RÉSUMÉ
Objective:To compare the safety and short-term efficacy of percutaneous thermal ablation for liver cancer at hepatic dome guided by ultrasound with assisted technologies or computed tomography.Methods:Patients who underwent thermal ablation of liver cancer at hepatic dome from January 2016 to October 2019 in the Xixi Hospital affiliated to Zhejiang Chinese Medical University were studied. Using the different guidance methods, the patients were divided into the ultrasound guidance combined with assisted technologies group (the ultrasound guided group) and the CT guided group. Assisted technologies included contrast-enhanced ultrasound, fusion imaging and artificial ascites. The complications during and within one week of ablation were recorded to compare the safety between the two guidance methods. One month after ablation, contrast-enhanced CT or contrast-enhanced MRI was performed to evaluate the short-term efficacy.Results:Of 52 patients who were included in the study, 39 had no previous treatment while 13 had recurrent liver cancer (7 underwent previous surgical resection and 6 thermal ablation). There were 41 males and 11 females, age ranged from 38.0 to 76.0 (57.3±10.0) years. The tumor size was 12.0 to 46.0 (30.7±8.8) mm. Of the 34 patients in the ultrasound guided group, the age ranged from 38.0 to 73.0 (56.6±10.2) years, and the tumor size ranged from 17.0 to 46.0 (30.6±8.7) mm. Of the 18 patients in the CT guided group, the age ranged from 39.0 to 76.0 (58.1±9.8) years, and the tumor size ranged from 12.0 to 45.0 (30.9±9.2) mm. There were no significant differences in age and tumor size between the two groups ( P>0.05). During and within one week of ablation, 3 patients developed hydrothorax in the ultrasound guided group and 8 patients developed hydrothorax, and 7 patients pneumothorax in the CT guided group. The difference between the two groups was significant ( P<0.05). All complications were successfully treated with conservative treatment. One month after ablation, the complete ablation rate was 91.2% (31/34) in the ultrasound guided group and 88.9% (16/18) in the CT guided group. There was no significant difference between the two groups ( P>0.05). Conclusion:The two methods of guidance resulted in similar short-term efficacy after thermal ablation for liver cancer at hepatic dome. Compared with computed tomography guidance, ultrasound guidance with assisted technologies significantly reduced the incidence of thoracic complication rates.
RÉSUMÉ
Objective To evaluate the role of two-dimensional ultrasound combined with contrast-enhanced ultrasonography (CEUS) in the classification of liver nodules in cirrhotic patients.Methods Consecutively cirrhotic patients with intrahepatic nodules at Xixi Hospital of Hangzhou were included from November 2015 to December 2016.All (142 nodules in 109 patiens) presented as non-cancerous focal lesions on conventional magnetic resonance imaging and CT examination and had available information of liver biopsy.Each lesion was percutaneous biopsied under the guidance of two-dimensional ultrasound.Ultrasonographic parameters evaluated were as following:(1) sizes of nodules under US;(2) ultrasonographic characteristics of the nodular;(3) CEUS enhancement features of the nodules.Four types of hepatic nodule suggesting different histology were defined according to the ultrasonographicparameters.x2 test was used to compare the difference of hepatocellular carcinoma (HCC) incidence among liver nodules with varying sizes and nodules with different enhancement features under CEUS.As for the statistical differences of HCC and high-grade dysplastic nodule (HGDN) incidence between type Ⅲ & Ⅳ nodules and type Ⅰ & Ⅱ nodules,x2 test was also used for analysis.Results A total of 142 eligible nodules were detected in 109 patients with cirrhosis,including 16 HCCs,2 intrahepatic cholangiocellular carcinomas (ICC),41 HGDNs,40 low-grade dysplastic nodules (LGDN) and 43 regenerative nodules (RN).In terms of diameter,all (6/6) the nodules larger than 2.0 cm,20.0％ (8/40) of middle size nodules (1.5-2.0 cm),were HCCs.The remained 2 lesions of HCC came from two subgroups with even small size nodules [1.0-1.4 cm (n=93),and ＜ 1.0 cm (n=3),in diameter],respectively.Two lesions of ICC were attributed to nodules with a 1.0-1.4 cm diameter.About 28 nodules with a diameter of 1.5-2.0 cm,13 nodules with a diameter of 1.0-1.4 cm were HGDN.HCC incidences between these 4 groups were different significantly (x2=61.425,P ＜ 0.001).Asfor the CEUS,14 nodules exhibited a rapid enhancement feature in arterial phase,12 of which were HCC.In56 nodules with a slow enhancement feature,4 nodules were HCC.HCC incidences between these 3 groups were different significantly (x2=75.752,P ＜ 0.001).Under the combined ultrasonography,HCC incidences of type Ⅲ and type Ⅳ nodules were significantly higher than that of type Ⅰ and type Ⅱ lesions [21.9％ (16/73)vs 0 (0/65),x2=15.222,P ＜ 0.001],similar result was observed in the comparison of HGDN incidences between type Ⅲ & Ⅳ and type Ⅰ & Ⅱ nodules[53.4％ (39/73) vs 3.1％ (2/65),x2=38.842,P ＜ 0.001].Conclusion The classification presented by this study,combining the three ultrasonographic parameters,which is nodule size,nodular echo characteristics and enhancement features of the nodules under CEUS,could be helpful for the diagnosis of HCC in cirrhotic patients with ill-defined nodule on routine image examination.