基于三维磁共振分析肝细胞癌微波消融后局部进展的空间规律  

Spatial distribution pattern of local tumor progression analysis after microwave ablation of hepatocellular carcinoma based on three-dimensional magnetic resonance imaging

作　　者：范方莹 丁文臻 刘方义 程志刚 韩治宇 于晓玲 梁萍 于杰 Fan Fangying;Ding Wenzhen;Liu Fangyi;Cheng Zhigang;Han Zhiyu;Yu Xiaoling;Liang Ping;Yu Jie(Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Chinese PLA Medical School,Beijing 100853,China)

机构地区：[1]解放军总医院第五医学中心介入超声科,北京100039 [2]解放军医学院,北京100853

出　　处：《中华肝脏病杂志》2024年第3期208-213,共6页Chinese Journal of Hepatology

基　　金：国家自然科学基金(82030047、81971625)。

摘　　要：目的探索≤5 cm肝细胞癌(HCC)微波消融后局部进展(LTP)的空间分布规律。方法回顾性分析2009年12月至2019年12月169枚具有消融前后匹配MRI的HCC。运用三维可视化技术重建肿瘤MRI,根据LTP是否与消融区边缘接触及发生时间(24个月),将LTP分类为接触型或非接触型LTP,早期或晚期LTP,利用八象限地图法将肿瘤周围空间划分8个象限,分析消融最短安全边界(AM)所在象限与不同类型LTP发生象限空间关系。计量资料用t检验或者秩和检验;计数资料用χ^(2)检验比较两组的差异。结果54.4%LTP分布于AM所在象限,64.2%早期LTP及69.1%接触型LTP分布于AM所在象限,较其他象限显著集中(P<0.001);仅15.2%非接触型LTP及17.1%晚期LTP分布于AM所在象限,与八象限平均分布概率12.5%差异无统计学意义(P=0.667,0.743)。46.6%早期接触型LTP位于消融针尖端方位,25.2%位于体部方位,28.1%位于尾部方位,而非早期接触型LTP的位置分布概率分别为34.8%,31.8%和33.3%。结论LTP多数发生于消融最短安全边界所在区域,但非接触型LTP及晚期LTP呈均匀分布特点,这类LTP可能为非消融安全边界不足导致。Objective To investigate the spatial distribution pattern of local tumor progression(LTP)for hepatocellular carcinoma(HCC)≤5 cm after microwave ablation.Methods A retrospective analysis was performed on 169 HCCs with matched MRI before and after ablation from December 2009 to December 2019.A tumor MRI was reconstructed using three-dimensional visualization technology.LTP was classified as contact or non-contact,early or late stage,according to whether LTP was in contact with the edge of the ablation zone and the occurrence time(24 months).The tumor-surrounded area was divided into eight quadrants by using the eight-quadrant map method.An analysis was conducted on the spatial correlation between the quadrant where the ablative margin(AM)safety boundary was located and the quadrant where different types of LTP occurred.The t-test,or rank-sum test,was used for the measurement data.2-test for count data was used to compare the difference between the two groups.Results The AM quadrant had a distribution of 54.4%LTP,64.2%early LTP stage,and 69.1%contact LTP,suggesting this quadrant was much more concentrated than the other quadrants(P<0.001).Additionally,the AM quadrant had only 15.2%of non-contact type LTP and 17.1%of late LTP,which was not significantly different from the average distribution probability of 12.5%(100/8%)among the eight quadrants(P=0.667,0.743).46.6%of early contact type LTP was located at the ablation needle tip,25.2%at the body,and 28.1%at the caudal,while the location distribution probabilities of non-early contact LTP were 34.8%,31.8%,and 33.3%,respectively.Conclusion LTP mostly occurs in areas where the ablation safety boundary is the shortest.However,non-contact LTP and late LTP stages exhibit the feature of uniform distribution.Thus,this type of LPT may result from an inadequate non-ablation safety boundary.

关 键 词：肝细胞癌 微波消融 局部进展 空间规律 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]