| Research BackgroundHepatocellular carcinoma(HCC)is the fourth common cause of death in China,which is a serious threat to the health of our people.Hepatocellular carcinoma usually develops from chronic hepatocellular disease.Regular monitoring can detect the lesions early.Early detection and early treatment is one of the keys to improve the survival rate of patients.Ultrasound is a common method to regularly monitor the occurrence of liver lesions in high-risk patients,but because some lesions can not be displayed in conventional ultrasound,when the patients have the corresponding clinical symptoms,the best treatment time is delayed.Therefore,it is very important to understand the factors that affect the poor display of liver cancer in ultrasound and adjust the mode of image monitoring in time.Ablation has been proved to be an effective method for local treatment of early hepatocellular carcinoma.Ultrasound has become the most commonly used imaging method to guide the ablation of liver cancer because of its real-time,convenient and low cost.however,a considerable number of liver cancer lesions can not be displayed or can not be clearly displayed in ultrasound.In order to overcome this problem,CT/MRI-US image fusion technology based on electromagnetic navigation system arises at the historic moment and is used to guide percutaneous liver cancer biopsy and ablation treatment of liver cancer.For liver cancer with poor conventional ultrasound,contrast enhanced computed tomography(CT)or magnetic resonance imaging(MRI)can also be used to guide ablation.CT has high spatial resolution,but poor soft tissue resolution and transient enhancement of contrast agent are not conducive to long-term display of lesions and monitoring of ablation range during operation.MRI has high soft tissue resolution,multi-parameter multimodal imaging,high detection rate of liver cancer lesions and no ionizing radiation,so it is an excellent means to guide and monitor liver cancer ablation.Most of the current studies only evaluate the feasibility or efficacy of ultrasound ablation of poor liver cancer guided by MRI or CT/MRI-US fusion imaging,but there are few comparative studies on the efficacy of these two image-guided methods in the treatment of poor liver cancer,but there are significant differences in the surgical methods and equipment requirements of the two image-guided methods.The differences and advantages and disadvantages of important indexes such as operation success rate,technical efficiency,local progression rate,operation time and occurrence of complications are not clear.therefore,the comparative study of the two image-guided methods is of great value and significance for the selection of ablation methods for poor ultrasound display of liver cancer.Chapterl Study on the related factors affecting the poor display of Hepatocellular carcinoma in UltrasonographyObjectiveTo explore the factors affecting the detection rate of hepatocellular carcinoma(HCC)which can be clearly displayed on MR but not in ultrasound.MethodsA total of 117 patients with HCC,87 males and 30 females,age range 37～79 years,mean age 61.96±8.03 years,with a total of 145 lesions seen in the interventional unit between December 2021 and December 2022 were included.All patients were examined by ultrasound within three days after liver cancer was found by MR scan,during which there was no anti-tumor therapy.Ultrasound doctors carefully explored the liver lesions after understanding the results of MR imaging of liver cancer.According to the results of ultrasound examination,the patients were divided into two groups:ultrasound visible display group(n=106)and ultrasound non-display group(n=39).General clinical data were collected from both groups:presence of cirrhosis,presence of hepatitis,history of Microwave Ablation(MWA)treatment,Child-Pugh classification,Body Mass Index(BMI).Body Mass Index(BMI);Serologic data:AFP,CEA,PIVKA-11;Imaging data:size of the lesion,distance between the lesion and the diaphragm,shortest distance between the lesion and the body surface,whether the lesion was located under the envelope,presence of ascites,and location of the lesion,the presence or absence of ascites,the liver segment where the lesion was located,and whether it was large nodular cirrhosis.The above data were analyzed by statistical one-way analysis using SPSS 27.0 software,followed by binary logistic regression analysis,and P<0.05 was considered a statistically significant difference.ResultsOf the 145 lesions,106(73.1%)had a median lesion diameter of 1.8 cm(1.3～3.0 cm),which was visible on conventional ultrasonography,and 39(26.9%)had a median lesion diameter of 1.0 cm(0.5～1.5 cm),which was not visible on conventional ultrasonography.The results of univariate analysis showed that the presence or absence of cirrhosis,history of MWA treatment,lesion size,distance between the lesion and the diaphragm,and whether the lesion was large nodular cirrhosis(all P values<0.05)were the influencing factors for hepatocellular carcinoma not visible on ultrasonography;in the multifactorial analysis,lesion size,distance between the lesion and the diaphragm,and large nodular cirrhosis were the influencing factors for hepatocellular carcinoma not visible on ultrasonography.The size of the lesion,the distance between the lesion and the diaphragm,and large nodular cirrhosis were significant factors affecting hepatocellular carcinoma in ultrasonography(P<0.05).Conclusions(1)In this study,ultrasound exploration was carried out under the condition that ultrasound doctors knew the results of MR imaging of liver cancer,and the total detection rate was 73.10%.(2)The small focus,the location of the focus near the top of the diaphragm and large nodular cirrhosis are the independent risk factors that can not be seen in ultrasonography.Chapter2 Comparative study on the efficacy of Microwave Ablation guided by MRI and MRI-US Fusion Imaging in the treatment of Hepatocellular carcinoma with poor Ultrasound displayObjectiveFor liver cancer lesions which are difficult to be ablated under conventional ultrasound guidance,the therapeutic effects of microwave ablation guided by MRI and MRI-US fusion imaging were compared in order to provide a research basis for the selection of ablation methods for this kind of lesions.MethodsA retrospective analysis of 85 patients with HCC admitted to the interventional therapy department from October 2020 to December 2021,with 125 lesions,all of which showed poorly on conventional ultrasonography.The patients were divided into MRI-guided ablation group(45 patients,66 lesions)and MRI-US fusion imaging-guided ablation group(40 patients,59 lesions)according to the different modes of microwave ablation imaging guidance.Five patients,with a total of 7 lesions,were transferred to the MRI-guided ablation group because of the failure of fusion imaging alignment to perform ablation under MRI-US fusion imaging guidance.The single procedure complete ablation rate,first treatment technique efficiency,local tumor progression rate,procedure time and postoperative complication rate of microwave ablation imaging-guided modality were compared between the two groups.The efficiency of the first treatment technique was assessed within 3 months after surgery,while the rate of local tumor progression was assessed more than 3 months after surgery.The median follow-up time to assess treatment response was 17 months(range 12～24 months).Data were processed using SPSS 27.0 statistical software,and all statistical analyses were completed.ResultsThe rate of complete single procedure ablation in the MRI-US fusion imaging-guided microwave ablation group 89.8%(53/59)was lower than the rate of complete single procedure ablation of lesions in the MRI-guided microwave ablation group 100%(66/66),and there was a statistically significant difference in the rate of complete single procedure ablation of lesions between the two groups(P=0.025).There was no statistically significant difference in the technical efficiency of the first treatment of the lesions in the MRI-US fusion imaging-guided microwave ablation group 96.6%(57/59)and the technical efficiency of the first treatment of the lesions in the MRI-guided microwave ablation group 98.5%(65/66)(P=0.922).The rate of local tumor progression at 1 year after MRI-US fusion imaging-guided microwave ablation 6.8%(4/59)was not statistically significantly different from the rate of local tumor progression at 1 year after MRI-guided microwave ablation 4.5%(3/66)(P=0.589).The success rate of MRI-US fusion imaging alignment was 89.4%(59/66),and all lesions with failed alignment were treated with microwave ablation under MRI guidance.The operative time in the MRI-US fusion imaging-guided microwave ablation group(60.05±18.94 min)was shorter than that in the MRI-guided microwave ablation group(68.15±16.61 min),and there was a statistically significant difference in the operative time between the two groups(P=0.015).The incidence of postoperative complications in the MRI-US fusion imaging-guided microwave ablation group 10%(4/40)was not statistically significantly different from that in the MRI-guided microwave ablation group 6.7%(3/45)(P=0.871).Conclusions(1)Both MRI and MRI-US fusion imaging-guided microwave ablation are feasible,safe,and effective for the treatment of hepatocellular carcinoma with poor ultrasound demonstration.(2)The rate of complete ablation in a single procedure was lower in the MRI-US fusion imaging-guided microwave ablation group than in the MRI-guided microwave ablation group,and some patients in the MRI-US fusion imaging group required postoperative remedial ablation.(3)MRI can effectively guide microwave ablation for liver cancer lesions that fail MRI-US fusion imaging alignment.(4)MRI and MRI-US fusion imaging-guided microwave ablation for ultrasound-displayed poor hepatocellular carcinoma showed similar recent outcomes and no significant differences in the incidence of postoperative complications.(5)The MRI-US fusion imaging-guided microwave ablation group had a shorter procedure time than the MRI-guided microwave ablation group. |
PDF Full Text Request