Eur Radiol：如何准确地测量甲状腺良性结节射频消融术后坏死组织体积

2021-03-09 shaosai MedSci原创

根据指南，射频消融术(RFA)是治疗良性甲状腺结节的一种安全有效的方法。许多研究表明消融术后体积的减少与临床局部症状的改善有显著的相关性。

根据指南，射频消融术(RFA)是治疗良性甲状腺结节的一种安全有效的方法。许多研究表明消融术后体积的减少与临床局部症状的改善有显著的相关性。虽然甲状腺及颈部解剖结构复杂，但良性结节射频消融术后并发症发生率仅为2.11%，且无危及生命的并发症发生。

消融后的评价指标包括体积缩小率(VRR)、治疗成功率等，大部分基于灰度和彩色多普勒超声(US)。随着研究的深入，出现了一些新评价消融效果的参数。有学者将RFA术后消融结节的总体积(Vt)分为坏死消融体积(Va)和未完全消融尚有活性体积(Vv)，且研究发现Vv增加可能是RFA后结节再生的早期表现。然而，消融区和有活性区之间的界限并不容易区分，这使得Va的测量准确性不高。

对比增强超声(CEUS)是一种谐波对比成像技术，通过使用第二代对比剂评估微血管化来检测和表征局灶性病变。超声造影是一种检测微血管循环动力学的优越方法，对消融引起的坏死区大小和边缘的精确定义十分有价值。

近日，发表在European Radiology杂志的一项研究探讨了灰阶及多普勒超声(US)与对比增强超声(CEUS)测量良性甲状腺结节射频消融(RFA)术后消融体积(Va)的观察者内及观察者间的可靠性及一致性。

本研究共纳入173位患者一共190个甲状腺良性结节，每位患者均接受了射频消融治疗。射频消融治疗后，消融结节总体积分为Va和未完全消融的有活性体积。随访时间分别为1、3、6、12个月及此后每12个月。在同一次随访中，两名独立观察者使用US和CEUS测量Va。采用95%置信区间内相关系数(ICC)评价两种测量方法的观察者内和观察者间的可靠性。采用Bland-Altman分析对一致性进行评价，以95%一致性界限(LOA)的均值差表示。

平均随访时间为23.17±12.70个月。US测量的Va明显大于CEUS 测量的Va (p < 0.001)。随访期间，观察组内和观察组间的可靠性均下降，12个月时两组的可靠性均为中等(所有ICC均< 0.75)。随访期间，平均差值越来越大，LOA越来越宽。在1个月时结节< 10 ml的一致性最好，平均差值为1.166，LOA在0.413 ~ 3.294之间。

表常规US与CEUS之间一致性的Bland-Altman分析

图随访中两种治疗方式测量结果的一致性的Bland-Altman图。(a)至(e)显示RFA术后1、3、6、12和24个月两种方式测量Va的 Bland-Altman图。x轴显示Va的两种测量方式的对数平均值。y轴显示测量之间的对数差异。实线为平均差(偏差)。顶部和底部虚线对应的上限和下限95%的协议(LOA)。

US和CEUS在测量Va方面的观察者内部和观察者之间的可靠性和一致性并不令人满意。在当需要进一步评价Va或疑似结节增长时，应考虑使用CEUS进行相应的检查。

原始出处：

Lin Yan,Yukun Luo,Jing Xiao,et al. Non-enhanced ultrasound is not a satisfactory modality for measuring necrotic ablated volume after radiofrequency ablation of benign thyroid nodules: a comparison with contrast-enhanced ultrasound.DOI:10.1007/s00330-020-07398-0

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2021-06-04 zhmscau

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2021-03-11 jinweidong

#射频消融#

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2021-03-11 millore

#坏死#

38 0
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2021-03-11 xiangyuzhou972

#消融#

40 0
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2021-03-11 cmj11wellington

#甲状腺良性结节#

46 0
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2021-03-11 dingxiaobo

#消融术#

26 0
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2021-03-11 dingxiaobo

#消融术#

0 0
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2021-03-10 科研科研科研

准确测量甲状腺良性结节射频消融术后还死组织

74 0
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2021-03-09 Wlgank

学习

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