安福 智子¹, 光本 保英¹, 奥田 佳一郎², 大矢 寛久¹, 片山 貴之¹, 山口 寛二², 水野 雅之¹, 島 俊英¹, 岡上 武¹

Tomoko YASUFUKU¹, Yasuhide MITSUMOTO¹, Keiichirou OKUDA², Hirohisa OOYA¹, Takayuki KATAYAMA¹, Kanji YAMAGUCHI², Masayuki MIZUNO¹, Toshihide SHIMA¹, Takeshi OKANOUE¹

¹大阪府済生会吹田病院消化器内科, ²京都府立医科大学消化器内科学

¹Department of Gastroenterology and Hepatology, Osaka Prefecture Saiseikai Suita Hospital, ²Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine

キーワード : ablation techniques, hepatocellular carcinoma, liver, neoplasms, ultrasonography, fusion imaging, fusion marker

目的：肝癌治療でFusion image技術は必要不可欠となっている．Fusion marker機能はプローブの方向や走査部位を計算し，画像上に標識した印を表示する機能である．この機能を応用し，我々はBモードで描出困難な肝癌を同定可能にしたFusion markers two point methodを確立し治療に応用してきた．今回この方法を応用し，ラジオ波焼灼療法（RFA）やマイクロ波アブレーション（MWA）で術中にablative marginが確保されているかを，Fusion markerを用いて簡便に視覚的に判断可能かどうか検討した．方法：肝癌の両側にFusion markerを2点セットし，リファレンス画像とエコー画像断面を同期させる（Fusion markers two point method）．次に腫瘍腹側の肝癌と非癌部の境界の非癌部側にFusion markerをセットする．背側も同様操作を行う．治療後凝固域は高エコー化し，その領域内にFusion markerが位置すれば，ablative marginの確保が術中に評価可能となる（Fusion markers margin method）．結果：肝癌症例にRFA/MWAを行い，治療後にFusion markers margin methodを用い，腫瘍が凝固域内に位置するのを確認した．結語：Fusion marker機能を用い，RFA/MWAのablative marginが確保されているかを術中に視覚的に判断可能であった．

Purpose: Fusion imaging methods are essential in local therapies for hepatocellular carcinoma. Fusion imaging using markers is a method that constantly tracks and displays points marked on the image by calculating the position of the sensor attached to the probe in real time. By applying this method, we have established a fusion marker two-point method that allows identification of hepatocellular carcinomas that are otherwise difficult to visualize by B-mode imaging, and have applied it to treatment. In this study, we examined whether ablation margins could be visualized in percutaneous radiofrequency ablation (RFA)/microwave ablation (MWA) for hepatocellular carcinoma using the fusion marker two-point method. Subjects and Methods: Fusion markers were set on both sides of the hepatocellular carcinoma using our fusion marker two-point method. Next, a fusion marker was set on the noncancerous side of the border between the cancerous and noncancerous portions on the ventral side of the hepatocellular carcinoma lesion. The same procedure was performed on the dorsal side. After the surgery, the coagulation area became hyperechoic, and if the fusion marker set in that area was located, it was possible to evaluate whether the ablative margin was secured during the surgery. Results: RFA/MWA was performed for hepatocellular carcinoma. Moreover, after the surgery, the reference image and echo sections were matched, and using the fusion marker margin method, it was confirmed that the hepatocellular carcinoma was located within the ablative margin. Conclusion: It was possible to visualize the ablative margin in RFA/MWA during the perioperative period using fusion markers.