目的：观察肝硬化背景下不同组织类型小肝癌（≤3.0cm）的超声造影灌注时间及增强模式，探讨超声造影对小肝癌的诊断价值。方法：146例肝局灶性病变行超声造影，其中经手术或穿刺病理确诊肝硬化合并小肝癌（≤3.0cm）42例48个病灶；记录分析48个病灶造影增强模式，并进行造影前后良恶性诊断5级评分比较。全部病例造影前、后半个月内行增强CT检查进行对比。结果：造影后中高低分化肝癌38个病灶（79.2%）动脉期发生快速强化，实质期快速消退，呈“快进快出”型；6个高分化小肝癌呈“快进慢出”型；4个肝透明细胞癌中3个≤1.5cm灶呈“慢进慢出”型，另1个2.2cm 肿瘤呈“快进快出”型。造影前仅27个病灶（56.0%）超声作出正确诊断或诊断恶性倾向；造影后14个病灶（29.0%）评分提高2～4分，17个病灶仅提高1分。最终有2个病灶仍未能获得定性诊断，有4个病灶仅诊断恶性倾向，余42个病灶被确认恶性，诊断正确率达87.5%（42/48灶）。结论：灰阶超声造影对肝硬化背景下不同组织类型小肝癌增强模式的初步研究，可为小癌灶的早期诊断提供依据；作为CT等影像诊断的互补手段，超声造影可成为诊断肝硬化合并小肝癌灵敏可靠的方法。

目的：探讨射频消融（RFA）治疗前超声造影（CEUS）对制定消融范围及治疗策略的应用价值，并与RFA前未应用CEUS的治疗组比较疗效。方法：161例原发性肝癌符合经皮RFA 入选条件患者进行超声引导RFA 治疗。其中，77例RFA前采用SonoVue 行CEUS 检查（CEUS组），84例RFA前未行CEUS检查（非CEUS组）。两组病例的临床资料无明显差异。肿瘤平均直径CEUS组（3.6±1.2）cm，非CEUS组（3.5±1.1）cm。治疗后采用常规超声、增强CT及（或）超声造影等影像检查进行规律性随访，至少随访6个月CT 判断肿瘤灭活程度。结果：CEUS 组77例105灶行RFA 治疗，造影动脉期显示59灶（56.2%）肿瘤范围较造影前增大其中42灶（71.2%）造影前肿瘤边界不清；49灶（46.7%）肿瘤形态较常规超声更不规则，其中39灶（79.6%）为造影前边界不清。造影组> 3.5cm肿瘤52灶，37灶（71.1%）在动脉期显示主荷瘤血管。10例CEUS新发现≤2.0cm 病灶16个，其中3 例为肝硬化随访病例，均进行RFA 治疗。两组平均治疗次数为1.2次和1.5次RFA后随访6～36个月，CEUS组完全灭活率高于非CEUS 组（95.4%对87.8%，P=0.042）。CEUS 组生存期高于非CEUS组[（34.2±1.2）月对（30.2±1.6）月，P=0.028]。结论：RFA前CEUS可清晰显示肿瘤浸润范围，灵敏发现卫星灶及其他区域微小病灶，确认荷瘤血管，为准确制定消融方案，施行治疗策略，整体覆盖灭活肿瘤提供了可靠的依据，从而有效地提高RFA对肝癌的治疗水平。

[目的]：研究建立超声引导射频消融复发率较高的肝肿瘤（>3.5cm）的治疗方案，评价临床应用效果。[方法]：根据治疗范围至少达肿瘤周边0.5～1.0cm的原则，采用5cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者83例及肝转移癌患者58例，计141例162个肿瘤，大小为3.6～7.7（4.79±0.96）cm。[结果]：162个肿瘤共穿刺消融712个球灶。治疗后1个月CT检查显示肿瘤完全灭活率达90.1%（146/162灶），随访3～38个月，局部复发率为21.0%（34/162灶），其中肝转移癌高于原发癌（P<0.05）；26例因肿瘤复发共进行了39次再次治疗，其中18例再治疗1次，8例再次治疗2～3次。严重并发症为4.9%（7/141例），仅1例复发癌再治疗1周后肠穿孔需外科手术治疗。[结论]：本计算方案的制定为超声引导射频消融治疗3.5cm以上肝肿瘤提供了依据，并可指导临床实际应用。治疗结果显示该方案可显著提高肝肿瘤消融灭活率，减少复发，具有较高的临床应用。

目的：分析超声造影（CEUS）对肝细胞性肝癌（HCC）各时相的时间定义及病灶增强模式，提出CEUS诊断肝癌的参考标准。方法：分析206例253个明确诊断的HCC病灶超声造影表现,记录注射造影剂后肝动脉、门静脉及肝实质的开始增强时间、肝实质增强峰值时间、HCC病灶开始增强、开始减退时间及增强特征。结果：设置以注射造影剂肝动脉开始显影（5.8～8.4秒）作为动脉相起始时间；以门静脉开始显影（8.7～23.8秒）作为门脉相起始时间；以肝实质增强达峰值（17.6～38.1秒）为实质相起始时间；以180～360秒作为延迟期时间。253个HCC中94.1%（238灶）在动脉期增强，5.9%（15灶）在门脉期增强；84.6%（214灶）在门脉期或实质期退出，11.1%（28灶）在延迟期退出；4.3%（11灶）最终未能退出。归纳HCC的造影表现显示为“快进快出”、“快进慢出”、“快进不出”、“慢进快出”、“慢进慢出或不出”五种模式。结论：根据超声造影时相定义及HCC增强退出特征,总结HCC超声造影模式及诊断参考标准。

AIM: To investigate the treatment efficacy of radiofrequency ablation (RFA) of hepatic malignant tumor and the relevant complications. METHODS: A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA (565 procedures). There were 204 cases of hepatic cellular carcinoma (HCC) with 430 tumors, the mean largest diameter was 4.0cm. Of them, 48 patients (23.5%) were in stages I-II (UICC Systems) and 156 (76.5%) in stages III-IV There were 134 cases of metastatic liver carcinoma (MLC), with 333 metastases in the liver, the mean diameter was 4.1cm, the liver metastases of 96 patients (71.6%) came from gastrointestinal tract. Ninety-three percent of the 338 patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 mo. RESULTS: The ablation success rate was 93.3% (401/430 tumors) for HCC and was 96.7% (322/333 tumors) for MLC. The local recurrence rate for HCC and MLC was 7.9% (34/430 tumors) and 10.5% (35/333 tumors), respectively. A total of 137 patients (40.5%) underwent 2-11 times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was 84.6%, 66.6%, and 63.1%, respectively; the survival rate from 48 patients of I-II stage HCC was 93.7%, 80.4%, and 80.4%, respectively. The major complication rate in this study was 2.5% (14 of 565 procedures), which consisted of 5 hemorrhages, 1 colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn. CONCLUSION: RFA, as a minimally invasive local treatment, has become an effective and relatively safe alternative for the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.