CEUS与二维超声预测肝癌US-PMMA治疗后复发的价值

doi:10.3760/cma.j.cn441417-20241104-10013

摘要/Abstract

摘要：

目的　探讨超声造影（contrast-enhanced ultrasound imaging，CEUS）与二维超声预测早期肝癌患者超声引导下经皮微波消融（percutaneous microwave ablation with ultrasonic guidance and polymerization of methyl methacrylate，US-PMMA）治疗后复发的价值。方法　选取2022年3月至2023年3月在西安国际医学中心医院接受US-PMMA治疗的早期肝癌患者82例为研究对象，其中男64例，女18例，年龄32～78（55.43±10.35）岁。所有患者术前均行二维超声、CEUS检查，根据术后1年内是否复发分为复发组21例和未复发组61例。比较两组CEUS及二维超声特征（肿瘤长径、肿瘤边界、大血管侵犯、血流分级、包膜类型、延迟期增强、廓清时间等特征）。多因素logistic回归分析早期肝癌患者US-PMMA治疗后复发的危险因素。绘制受试者操作特征曲线（receiver operating characteristic，ROC），计算曲线下面积（area under the curve，AUC），评估CEUS及二维超声特征对早期肝癌患者US-PMMA治疗后复发的预测价值。采用t检验和χ2检验进行统计分析。结果　两组肿瘤长径、肿瘤边界、大血管侵犯、血流分级、包膜类型、延迟期增强、廓清时间等特征比较，差异均有统计学意义（χ2=9.277、5.178、8.433、5.763、20.038、32.382，t=6.578，均P<0.05）。多因素logistic回归分析显示，肿瘤长径≥5 cm（OR=3.916）、肿瘤边界不光滑（OR=4.371）、合并大血管侵犯（OR=4.003）、血流分级Ⅱ～Ⅲ级（OR=3.959）、包膜不完整（OR=4.233）、延迟期低增强（OR=3.873）、廓清时间<70 s（OR=4.212）均为影响早期肝癌患者US-PMMA治疗后复发的独立危险因素（均P<0.05）。ROC显示，联合肿瘤长径≥5 cm、肿瘤边界不光滑、合并大血管侵犯、血流分级Ⅱ～Ⅲ级、包膜不完整、延迟期低增强、廓清时间<70 s预测早期肝癌患者US-PMMA治疗后复发的AUC为0.836，特异度和灵敏度分别为86.89%（53/61）、85.71%（18/21）。结论　CEUS及二维超声通过肿瘤长径、边界、大血管侵犯、包膜等形态学特征和血供情况可有效预测早期肝癌患者US-PMMA治疗后复发的风险。

关键词: 肝癌, , , 超声造影, , , 经皮微波消融, , , 复发, , , 血管侵犯, , , 包膜

Abstract:

Objective　To explore the value of contrast-enhanced ultrasound imaging (CEUS) and two-dimensional ultrasound in the prediction of recurrence of hepatocellular carcinoma after percutaneous microwave ablation with ultrasonic guidance and polymerization of methyl methacrylate (US-PMMA). Methods　Eighty-two patients with early hepatocellular carcinoma who received US-PMMA treatment in Xi'an International Medical Center Hospital from March 2022 to March 2023 were selected as the study objects, including 64 males and 18 females who were 32-78 (55.43±10.35) years old. All the patients underwent preoperative two-dimensional ultrasound and CEUS examinations. They were divided into a recurrence group (21 cases) and a non-recurrence group (61 cases) according to whether they recurred within 1 year after the surgery. The CEUS and two-dimensional ultrasound characteristics (maximum tumor diameter, tumor boundary, macrovascular invasion, blood flow grade, envelope type, enhanced delay period, clearance time, etc) were compared between the two groups. The multivariate logistic regression analysis was conducted to analyze the risk factors for the recurrence of hepatocellular carcinoma after US-PMMA. The receiver operating characteristic curve (ROC) was drawn, and the area under the curve (AUC) was calculated to evaluate the predictive value of CEUS and two-dimensional ultrasound features for the recurrence of early hepatocellular carcinoma after US-PMMA. t and χ² tests were used for the statistical analysis. Results　There were statistical differences between the recurrence group and the non-recurrence group in maximum tumor diameter, tumor boundary, macrovascular invasion, blood flow grade, envelope type, enhanced delay period, clearance time, and other characteristics (χ²=9.277, 5.178, 8.433, 5.763, 20.038, and 32.382; t=6.578; all P<0.05). The multivariate logistic regression analysis showed that the maximum tumor diameter ≥ 5 cm (OR=3.916), unsmooth tumor boundary (OR=4.371), macrovascular invasion (OR=4.003), blood flow grade Ⅱ～Ⅲ (OR=3.959), incomplete envelope (OR=4.233), low enhancement in delay period (OR=3.873), and clearance time < 70 s (OR=4.212) were the independent risk factors for the recurrence of early hepatocellular carcinoma after US-PMMA (all P<0.05). The ROC showed that the combination of maximum tumor diameter ≥5 cm, unsmooth tumor boundary, macrovascular invasion, blood flow grade Ⅱ～Ⅲ, incomplete envelope, low enhancement in delay period, and clearance time <70 s in the prediction of early hepatocellular carcinoma recurrence after US-PMMA had an AUC of 0.836, a specificity of 86.89% (53/61), and a sensitivity of 85.71% (18/21). Conclusion　CEUS and two-dimensional ultrasound can effectively predict the risk of recurrence of hepatocellular carcinoma after US-PMMA through maximum tumor diameter, boundary, macrovascular invasion, capsule morphology, and blood supply.

Key words: Hepatocellular carcinoma, , Contrast-enhanced ultrasound, , Percutaneous microwave ablation, , Recurrence, , Vascular invasion, , Envelope

杨尚云佘雯许诚. CEUS与二维超声预测肝癌US-PMMA治疗后复发的价值 [J]. 国际医药卫生导报, 2025, 31(10): 1646-1650.

Yang Shangyun, She Wen, Xu Cheng.

Value of CEUS and two-dimensional ultrasound in prediction of recurrence of hepatocellular carcinoma after US-PMMA [J]. International Medicine and Health Guidance News, 2025, 31(10): 1646-1650.

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