采用三维超声造影和自动配准技术快速判断肝癌消融效果的应用基础研究

Hepatocellular carcinoma (HCC) is a common disease in our country. Surgical resection is recognized as the preferred method of treatment of HCC. Since most patients often accompanied by cirrhosis, liver dysfunction, only about 30% of the patients were able to receive the surgical treatment. Currently, radiofrequency ablation has been widely used in non-surgical treatment of hepatocellular carcinoma and has obtained good prognosis. Due to the limited extent of coagulation necrosis, the treatment of medium and large HCC require multiple puncture. Gases generated during ablation will interfere in the subsequence needle puncture which caused the uncertainty of puncture, resulted in inaccurate ablation position and irregular ablation area. It is difficult to timely and accurately determine the safety margin and therapeutic efficacy of the tumor. Contrast-enhanced CT or MR is considered to the gold standard method to determine whether the tumor is complete ablation. due to the surrounding liver parenchymal prone to inflammatory congestive reaction within one month after ablation, it is sometimes difficult to discriminate from residual tumor. In order to accurately ablate the tumor and determine the treatment efficacy, three-dimensional contrast-enhanced ultrasound imaging before and after ablation of liver tumors will be performed to compare the relationship of the three-dimensional structure of lesion with that of ablated area, accurately calculate the safety margin of the tumor, and accurately determine the treatment outcome with the application of automatic registration technique and multi-planar technique.

肝细胞癌是我国的常见病和多发病。外科切除是公认治疗肝细胞癌的首选方法。由于大多数患者常伴有肝硬化，肝功能差，仅有30%左右的患者能够获得手术机会。目前，射频消融已经广泛应用于肝细胞癌的非手术治疗，并取得较好的疗效。但是由于消融范围有限，治疗中、大肝癌需要多次穿刺、消融过程中产生的气体会干扰二次进针，增加穿刺的不确定性，导致消融位置不准确和消融范围不规则，难以及时准确判断安全边缘及治疗效果。增强CT或MR被公认为判断肿瘤是否完全消融的金标准，但是射频消融后1月内病灶周围的肝实质容易产生炎症充血性反应，难与肿瘤残留鉴别开来。为了精准地进行肿瘤消融和疗效判断，本研究拟在消融前后进行肝脏肿瘤快速三维超声造影成像，应用自动配准技术和多平面重建技术，比较病灶与消融灶的空间立体结构，精确计算出肿瘤的安全消融边缘从而准确判断病灶的消融效果

射频消融已经广泛应用于肝细胞癌的非手术治疗，并取得较好的疗效。但是由于消融范围有限，治疗中、大肝癌需要多次穿刺、消融过程中产生的气体会干扰二次进针，增加穿刺的不确定性，导致消融位置不准确和消融范围不规则，难以及时准确判断安全边缘及治疗效果。增强CT或MR被公认为判断肿瘤是否完全消融的金标准，但是射频消融后1月内病灶周围的肝实质容易产生炎症充血性反应，难与肿瘤残留鉴别开来。为了精准地进行肿瘤消融和疗效判断，本研究拟在消融前后进行肝脏肿瘤快速三维超声造影成像，应用自动配准技术和多平面重建技术，比较病灶与消融灶的空间立体结构，精确计算出肿瘤的安全消融边界从而准确判断病灶的消融效果。.主要研究内容包括通过体外实验验证单模态3DCEUS融合成像技术评估肿瘤消融安全边界的准确性和可重复性，通过临床研究评估该平台的可行性、准确性和临床意义。第一部分为单模态3DCEUS融合成像技术评估肿瘤消融安全边界的体外实验研究，重要结果包括：1、制作体外模型，其中体外实验的安全边界不足模型部分（n=36）已完成；2、术前、术后3DCEUS图像质量良好；3、3DCEUS融合成像效能分析：配准成功率高，耗时短；4、3DCEUS融合成像评估安全边界：准确性、可重复性高。第二部分为单模态3DCEUS融合成像技术评估肝癌安全边界的临床研究，重要结果包括：共收集120例患者的临床资料，配准平均耗时短，配准成功率约90%，安全边界<5mm与肿瘤局部进展相关；3DCEUS融合成像与CT融合成像评估消融安全边界的一致性高。总之，三维超声造影融合成像技术可以即刻评估肝癌射频消融的安全边界，安全边界小于5mm对肿瘤局部进展的发生有较高的预测价值。如在术中判断安全边界不足（< 5mm），可在术中即刻进行补充消融。