1、秀傳醫療社團法人秀傳紀念醫院 全院性演講節目表時間98/8/7 (五) AM 7:30-9:00地點總院九樓會議室主  題Contrast-enhanced Ultrasonography in Hepatic Tumor 主講者臺北榮民總醫院 放射線部超音波科周宜宏主任主持人秀傳紀念醫院 陳建華部長對  象醫護人員Biographical Notes Yi-Hong Chou, M.D.Dr. Yi-Hong Chou is chief of Ultrasound Section at Taipei Veterans General Hospital and Profes

2、sor of Radiology at National Yang Ming University School of Medicine, Taipei, Taiwan.He is the former president of Society of Ultrasound in Medicine, ROC (SUMROC), the former Chairman of Education Committee of the Asian Federation of Societies for Ultrasound in Medicine and Biology (AFSUMB) and the

3、Associate Editor of the Ultrasound in Medicine and Biology (the official journal of World Federation of Ultrasound in Medicine and Biology, WFUMB). He is currently the President of the Radiological Society of the ROC , Treasurer of the AFSUMB, Treasurer of the Asian Society of Abdominal Radiology (A

4、SAR), Chairman of Education Committee of the SUMROC, Former Chairman of the Education Committee of the AFSUMB, Councilor of the Asian-Ocean Society of Radiology (AOSR), and the Editor in Chief of the Journal of Medical Ultrasound (JMU, the official journal of the AFSUMB). Dr. Chou has been active in

5、 scientific and teaching programmes nationally and internationally, and has organized a number of international congresses, workshops, and symposia, particularly on Ultrasound and Imaging of the Liver, Breast and Emergency and Critical Care.He has expertise in all imaging modalities of abdominal and

6、 breast diseases, and emergency medicine and critical care. His scientific interests include ultrasound image analysis, computer-aided diagnosis and detection, and ultrasound-guided minimally invasive techniques. He has strong commitments to the teaching of clinical ultrasound and medical imaging, a

7、nd all topics relating to ultrasound diagnosis, interventional procedures, and Doppler techniques. He devotes himself to promote the medical ultrasound education in the developing countries. He is one of the faculty of International Breast Ultrasound School (IBUS), the honorary fellow of American In

8、stitute of Ultrasound in Medicine (AIUM), and is also the Secretary General of the International Association for Breast Ultrasound.Dr. Chou has published more than 320 articles and book chapters and has co-edited one book on imaging of acute abdomen. His current researches include clinical and exper

9、imental studies on various aspects of tumor vascularity with regard to color Doppler techniques and microbubble contrast agents, and interventional techniques in tumor ablation.肝臟腫瘤的對比劑增強超音波檢查（Contrast-enhanced Ultrasonography in Hepatic Tumor）臺北榮總 放射線部超音波科周宜宏主任中文摘要超音波（ultrasound, US) 雖是目前使用最廣的影像工具之

10、一，但本身具有先天的缺陷，包括技術上的問題；超音波本身的物理特性：對於性質與臟器背景相似的腫瘤，因其音波特性相似，就無法或不易區分，所以就非常需要有對比劑（USCA）來增加信雜比 （signal to noise ratio, S/N），以增強某些特定的腫瘤在灰階中的反射信號或血管內都卜勒的反射信號。USCA藉著能增加信雜比，使得標的器官（target organ）或標的病灶（target lesion）的影像得到改善，使得病變區與正常組織的界限可以清楚區分，而得到組織定性（tissue characterization）或腫瘤的特性分析的目的，增加診斷率。USCA在目前常用的有三種形式，（1

11、）用於中空器官（hollow organ）；（2）使得血管構造（vascular structure）的呈示更清楚；（3）使固體臟器的實質或其內的構造因實質顯影增強而呈示得更好，或使腫瘤的顯影清晰。對比劑應用於肝臟腫瘤可顯著提升腫瘤的血管性分析：(1) 對小的肝癌：原來不顯著的腫瘤血管性（tumor vascularity）可以利用USCA而得知。(2) 對略大的腫瘤（2-4cm）更加強血管性呈示；(3) 肝臟左葉的腫瘤；（4）可評估腫瘤內血管分佈而達到鑑別的目的；（5）腫瘤治療效果之評估；（6）藉分析腫瘤顯影增強的型式以鑑別腫瘤。在分析時要看腫瘤在USCA注射後的各個相態（phases），包

12、括在早期動脈相(early arterial phase)，在動脈相末期（late arterial phase）、或門靜脈相（portal phase），並分析各種腫瘤的顯影增強或塗染的型式。以往使用Levovist其顯影增強時間一般為5 min，而Sonovue可達10 min；Sonszoid則因可被肝臟的kuppfer cell攝入，故可應用其特殊的kuppfer phase使肝臟的背景（background）在portal phase或 kuppfer phase被顯影增強，在USCA使用後即使小腫瘤，可呈defect而被偵測到。目前USCA跟聲音的相互作用（interaction）

13、其實還有很多有待開發的部份，有待繼續研究。USCA在鑑別局部或瀰漫性肝病灶，可以提供相當大部份的資料，對治療的追蹤和監視具有明確的價值。未來的進展則包括應用微氣泡帶著化學藥物到標的器官，應用爆破的效果或加溫，把腫瘤中帶有藥物的微氣泡打碎，以便把藥物送出而達到治療的效果。英文摘要Ultrasound (US), being one of the most commonly utilized medical imaging modalities, has certain inherited deficits, such as technique-dependence and poor differ

14、entiation between certain tumors in a background with similar reflectivity. By increasing the signal to noise ratio (S/N), ultrasonographic contrast agents (USCA) can enhance the reflectivity of tumor tissue on gray-scale US or vascular pool/vessels on color Doppler US (CDU) or gray-scale imaging. T

15、here are 3 major categories in USCA, i.e., USCA used in hollow organ, those used in vascular structures, and those used for tumor/parenchyma enhancement. It is well known now that USCA can be quite useful in the following situations: (1) to enhance visualization of vascularity of small tumors (2cm);

16、 (2) to enhance larger tumors (2-4 cm); (3) to demonstrate vascularity of left lobe tumor; (4) to evaluate the vascularity of a focal lesion/tumor; (5) to evaluate the therapeutic effect in hepatic tumors; (6) to differentiate a tumor by using enhancing patterns. The evaluation of any focal lesion is based on the analysis of various phases after intravenous administration of USCA. Some USCA may be phagocytosed by the Kuppfer cells in the liver and the “Kuppfer phase” can be used to detect small tumors (presenting as defects) or to differentiate the nature of