探讨超声造影（CEUS）在肝泡型包虫病（HAE）微波消融疗效评估中的价值。

回顾性分析2019年6月至2021年1月在青海大学附属医院接受微波消融治疗的45例早期HAE患者临床资料。其中男25例，女20例；年龄17~56岁,中位年龄36岁。患者均签署知情同意书，符合医学伦理学规定。微波消融前后行CEUS检查，观察病灶大小、影像学特征和造影参数变化，并于术后3 d及3、6、12个月行CEUS检查，观察微波消融的疗效。术后病灶直径比较采用单因素方差分析，两组血流灌注指数比较采用t检验。

45例患者共45个病灶均成功完全微波消融。术后3 d完全消融率为100%（45/45），术后3、6、12个月消融有效率分别为100%（45/45）、96%（43/45）、88%（23/26）。消融术前病灶内部动脉期、门静脉期、延迟期均呈现为无增强；而病灶边缘区环状高增强19例，均匀结节状高增强26例。术前病灶边缘区平均血流灌注指数为（100±22）db，明显高于正常肝组织的（70±27）db（t=8.704，P<0.05）。术后病灶完全消融，血流灌注指数为0。患者术后随访时间均超过6个月，术后6、12个月分别有2、3例病灶边缘区表现为不均匀高增强，血流灌注指数高于正常肝组织，考虑病灶复发。26例随访时间超过12个月，术后3 d及3、6、12个月病灶直径分别为（4.6±0.6）、（3.7±0.5）、（3.5±0.4）、（2.9±0.4）cm，病灶直径呈逐渐减小趋势（F=175.980，P<0.05）。

CEUS可动态观察HAE微波消融前后病灶大小和边缘区动脉血供，能准确评估微波消融疗效和随访复发。

To explore the value of contrast-enhanced ultrasound (CEUS) in therapeutic evaluation of microwave ablation for hepatic alveolar echinococcosis (HAE).

Clinical data of 45 patients with early HAE who received microwave ablation in the Affiliated Hospital of Qinghai University from June 2019 to January 2021 were retrospectively analyzed. Among them, 25 patients were male and 20 female, aged from 17 to 56 years, with a median age of 36 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Before and after microwave ablation, CEUS was performed to observe the changes of lesion size, imaging features and contrast parameters. CEUS was performed at postoperative 3 d and 3, 6 and 12 months to assess the clinical efficacy of microwave ablation. The postoperative lesion diameter were compared by one-way ANOVA. The blood perfusion indexes between two groups were compared by t test.

All 45 lesions from 45 cases were completely ablated by microwave ablation. The complete ablation rate was 100%(45/45) at postoperative 3 d. The effective ablation rates were 100%(45/45), 96%(43/45) and 88%(23/26) at postoperative 3, 6 and 12 months, respectively. Before ablation, no enhancement was observed within the lesions during the arterial phase, portal vein phase and delayed phase. Ring-shaped hyperenhancement was observed at the margins of lesions in 19 cases and 26 cases with homogeneous nodular hyperenhancement. The average preoperative blood perfusion index at the margins of lesions was (100±22) db, significantly higher than (70±27) d in the normal liver tissue (t=8.704, P<0.05). The lesions were completely ablated by microwave ablation, and the blood perfusion index was 0. All patients were followed up for more than 6 months. At postoperative 6 and 12 months, non-homogeneous hyperenhancement was observed at the margins of lesions in 2, 3 cases, respectively, and the blood perfusion index was higher than that of normal liver tissues. The possibility of recurrence was considered. 26 patients were followed up for more than 12 months. The lesion diameter was (4.6±0.6), (3.7±0.5), (3.5±0.4), (2.9±0.4) cm at postoperative 3 d and 3, 6, 12 months, which tended to gradually decrease (F=175.980, P<0.05).

CEUS can dynamically observe the lesion size and arterial blood supply at the margins of lesions in HAE patients, which can accurately evaluate clinical efficacy of microwave ablation and predict the risk of recurrence during follow-up.