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ENGLISH ABSTRACT
超声造影在肝细胞癌诊断及射频消融治疗效果评估中的应用
潜潇
陈志辉
周芳芳
作者及单位信息
·
DOI： 10.3760/cma.j.cn341190-20240605-00690
Application of contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma and evaluation of the therapeutic efficacy of radiofrequency ablation
Qian Xiao
Chen Zhihui
Zhou Fangfang
Authors Info & Affiliations
Qian Xiao
Graduate School, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Chen Zhihui
Department of Ultrasonography, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
Zhou Fangfang
Department of Ultrasonography, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
·
DOI： 10.3760/cma.j.cn341190-20240605-00690
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摘要

目的探讨超声造影（CEUS）在肝细胞癌（HCC）诊断及射频消融治疗效果评估中的应用价值。

方法采用病例对照研究，在丽水市中心医院2019年1月至2023年1月诊治的HCC高风险患者（接受穿刺活检）中，选取确诊为HCC患者118例为病例组，按1∶1原则选取乙型病毒性肝炎肝硬化患者118例为对照组；两组患者均进行CEUS检查，对比分析CEUS对HCC的诊断价值；病例组给予1个月射频消融治疗，以钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）检查结果为标准，评估CEUS在HCC射频消融疗效评估中的应用价值。

结果CEUS检查结果与病理诊断结果比较，病例组误诊6例，对照组漏诊8例。CEUS检查诊断准确率为94.07%，CEUS检查 Cohen´s Kappa值为0.88，提示CEUS诊断结果和病理诊断结果一致性较好。射频消融后，病例组甲胎蛋白水平［（59.78±14.55）μg/L］较射频消融前［（141.27±34.90）μg/L］显著降低，病灶最长径［（28.47±5.41）mm］较射频消融前［（17.44±4.17）mm］增大（ t=24.32、-16.46，均 P < 0.001）。CEUS评估术后肿瘤最长径与Gd-EOB-DTPA增强MRI结果差异无统计学意义（ P > 0.05）；CEUS评估射频消融疗效与Gd-EOB-DTPA增强MRI结果比较，真阳性8例，真阴性107例，误诊3例。CEUS检查在HCC射频消融疗效评估中准确率为97.46%， Cohen´s Kappa为0.83。

结论CEUS在HCC诊断中具有较高的准确率，并可作为射频消融疗效评估的有效手段，与病理诊断及Gd-EOB-DTPA增强MRI结果一致性良好，具有较高的临床应用价值。

癌，肝细胞;超声检查，多普勒，彩色;血管造影术;导管消融术;磁共振成像;钆塞酸二钠
ABSTRACT

ObjectiveTo investigate the application of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatocellular carcinoma (HCC) and evaluate the therapeutic efficacy of radiofrequency ablation.

MethodsA case-control study was conducted among high-risk HCC patients who underwent puncture biopsies at Lishui Central Hospital from January 2019 to January 2023. A total of 118 confirmed HCC patients were selected as the case group, and 118 patients with hepatitis B cirrhosis were selected as the control group, following a 1:1 matching principle. All patients underwent a CEUS examination, and the therapeutic efficacy of CEUS in detecting HCC was analyzed. The case group underwent radiofrequency ablation for 1 month. The case group underwent 1 month of radiofrequency ablation treatment, and the application value of CEUS in assessing the efficacy of radiofrequency ablation for HCC was evaluated based on the results of Gd-EOB-DTPA-enhanced magnetic resonance imaging.

ResultsThe results of the CEUS examination were compared with the pathological diagnosis results. In the case group, 6 cases were misdiagnosed, while in the control group, 8 cases were missed. The diagnostic accuracy of CEUS was 94.07%, and the Cohen's Kappa value for CEUS was 0.88, indicating a good consistency between CEUS and pathological diagnosis results. After radiofrequency ablation, the alpha-fetoprotein levels in the case group decreased significantly from [(141.27 ± 34.90) μg/L] before the procedure to [(59.78 ± 14.55) μg/L] after the procedure ( t = 24.32, P < 0.001). However, the longest diameter of the lesions increased from [(17.44 ± 4.17) mm] before the procedure to [(28.47 ± 5.41) mm] after the procedure ( t = -16.46, P < 0.001). There was no statistically significant difference in the longest diameter of the tumors assessed by CEUS postoperatively compared to the Gd-EOB-DTPA-enhanced MRI results ( P > 0.05). When comparing the efficacy of radiofrequency ablation assessed by CEUS to the results from Gd-EOB-DTPA-enhanced MRI, there were 8 true positive cases, 107 true negative cases, and 3 cases that were misdiagnosed. The accuracy of CEUS in assessing the efficacy of radiofrequency ablation for HCC was 97.46%, with a Cohen's Kappa value of 0.83.

ConclusionsCEUS demonstrates a high accuracy in the diagnosis of HCC and can serve as an effective method for evaluating the efficacy of radiofrequency ablation. It shows good consistency with pathological diagnoses and Gd-EOB-DTPA-enhanced MRI results, indicating a high clinical application value.

Carcinoma, hepatocellular;Ultrasonography, doppler, color;Angiography;Catheter ablation;Magnetic resonance imaging;Disodium gadolinium selenate
Qian Xiao, Email: mocdef.3ab6171042875881

Qian Xiao is currently working at Lishui Central Hospital, Lishui 323000, Zhejiang Province, China

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引用本文

潜潇,陈志辉,周芳芳. 超声造影在肝细胞癌诊断及射频消融治疗效果评估中的应用[J]. 中国基层医药,2025,32(03)：326-330.

DOI:10.3760/cma.j.cn341190-20240605-00690

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肝细胞癌（HCC）为临床常见的恶性肿瘤，其早期症状隐匿，诊断时多已进入中晚期。因此，及早发现与准确诊断对于改善患者预后具有重要意义。传统的二维灰阶超声虽然简便，但在获取肿瘤供血和血管信息方面存在局限性，无法满足临床对肝细胞癌早期诊断的需求 ［ 1 ］ 。近年来，超声造影（CEUS）技术的出现，为HCC的诊断打开了新局面。CEUS能够实时清晰地显示肝脏内各时期血流灌注情况，获取肝脏内微循环分布状态，并通过分析肝脏血流动力学变化特征，对病灶性质进行判定 ［ 2 , 3 ］ 。这一技术的应用，显著提高了肝脏小病灶的检出率、鉴别诊断率和早期肝癌诊断率，为HCC的早期发现提供了有力工具 ［ 4 ］ 。此外，随着射频消融等微创治疗技术在HCC治疗中的广泛应用，如何准确评估治疗效果成为临床关注的焦点 ［ 5 ］ 。传统的增强磁共振成像（MRI）或计算机体层成像（CT）虽然能够提供一定的疗效评估信息，但存在辐射、检查时间长、受患者体内金属异物影响等不足 ［ 6 ］ 。相比之下，CEUS因其无创、实时、简便等优点，在射频消融疗效评估中展现出独特的优势 ［ 7 ］ 。鉴于此，该研究旨在通过对比分析CEUS与肝穿刺组织病理学检查结果，评估CEUS在HCC诊断中的价值；同时，结合射频消融术后CEUS与MRI检查结果，探讨CEUS在射频消融治疗效果评估中的应用价值。
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备注信息
A
潜潇，Email： mocdef.3ab6171042875881
B

潜潇：设计试验、采集数据、数据整理、统计分析、技术支持、起草文章；陈志辉：数据整理、统计分析、技术支持、研究指导、论文修改；周芳芳：设计试验、起草文章

C

潜潇现在丽水市中心医院超声科，丽水 323000

D
潜潇, 陈志辉, 周芳芳. 超声造影在肝细胞癌诊断及射频消融治疗效果评估中的应用[J]. 中国基层医药,2025,32(3):326-330. DOI:10.3760/cma.j.cn341190-20240605-00690.
E
所有作者声明不存在利益冲突
F
浙江省医药卫生科技计划 (2022ZH087)
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