原发性肝细胞癌射频消融治疗后MR动态随访研究  

Sequential follow-up MR studies of hepatocellular carcinoma after radio-frequency ablation

作　　者：饶圣祥[1] 曾蒙苏[1] 陈财忠[1] 李轫晨[1] 干育红[2] 

机构地区：[1]复旦大学附属中山医院放射科上海市影像医学研究所复旦大学上海医学院影像医学系,200032 [2]复旦大学附属中山医院肝癌研究所

出　　处：《中华放射学杂志》2010年第12期1244-1247,共4页Chinese Journal of Radiology

摘　　要：目的 探讨原发性肝细胞癌射频消融（RFA）治疗后的MR随访表现特征及规律.方法 回顾性分析2008年8月至12月住院的110例原发性肝细胞癌患者RFA治疗后的MR资料,根据MR检查时间分为3组：消融后48 h内、1～6个月、6个月以上.采用卡方检验分析比较肝细胞癌RFA治疗后肿瘤MR表现的动态变化.结果 110例短期（48 h内）RFA区域在GRE-TtWI表现为高信号,快速自旋回波（TSE）-T2WI则呈低信号,增强扫描无强化.1～6个月,GRE-T1WI示RFA区域信号呈不均匀下降,72例呈高信号,4例呈等低信号;＞6个月时,60例呈高信号,17例呈等低信号,此改变在6个月后与48 h内和1～6个月比较差异均有统计学意义（P值均＜0.015）.TSE-T2WI示RFA区域信号呈不均匀轻度增高,1～6个月,65例呈低信号,11例呈等信号;＞6个月时,47例呈等信号,30例呈低信号,而此信号改变在6个月后与48 h内和1～6个月比较差异均有统计学意义（P值均＜0.015）.增强后早期RFA区域主要表现为环状强化伴或不伴异常灌注,而随着时间延长趋向无强化,1～6个月,37例无强化;＞6个月,63例无强化,此改变在3组间差异均有统计学意义（P值均＜0.015）.6例肿瘤残留或局部进展,表现RFA区边缘结节,TSE-T2WI抑脂像呈中等高信号,GRE-T1WI呈低信号并伴有不同程度的强化.结论 原发性肝细胞癌RFA治疗后,动态MR随访能显示肿瘤完全坏死、肿瘤残留或局部进展及并发症的相关特征.Objective To describe the characteristic MR appearances in hepatocellular carcinoma after radiofrequency ablation （RFA） during follow-up studies. Methods MR images of 110 patients with hepatocellular carcinoma after RFA ,which were categorized into 3 MR examination intervals （ ≤48 h, 1-6 m, ＞6 m）, were analyzed retrospectively. The sequential changes of MR images were assessed and compared using Chi-square test. Results All RFA areas of 110 patients typically exhibited hyperintensity on GRE-T1 WI and hypointensity on TSE-T2 WI with fat suppression within 48 h after ablation. Subsequently,the signal intensities of the RFA areas decreased on GRE-T1 WI which showed significant differences after 6 months（ P ＜0. 015 ）. On GRE-T1 WI , RFA lesions were hyperintense in 72, iso-or hypo-intense in 4 at 1-6 months and hyperintense in 60, iso-or hypo-intense in 17 after 6 months. On TSE-T2 WI, 65 RFA lesions were hypointense, 11 isointense at 1-6 months and 47 were hypointense, 30 isointense after 6 months. The increased intensity on TSE-T2 WI showed significant differences after 6 months（ P ＜ 0. 015 ）.On contrast-enhanced MR images, RFA lesions showed peripheral rim of enhancement within 48 h and exhibited a tendency to show no enhancement （ n = 37 at 16 months and n = 63 after 6 months ） with significant differences between MR examination intervals（ P ＜ 0. 015 ）. In 6 patients with residual tumor or local tumor progression, nodular lesions were found at the periphery of the RFA. These nodular lesions showed moderate to marked enhancement as well as hypointense signal on GRE-T1WI, and moderate hyperintense signal on TSE-T2WI. Conclusion MR imaging could depict the characteristics of coagulative necrosis of tumor, residual tumor or local tumor progression in patients with hepatocellular carcinoma after RFA therapy.

关 键 词：肝肿瘤 导管消融术 磁共振成像 

分 类 号：R686[医药卫生—骨科学]