MR早期评估肝癌微波消融范围的临床研究  

MR early evaluation of microwave ablation extent of liver:a clinical study

作　　者：陈奇峰 贾振宇 杨正强 吴文涛 施海彬 CHEN Qi-feng JIA Zhen- yu YANG Zheng-qiang WU Wen-tao SHI Hai-bin.(Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing , Jiangsu Province 210000, China)

机构地区：[1]南京医科大学第一附属医院介入放射科,210000

出　　处：《介入放射学杂志》2017年第1期55-59,共5页Journal of Interventional Radiology

摘　　要：目的应用MR早期评估经皮微波消融(MWA)肝脏肿瘤的消融范围。方法 2015年1月1日至2016年1月31日,46例肝脏肿瘤患者[55个病灶,平均直径(26.0±5.3)mm]行CT引导下经皮MWA治疗。消融后第2天,MR评估消融疗效,记录消融范围(长径×短径),与微波厂家提供的参考值进行对比分析,并对消融并发症进行记录分析(消融不足或过度)。结果术后第2天MR显示55个病灶均成功进行MWA治疗,无严重消融后即刻并发症发生。病例分布:60 W 5 min(n=4)、60 W 8 min(n=4)、60 W10 min(n=14)、70 W 8 min(n=4)、70 W 10 min(n=11)、80 W 10 min(n=18),对应的消融范围分别为41.3 mm×31.2 mm、52.0 mm×36.3 mm、51.5 mm×34.3 mm、52.9 mm×35.5 mm、56.8 mm×36.1 mm、64.0 mm×44.0 mm。相比参考值均偏大,其中80 W 10 min组差异最大(64.0 mm×44.0 mm比54.0 mm×37.0 mm,P<0.01)。未观察到消融不足病灶,可观察到过度消融病灶12个,主要表现为消融范围累及肝包膜或皮下肌层。结论术后MR早期复查可用于精准评估消融范围,本研究MWA作用范围比参考值大,术前精确预估消融范围有利于肿瘤的完全消融及提高消融的安全性。Objective To discuss the application of MRI in making early assessment of the coagulation extent of liver tumor after microwave ablation（MWA）. Methods From January 1, 2015 to January 31, 2016, CT-guided percutaneous MWA was employed in 46 patients with liver tumor. A total of 55 hepatic lesions were detected in the 46 patients, the mean diameter of the lesion was （26.0±5.3） mm. On the second day after MWA, MRI was performed to evaluate the ablation effect, the ablated extent （long axisxshort axis） was calculated, the results were compared with the referential data provided by manufacturer. The MWA- related complications, including inadequate ablation and excessive ablation, were recorded and analyzed. Results MRI performed on the second day after MWA showed that successful MWA treatment was obtained in all the 55 hepatic lesions, and no serious complications occurred immediately after ablation. The used parameter settings of microwave energy included 60 W-5 min （n=4）, 60 W-8 min （n=4）, 60 W-10 rain （n= 14）, 70 W-8 min （n=-40）, 70 W-10 min （n=l 1） and 80 W-10 min （n=18）; the corresponding ablated extents produced by the above parameter settings were 41.3 mm×31.2 mm, 52.0 mm×36.3 mm, 51.5 mm×34.3 mm, 52.9 mm×35.5 mm, 56.8 mm×36.1 mm and 64.0 mm×44.0 mm respectively; all the above actual ablated values were larger than the referential data provided by manufacturer, and among them the real ablated extent of 80 W-10 min group carried the biggest difference with that provided by manufacturer （64.0 mm×44.0 mm vs. 54.0 mm×37.0 mm, P〈0.01）. No inadequate ablation of lesion was observed, and excessive ablation was seen in 12 lesions, presenting as the involvement of the hepatic capsule or even the subcutaneous muscle layer. Conclusion Early MRI examination after MWA can precisely evaluate the ablation extent. The results of this study indicate that the actual ablated value is bigger than the referential value provided by manufacturer.Accurate prediction of ablation range b

关 键 词：微波消融 范围 磁共振早期评估 肝脏肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]