肝肿瘤射频消融术后CT表现及其临床意义  

CT manifestation and its clinical significance of liver tumors after radiofrequency ablation

作　　者：徐守军[1] 杜端明[2,3] 刘鹏程[4] 罗莉丽[4] 干芸根[1] 

机构地区：[1]深圳市儿童医院放射科,518026 [2]深圳大学第一附属医院 [3]深圳市第二人民医院介入治疗科 [4]北京大学深圳医院医学影像科

出　　处：《介入放射学杂志》2014年第1期69-73,共5页Journal of Interventional Radiology

摘　　要：目的探讨肝肿瘤经皮射频消融(RFA)治疗后的CT表现并分析其临床意义,以指导临床治疗。方法回顾性分析59例(82个病灶)肝肿瘤患者经皮RFA前后的CT影像学资料,分析病灶的大小、密度及强化方式等变化特点。结果 RFA治疗后1个月内完全坏死病灶范围较术前有所增大,呈无强化的低密度影,或呈囊状更低密度影。坏死灶周围常见一层薄而均匀的环形强化,强化特点和正常肝实质基本一致,随着时间的变化逐渐模糊,最终消失。2个月内完全坏死灶范围较术前可略显增大、相仿或略缩小,呈低密度影或更低囊变影。增强扫描无明显强化或动脉期消融区边缘出现一层薄而均匀的环形强化,但较前模糊,显示欠清。2个月以后完全坏死区范围逐渐缩小,增强扫描无明显强化。当肿瘤组织残存时,术后即刻CT显示消融区范围没有完全包括术前病灶的范围,动脉期病灶边缘出现不规则局灶样或结节状强化,门脉期迅速减退,延迟期强化程度低于肝实质,呈"快进快出"特点。如肿瘤复发,病灶局部出现异常强化。血供良好的肿瘤组织显示病灶范围有所增大,动脉期消融区出现局灶样或结节状强化;乏血供的病灶消融区范围较前增大,边缘不光整。结论肝肿瘤RFA术后的CT检查具有特征性的影像学表现,能有效检出肿瘤的残存或(和)复发,指导临床作出进一步合理、有效的治疗。Objective To analyze CT findings of hepatic tumors after percutaneous radiofrequency ablation （RFA） and to discuss their clinical significance in guiding clinical treatment. Methods A total of 59 patients with hepatic tumor （82 lesions in total） were enrolled in this study. The diseases included primary liver tumor （n = 42） and hepatic metastases （n = 17）. RFA was carried out in all patients. Both pre-operative and post- operative CT findings were retrospectively analyzed, focusing on the lesion＇s size, density, enhancement pattern, ,etc. The results were analyzed. Results Within one month after RFA, the completely necrotic areas, which were characterized＇ by non- enhanced low density areas or lower cystic density areas, became larger than before. A thin layer of annular uniform enhancement was often seen around the necrotic area, and the enhancement feature was basically consistent with the normal liver parenchyma, and the enhancement became blurred gradually with increasing time until it faded away finally. About 2 months after RFA, the completely necrotic areas became slightly larger, or equal to, or slightly smaller than the necrotic areas observed before RFA. And the necrosis was manifested as low density area, or cystic shadow with much lower density. On enhanced scanning, the lesions showed no obvious enhancement, Sometimes a thin uniform annular enhancement at the border of the treated area could be seen in arterial phase. However, the thin uniform annular enhancement was more subtle than that observed before and its clearance usually took longer time. Two months after RFA, the necrotic areas became smaller gradually and showed no contrastenhancement. When there was residual tumor, the ablation zone showed on CT that was performed immediately after RFA would be smaller than ~the tumor extent that was determined on preoperative CTscanning, besides, irregular local thickening or nodular enhancement could be found at the lesion＇s periphery in arterial phase, which rapidly vanished in po

关 键 词：肝肿瘤 消融技术 CT 

分 类 号：R735.7[医药卫生—肿瘤]