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英文誌(2004-)

Journal of Medical Ultrasonics

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2005 - Vol.32

Vol.32 No.03

State of the Art(特集)

(291 - 304)

造影超音波による原発性肝細胞癌の治療効果判定

Contrast-Enhanced Sonography to Assess the Efficacy of Therapy for Unresectable Hepatocellular Carcinoma

沼田 和司, 杉森 一哉, 平尾 充成, 森本 学, 岡 裕之, 綛恰召 欣吾, 粉川 敦史, 今田 敏夫, 田中 克明

Kazushi NUMATA, Kazuya SUGIMORI, Mitsuaki HIRAO, Manabu MORIMOTO, Hiroyuki OKA, Kingo HIRASAWA, Atsushi KOKAWA, Toshio IMADA, Katsuaki TANAKA

横浜市立大学医学部附属市民総合医療センター消化器病センター

Gastroenterological Center, Yokohama City University Medical Center

キーワード : contrast-enhanced harmonic grayscale sonography, hepatocellular carcinoma, percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial embolization

肝細胞癌に対する肝動脈塞栓療法, エタノール注入療法, ラジオ波熱焼灼療法後の治療効果判定を造影エコーで施行し, その有用性について検討した. また経過観察時における造影エコーの再発診断の有用性の有無についても検討した. 造影エコー結節内に濃染がある場合はviableな腫瘍が残存していると判定した. TAE治療後の結節が造影エコーlate vascular phaseで境界明瞭な陰影欠損として描出された場合, 腫瘍は適切に治療されたと判定した. PEI, RFA治療後, 治療前の濃染部の範囲よりもさらに広い範囲が陰影欠損となった場合, 適切に治療したと判定した. 造影CTでTAEの治療効果判定をした場合, Lipiodolによるアーチファクトのため, 腫瘍濃染の有無が判定できないことが多い. 一方, 造影エコーはLipiodol貯留の影響を受けないため, 腫瘍内の壊死部と壊死部を区別することが可能である. 造影エコーで残存ありと判定した結節は半年以内に造影CTでも再発を確認した. 造影エコーで適切に治療したと判定した結節は平均24ヵ月の経過観察期間, 局所再発はあるもののその割合は低かった. 造影エコーはTAE, PEI, RFA (それらの併用療法)後の治療効果判定として有用であり, 同時に腫瘍残存部位へのPEI, RFAの穿刺治療のガイドとしても有用である.

We evaluated the usefulness of contrast-enhanced harmonic grayscale sonography (contrast US) to assess the therapeutic efficacy of transcatheter arterial embolization (TAE) with iodized oil, percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), and combination therapy for patients with hepatocellular carcinoma (HCC), and we evaluated the patients for incomplete local treatment during the follow-up periods. Lesions were considered to contain viable tumor residue when hypervascular enhancement was observed within the tumor. We concluded that adequate tumor necrosis had occurred in the lesions when an oval or round perfusion defect with distinct margins was observed in the late vascular phase of contrast ultrasound after transcatheter arterial embolization. Further, we concluded that adequate tumor necrosis had occurred when lesions treated by percutaneous ethanol injection or radiofrequency ablation showed a nonenhancing area in the late vascular phase of contrast ultrasound whose area exceeded that of the hypervascular enhancement seen in the early or late vascular phase of contrast ultrasound before treatment. Because artifacts were produced by accumulation of iodized oil in the tumor, hardly any of the hepatocellular carcinoma lesions could be evaluated for the presence of tumor residue by helical CT. However, contrast ultrasound enabled us to distinguish between viable and necrotic portions of hepatocellular carcinoma lesions, because iodized oil deposition did not interfere with the perfusion images. Local recurrence within about 6 months after therapy was observed by helical CT in all lesions in which contrast ultrasound had detected viable tumor residue. Lesions in which adequate tumor necrosis was observed by contrast ultrasound after transcatheter arterial embolization, percutaneous ethanol injection, radiofrequency ablation, or combined therapy exhibited a low rate of local recurrence during the follow-up period (mean, 24 months). Contrast ultrasound proved useful for evaluating the therapeutic effect of transcatheter arterial embolization percutaneous ethanol injection, radiofrequency ablation, or combined therapy of hepatocellular carcinoma, and it was also useful for guiding percutaneous ethanol injection, radiofrequency ablation, and other additional treatments.