原发性肝癌经导管动脉化疗栓塞联合射频消融治疗后3.0T MRI的表现  

Follow up 3.0T MR Findings of Primary Hepatocellular Carcimoma After Transcatheter Arterial Chemoembolization Combined Radiofrequency Ablation

作　　者：刘翠翠[1] 曲金荣[2,3] 张宏凯[2,3] 邵楠楠[2,3] 张建伟[2,3] 李祥[2,3] 张首宁[2,3] 李彦乐[2,3] 黎海亮[2,3] 

机构地区：[1]河南大学医学院,开封475004 [2]河南省肿瘤医院 [3]郑州大学附属肿瘤医院放射介入科,郑州450008

出　　处：《临床放射学杂志》2013年第3期362-366,共5页Journal of Clinical Radiology

基　　金：河南省科技厅重点科技攻关项目(编号:102102310006)

摘　　要：目的探讨原发性肝癌经肝动脉导管化疗栓塞(TACE)联合射频消融(RFA)术后的3.0 T MRI的表现特点。方法 2010年3月至2012年3月住院患者中42例经TACE联合RFA治疗的原发性肝癌患者,分别对其进行常规MRI、动态增强及扩散加权成像(DWI)序列(b=0、700 s/mm2)扫描,根据术后患者血清AFP值及MRI动态增强有无血供等指标将治疗疗效分为三组(好、中、差),分别分析介入治疗后1个月的MRI表现特征。结果疗效好的病例血清AFP未见异常升高,其MRI表现特点是T1WI呈边缘高信号,反相位内见信号减低区,T2WI呈等、低信号,内见不规则低信号,DWI呈低混杂信号为主,增强扫描时各期均未见强化,病灶边缘光整;疗效中和差的病例AFP高于正常值,动态增强时有强化部分,其MRI表现特点是T1WI呈边缘低信号为主,混杂信号,T2WI呈中高、等信号,DWI呈低信号为主,混杂高信号,部分边缘见高信号结节,增强时可见环形及边缘结节样强化,部分肿瘤出现子灶或者癌栓。结论原发性肝癌TACE联合RFA治疗之后,可以使用MRI评价栓塞和射频是否完全,或者是否存在残留或者复发,进一步指导患者临床治疗。Objective To investigate 3.0T MRI characteristics in patients with HCC after transcatheter arterial chemo- embolizstion （TACE） combined radiofrequency ablation （RFA）. Methods During March 2010 to March 2012, routine and contrast enhanced dynamic MRI as well as DWI （b =0,700 s/mm2） were performed in 42 patients with primary liver cancer after TACE combined with RFA. According to postoperative AFP values, MRI enhancement and other indicators of treatment efficacy, the patients were divided into three groups （good, moderate, poor）. MRI characteristics were analyzed at 1 month after interventional therapy. Results AFP values of good group showed normal and no abnormal elevation. The edge of the lesions in good group showed hyperintense on T1WI, and the lesions showed low signal on opposed phase, het- erogeneously low signal on T2WI and hypointense or mixed hypo and isointense on DWI. Nonenhancement was found and the edge of lesions was smooth and clear in good group. AFP values of moderate and poor groups showed abnormal eleva- tion. The edge of the lesions in moderate and poor group showed low and mixed signal intensity on T1WI, and the lesions showed low signal on opposed phase, heterogeneously high signal on T2 WI and heterogeneous hypointensity or hypointensity on DWI. Nodular and ring enhancement were found at the edge of the lesions, new lesions and tumor thrombus were found in some cases. Conclusion MRI can be used to evaluate whether residual or recurrence in patients with hepatocellular carcinoma after TACE combined RFA, and further guide for the clinical treatment.

关 键 词：癌 肝细胞 肝动脉导管化疗栓塞 射频消融 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤]