and percutaneous portal vein puncture perfusion chemotherapy.Among them,37 cases had chronic viral hepatitis,31 cases had liver cirrhosis,30 cases were HBV markers positive,7 cases were HCV markers positive,1 case had autoimmune hepatitis,12 cases had hypertension,3 cases had diabetes.All patients had done CE-US and contrast-enhanced magnetic resonance imaging(CE-MRI)scan before interventional therapy.The purpose was to know the numbers,size,location,shape,internal echo,color doppler of lesions and tumor nourish blood vessels and it’s branch,master whether there were important organs and great vessels around them or not,learn the liver basic situation and looked for satellite nodules.53 nodules were detected among all patients.After microwave ablation and percutaneous portal vein puncture perfusion chemotherapy guilded by ultrasound about 15 to 20 minutes,as all strong echo bubbles was over,all patients underwent contrast-enhanced ultrasonography to evaluate the degree of tumor ablation.Further ablation should be performed immediately when the incomplete part was found,it also can be arranged at another time if patient conditions did not allow.According to the reexamination requirements,all the cases were followed-up by CE-US,CE-MRI and clinical examination after 1-12 months which can evaluate the efficacy of the interventional therapy.The lesion would be diagnosed completely ablated by CE-US if the entire ablation lesion was not enhanced all the time.If the internal or surrounding parts of the ablation lesion appeared patchy enhancement in arterial phase and rapidly fading in the portal venous phase and delay period,the lesion would be diagnosed incompletely ablated.The lesion would be diagnosed completely ablated by CE-MRI if the ablation zone present low signal,which meant no enhancement all the time;If part of the ablation lesion presented different degree of enhancement in arterial phase,and rapidly fading in delayed phase,the lesion would be diagnosed incompletely ablated.Result:1.48 cancer lesions showed the typical enhanced mode(fast-in and fast-out)by CE-US:hyperechoic enhancement in the arterial phase,hypoechoic enhancement in the portal and delayed phases.4 cancer lesions(diameter of less than 2 cm)showed hyperechoic enhancement in the arterial and isoechoic in the portal and delayed phases.2.During preoperative examination,conventional ultrasound detected 46 cancer lesions,CE-US 52 lesions and CE-MRI 53 lesions.In terms of detecting lesions’ number,compared with conventional ultrasound,CE-US had significant difference(X2=4.867,P=0.027,p<0.05),however,CE-US and CE-MRI had no significant difference(X2=1.010,P=0.315,p>0.05).Through comparing the cancer lesions’ size before and after microwave ablation,the results was as follows.When used CE-US,the average length diameter and average short diameter respectively were 3.01±1.05 and 2.6±1.22 before operation,4.4±1.61 and 4.2±1.23 were gotten after the operation.When used CE-MRI,the average length diameter and average short diameter respectively were 3.06±1.08 and 2.3±1.9 before operation,5.0±1.89 and 4.0±1.21 were gotten after the operation.The results expressed there was no statistically significant in the range of the cancer lesions’ size compared CE-US and CE-MRI(P>0.05).3.All patients had done CE-US after operation,46 lesions were diagnosed completely ablated.7 lesions were diagnosed incompletely ablated because of displaying irregular hyperechoic enhancement in their internal or surrounding at arterial phase,rapidly fading in the portal venous phase and delayed phase.After further ablation,next CE-US showed ablated completely.4.Among 7 lesions which had undergone further ablation,2 lesions were diagnosed incompletely ablated by CE-MRI because of displaying different degree of enhancement in their internal or surrounding in arterial phase,rapidly fading in delayed phase and alive tumor cells confirmed by biopsy in these lesions.Further ablation would be arranged at a good time.The other 51 lesions were demonstrated completely ablated.5.Among 51 lesions which were confirmed completely ablated by CE-US and CE-MRI,2 patients’ serum AFP kept higher than 200μg/L in the process of the late follow-up(who had only one lesion).After operation 1-2 months,reexamination of CE-MRI hinted there had local residual and alive tumor cells were confirmed by biopsy in these lesions.The final diagnosis: 49 lesions ablated completely,4 lesions had local residual.Actually CE-US displayed that 53 lesions were completely ablated,while CE-MRI hinted 51 lesions completely ablated and 2 lesions had local residual.In terms of evaluating effect of microwave ablation,compared with CE-MRI,CE-US had no statistical differences(k=1.00,P<0.05).Conclusion:The key to the success of microwave ablation cancer lesion is the whole tumor was completely inactivated,so it is significantly relevant to estimate the degree of ablated nodules.CE-US not only can identify benign and malignant lesions,show tumor infiltrating range and the relationship of important organs or great vessels around them,especially distribution of cancer lesions’ nourishing blood vessels and its’ branch,guide the needle direction and melting range and estimate the degree of ablated nodules.Compared with CE-MRI,CE-US has the following advantages: low demands on patients condition,simple operation,price moderate,repeated examination in short period,It is indeed an effective method to estimate the curative effect of interventional treatment of hepatocellular carcinoma. |
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