| Objective:(1) To study the characteristics of blood perfusion in hepatocellular carcinoma (HCC), and to explore the effect of blood perfusion of HCC on radiofrequency ablation (RFA) parameters and ablation zone. (2) To study the effect of liver tissue stiffness measurement (LSM) on the efficacy of RFA in treatment of HCC. (3) To analyse the influence factors on local tumor progression after RFA of HCC, and provide the basis for the RFA in treatment of HCC.Materials and methods:1. From September 2013 to December 2015,62 cases with 66 lesions were involved in the study.66 lesions were given CEUS examination and received CEUS parameters. According the AUC value, the lseions were divided into two gorups:high perfusion group and low perfusion group. The RFA parameters including output power, tissue impedance and treatment time were recorded during the ablation. During the ablation, real-time temperature monitored was applied at two point in the lesion. After the completion of 25KJ ablation-energy, CEUS was performed to measure the LAD, SAD and Volume of the ablated zone. Explore the effects of the blood perfusion on the RFA parameters and temperature field of heat. Study on the relationships of the AUC values and ablated zone.2. From September 2013 to October 2015,106 cases with 114 lesions underwent ultrasound (US)-guided RFA were involved. According the cutoff value of 17.6 kPa, the cases were divided into high-LSM group and low-LSM group. Study the effect of the type of background liver disease and LSM value on the efficacy of RFA.3. A total of 99 cases with 107 lesions were involved in the study. Kaplan-Meier model and log-rank test were used in univariate analysis and Cox proportional hazard model was used in multivariate analysis to identify risk factors for local tumor progression.Results:1.(1) there is a positive linear correlation between HCC perfusion and RFA average output power, ablation time. (2) The T1 and T2 temperatures in the low perfusion group were statistical higher than that of high perfusion group. (3) There is a negative correlation between HCC perfusion and ablation zone including the LAD, SAD and the Volume. The correlations were:y=-0.18×10-3x+3.2711 (r=-0.662, p=0.00)、γ=-0.21×10-3x+2.9988 (r=-0.765, p-0.00) and γ=-0.0031x+15.892 (r=-0.761, p=0.00).2. The TER of high LSM group and low LSM group were 94.4% and 95.3% respectively, and there was no statistical difference between two groups. The LTP rates of high LSM group and low LSM group were 16.9% and 7.0% respectively, and the two groups had statistical difference. The intrahepatic recurence rates of high LSM group and low LSM group were 28.4% and 10.3% respectively, and the two groups had statistical difference.3. Univariate analysis indicated tumor size, adjacent to large vessels, underwent TACE before ablation, Child-Pugh classification, tumor perfusion, the background liver disease and LSM as risk factors for LTP. Multivariate model showed tumor size, adjacent to large vessels, tumor perfusion and LSM were independent risk factors, and the hazard ratio (HR) were 1.12,1.38,1.59 and 1.77 respectively. The patient underwent TACE before ablation was protective factor for LTP (HR 0.52).Conclusions:1. HCC blood perfusion had the side effect on the ablation zone, and HCC blood perfusion had "heat sink effect" on RFA.2. LSM value was a useful predictor of LTP and intrahepatic recurence after RFA.3. Tumor size, adjacent to large vesels, HCC perfusion and LSM were most important risk factors for LTP after RFA. Patient underwent TACE before ablation can decrease the rate of LTP. |
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