【作者】 李远竞；

【导师】 刘颖；

【作者基本信息】 大连医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:探讨超声背向散射积分(integrated backscatter,IBS)在兔VX2肝肿瘤射频消融治疗疗效评价中的应用价值。方法:超声引导下将VX2肿瘤组织块接种于兔肝脏内,建立24只兔肝VX2瘤模型,随机抽取3只,处死,进行病理学检查。对余下21只兔VX2肝肿瘤进行超声背向散射积分参数测定后,超声引导下行射频消融治疗。射频消融治疗后将21只兔随机分为3组,每组7只(即射频消融术后1天组、7天组、14天组),分别于术后1天、7天和14天,对消融区进行超声背向散射积分参数测定和超声检查。测定IBS数值时,应用HP Sonos 5500型彩色多普勒超声诊断仪,配有IBS联机分析系统,保证彩超仪器设置条件相同,获得兔肝肿瘤和消融前后感兴趣区的标化IBS(IBS%)和IBS变化率,并抽取耳缘静脉血进行肝肾功能测定,于检查后处死动物,行大体病理和显微病理检查,对照IBS参数值,分析评价病理结果与IBS参数值间的相关性。结果:1、与肿瘤组织标化IBS值相比,消融区中心及边缘组织标化IBS值明显增高,差异均有显著性意义(p<0.05);且射频消融术后1天、7天、14天标化IBS值逐渐增高,组间差异均有显著性意义(p<0.05);消融区中心组织IBS值高于消融区边缘组织,标化IBS值之间差异均有显著性意义(p<0.05)。消融区中心组织及边缘组织IBS%变化率均≥50%。IBS平均变化率≥50%,病理确定为肿瘤组织坏死。消融前、后消融区周围肝组织标化IBS值无明显变化,差异无显著性意义(p>0.05)。不同组织的IBS%值由低到高依次是:肿瘤组织、消融区周围正常肝组织、消融后消融区边缘的组织、消融后消融区中心的组织。2、光镜下,射频治疗后肿瘤组织大片凝固性坏死,肿瘤细胞核固缩,碎裂,溶解,一周后周边纤维组织逐渐增生。3、射频后7天内肝功能出现明显异常改变,多数指标14天左右恢复,具体变化是:总蛋白、白蛋白明显降低,总胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶均有增高;除总蛋白、碱性磷酸酶在7天恢复正常外,其余指标均在14天左右恢复。肾功能化验,射频消融后的第1天尿素氮及肌酐呈一过性增高,第7天内恢复到正常水平。结论:超声背向散射积分能评价兔VX2肝肿瘤射频消融治疗情况,IBS%和IBS变化率可作为评价消融疗效的指标,为肝脏肿瘤射频消融治疗疗效评价提供了一种无创的量化检查方法。更多还原

【Abstract】 Objective:To evaluate the role of ultrasonic integrated backscatter (IBS) in assessing the therapeutic response to radiofrequency ablation in rabbit VX2 liver tumor.Methods:After twenty four models of rabbit VX2 liver tumor were set up by ultrasonography-guided implantation of VX2 constitution masses,three rabbits were selected randomly to receive pathological examination. 21 rabbits VX2 liver tumors were subjected to radio frequency ablation treatment under ultrasonic guide after integrated backscatter were measured. After the treatment, 21 rabbits were divided three groups. There were 7 rabbits in every group. The IBS of the regions of interest were measured at different time points (1day, 7day and 14day, respectively). HP Sonos 5500 image system with quantitative analysis function was used for IBS measurement. With the machine setting fixed and optimal image obtained, the IBS and its changes in the rabbit liver tumor and the regions of interest were received and compared before and after the treatment. In the meantime, the peripheral blood was taken out respe- ctively before and after RFA. After that, all the rabbits were executed and pathological examination was performed.Results:1. The values standardized IBS showed significant difference before and after radiofrequency ablation at different time points(p<0.05); the values standardized IBS became higher and higher, there was significant difference between each groups(p<0.05). The IBS of the center of target was higher than that of peripheral,the values standardized IBS showed significant difference at different time points(p<0.05). The change of IBS were over 50%, can be determined necrosis by pathological examination. There was no significant difference of IBS in the normal liver of the around between the before and after RFA(p>0.05). The IBS of different organize according the go-up order was: the rabbit liver tumor, normal liver, peripheral of the target,center of the target.2. Light microscopic examination showed tumor tissue coagulative necrosis, tumor cells appeared nuclear pyknonsis, karyorrhexis and karyolysis, fibrin organi- zation was increase from the seven days.3. After RFA hepatic function changed apparently in seven days and restored gradually to the normal level in 14 days. Concrete variety: total protein(TP) and albu- min(A) obviously lowers, total bilirubin(T-BIL), ALT, AST, ALP were all increased. Besides TP, ALP, the rest index sign were all restored on about 14 days. After RFA, the kidney function analyzes was BUN and Cr increased on the 1 shorterly, in a while recovered the normal level.Conclusion:Ultrasonic integrated backscatter could assess the therapeutic response to radiofrequency ablation in Rabbit VX2 Liver tumor and heralds a new method of noninvasive quantitative measurement.更多还原