Clinical Research On Combination Of Intraoperative CEUS And Synchronal MRI In Monitoring Posttreatment Response Of Microwave Ablation Procedure In Patients With Hepatic Tumor

ObjectiveTo discuss the value of intraoperative contrast enhanced ultrasound(CEUS) combined with synchronal magnetic resonance imaging (MRI) in evaluating the curative effect of percutaneous microwave ablation procedure in patients with hepatic tumor as to increase the inactivated rate in a relatively short period of treatment.Methods30 patients with 36 lesions (24 male,6 female; age range,44-74 years; mean age,56.3 years; 22 cases with primary carcinoma of the liver,2 cases with cholangiocellular carcinoma, and 6 cases with metastatic tumor) who were referred to our institution between September 2008 and September 2010 underwent microwave ablation guided by ultrasound. All the lesions were examined exactly by CEUS after venous bolus injection of SonoVue to investigate the curative effect of microwave ablation. When the suspected lesion was identified further ablation was performed immediately. The result of last CEUS was compared with synchronal MR images (within 6-24hours) to evaluate the curative effect of microwave ablation. If any suspected lesion was found, further ablation would be performed within 48 hours. All the cases were followed-up by CEUS, CECT/CE, MRI and clinical examination after 1-6 months, and biopsy was conducted if necessary. The final curative effect according to the follow up or histologic examination.ResultsIn the 36 lesions treated with microwave ablation,32 were demonstrated completely ablated with immediate CEUS after the ablating procedure. The other 4 lesions who were identified partially remnant were undergone further ablation, and next CEUS showed ablated completely.The 36 lesions were examined by MR synchronally. The 32 lesions that were demonstrated completely ablated with immediate CEUS were showed completely ablated on MR images. In the other 4 lesions, 2 were showed inhomogeneous signals on MR images that were manifested residue with puncture biopsy, and the other 2 lesions were demonstrated completed ablated.There was well consistency in investigating curative effect between immediate CEUS and synchronal MR with the coincidence of 88.9%(32/36) and 94.4%(34/36) respectively.The results of curative effect investigation between CEUS and MRI were not significantly different (P>0.05). The comparison in extent of those lesions between them was not statistically different either (P>0.05). Combined application of them could shorten treatment cycles and increase the inactivated rate.ConclusionBoth intraoperative CEUS and synchronal MRI can exactly detect the hepatic tumor inactivated degree and evaluate the treatment extent of microwave ablation. And each of the two owns its advantages. The combination of intraoperative CEUS and synchronal MRI is proved to be the effective imaging modalities for detection and assessment of post-treatment response of microwave ablation.