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目的探讨低机械指数灰阶超声造影(CEUS)评估经皮微波消融肾细胞癌临床疗效的可行性与准确性。方法 2006年3月—2013年7月,105例肾细胞癌患者109个病灶,平均直径(3.1±1.3)cm行超声引导下经皮微波消融治疗。消融后3 d,CEUS对消融区检查结果与同期增强CT/MRI及穿刺活检病理结果进行比较,对近期消融疗效进行评估;随后1、3和6个月及之后每6个月进行CEUS和CT/MRI检查,对远期消融疗效进行评估。结果微波消融后3 d,CEUS检查显示94个(94/109,86.2%)病灶呈完全消融状态,15个(15/109,13.8%)病灶有残癌。其中,13个(13/15,86.7%)残癌病灶由同期增强CT/MRI检查或活检病理证实。CEUS对微波消融肾癌近期疗效评价的灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为100%、97.9%、98.2%、86.7%和100%。在3~90个月(中位24.6个月)的随访期内,CEUS检查显示有7例复发(1例肾实质内、2例外凸靠近肠道及4例内凸靠近肾盂),其中6例与同期CT/MRI检查相一致,CEUS对消融区的远期疗效评价的灵敏度、特异度、准确性、阳性预测值和阴性预测值分别为85.7%、99.0%、98.2%、85.7%和99.0%。结论实时灰阶CEUS在评估经皮微波消融肾细胞癌疗效方面具有灵敏、准确、便捷的应用价值。
Objective To investigate the feasibility and accuracy of low mechanical index grayscale contrast echocardiography (CEUS) in assessing the clinical efficacy of percutaneous microwave ablation of renal cell carcinoma. Methods From March 2006 to July 2013, 109 patients with 105 renal cell carcinoma were treated with percutaneous microwave ablation under the guidance of ultrasound. The mean diameter was (3.1 ± 1.3) cm. Three days after ablation, CEUS compared ablation zone findings with concurrent enhanced CT / MRI and biopsy pathology results to assess recent ablation efficacy; followed by CEUS and CT at 1, 3, and 6 months and thereafter / MRI examination to evaluate the efficacy of long-term ablation. Results Three days after microwave ablation, CEUS showed 94 cases (94/109, 86.2%) completely ablated and 15 (109/109, 13.8%) had residual cancer. Among them, 13 (13/15, 86.7%) of the lesions were confirmed by concurrent enhanced CT / MRI or biopsy. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS for microwave ablation of renal cell carcinoma were 100%, 97.9%, 98.2%, 86.7% and 100%, respectively. During the follow-up period of 3-90 months (median 24.6 months), CEUS showed a recurrence of 7 (1 in the renal parenchyma, 2 in the proximal gut and 4 in the adjacent renal pelvis), of which 6 Consistent with the CT / MRI examination in the same period, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in evaluating the long-term curative effect of the ablation zone were 85.7%, 99.0%, 98.2%, 85.7% and 99.0% . Conclusion The real-time grayscale CEUS has a sensitive, accurate and convenient application value in evaluating the curative effect of percutaneous microwave ablation of renal cell carcinoma.