高场开放式MR自由手透视技术导引冷冻消融37例膈顶部肝细胞癌临床实践
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摘要
目的分析及评价1.0T开放性MR自由手透视技术导引下经皮穿刺冷冻消融膈顶部肝细胞癌的安全性、可行性及有效性。方法对37例近膈顶部肝细胞癌病人行1.0T开放式磁共振导引经皮穿刺冷冻消融治疗,病变最大直径范围为8~38mm。穿刺过程中,采用自由手透视技术序列(T1-FFE,采集时间1.6 s或Breath-hold THRIVE,采集时间4.8s)进行实时扫描、导引与监控。术后随访至少12个月或至病人死亡。如果局部肿瘤进展,则再次行冷冻消融手术治疗。记录病人生存期、局部肿瘤控制情况及并发症。结果 37例病人均成功施行MR导引下经皮冷冻消融手术,技术成功率为100%。平均随访时间为21.0个月(10个月~26个月)。在第6个月时,局部肿瘤进展率和整体生存率分别为2.7%(1/37)和100%(37/37),1年时分别为5.4%(2/37)和97.3%(36/37);2例局部肿瘤进展病人于手术后第4个月、第11个月进行2次补充冷冻治疗。1名病人在术后第10个月因上消化道出血而死亡。有2例病人术后需要胸腔引流;无其他严重并发症。结论 1.0 T开放式磁共振自由手透视技术导引下经皮穿刺冷冻消融治疗近膈顶部肝细胞癌是一种安全、可行和有效的方法。
Objective To prospectively evaluate the feasibility, safety and effectiveness of 1.0 T open MR fluoroscopy with free-hand techinique guided percutaneous cryoablation of hepatic dome hepatocellular carcinomas. Methods 37 cases of HCC on hepatic dome underwent MR guided percutaneous cryoablations using 1.0 T open MR scanner. MR fluoroscopy with free-hand techinique(T1-FFE, acquisition time 1.6 s or Breath-hold THRIVE, acquisition time 4.8 s) was applied to guidance in the puncture procedure. The lesions were 8 to 38 mm in the maximum diameter. Patients were followed for at least 12 months or until death. The supplementary cryoablation was performed if local tumor progression was found. Survival period, local tumor control and complications were recorded. Results MRguided percutaneous cryoablation procedures were successfully performed in all the 37 lesions. The technical success rate was 100%. The median follow-up time was 21.0 months(from 10 to 26 months). Two patients with local tumor progression at the 4 th and 11 th month after the procedure were retreated with two supplementary cryoablations. One patient died from upper gastrointestinal hemorrhage at the 10 th month postcryoablation. Local tumor progression and overall survival rates were 2.7%(1/37) and 100%(37/37) at 6 months, and 5.4%(2/37) and 97.3%(36/37) at 1 year, respectively. There were 2 patients with postoperative hydrothorax needing chest tube drainage, no other severe complications occurred. Conclusions Under 1.0 T open MR fluoroscopy with free-hand techinique, Cryoablation of hepatic dome hepatocellular carcinomas is a feasible, safe and effective therapy method.
Objective To prospectively evaluate the feasibility, safety and effectiveness of 1.0 T open MR fluoroscopy with free-hand techinique guided percutaneous cryoablation of hepatic dome hepatocellular carcinomas. Methods 37 cases of HCC on hepatic dome underwent MR guided percutaneous cryoablations using 1.0 T open MR scanner. MR fluoroscopy with free-hand techinique(T1-FFE, acquisition time 1.6 s or Breath-hold THRIVE, acquisition time 4.8 s) was applied to guidance in the puncture procedure. The lesions were 8 to 38 mm in the maximum diameter. Patients were followed for at least 12 months or until death. The supplementary cryoablation was performed if local tumor progression was found. Survival period, local tumor control and complications were recorded. Results MRguided percutaneous cryoablation procedures were successfully performed in all the 37 lesions. The technical success rate was 100%. The median follow-up time was 21.0 months(from 10 to 26 months). Two patients with local tumor progression at the 4 th and 11 th month after the procedure were retreated with two supplementary cryoablations. One patient died from upper gastrointestinal hemorrhage at the 10 th month postcryoablation. Local tumor progression and overall survival rates were 2.7%(1/37) and 100%(37/37) at 6 months, and 5.4%(2/37) and 97.3%(36/37) at 1 year, respectively. There were 2 patients with postoperative hydrothorax needing chest tube drainage, no other severe complications occurred. Conclusions Under 1.0 T open MR fluoroscopy with free-hand techinique, Cryoablation of hepatic dome hepatocellular carcinomas is a feasible, safe and effective therapy method.
引文
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[9]Asvadi NH,Anvari A,Uppot RN,et al.CT-guided percutaneous microwave ablation of tumors in the hepatic dome:assessment of efficacy and safety[J].J Vasc Interv Radiol,2016 Apr,27:496-502.
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[11]Iwai S,Sakaguchi H,Fujii H,et al.Benefits of artificially induced pleural effusion and/or ascites for percutaneous radiofre quency ablation of hepatocellular carcinoma located on the liver surface and in the hepatic dome[J].Hepatogas-troenterolo gy,2012 Mar-Apr,59:546-550.
[12]Wang C,Wang H,Yang W,et al.A multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma[J].Hepatology,2015 May,61:1579-1590.
[13]Wu S,Hou J,Ding Y,et al.Cryoablation versus radiofrequency ablation for hepatic malignancies:a systematic review and literature-based analysis[J].Medicine(Baltimore),2015 Dec,94:e2252.
[14]李晓光.CT和MRI用于肝癌消融术后疗效评价和随访的研究进展[J].肝癌电子杂志,2016,3(1):19-21.
[15]Liu S,Ren R,Liu M,et al.MR imaging-guided percutaneous cryotherapy for lung tumors:initial experience[J].J Vasc Interv Radiol,2014 Sep,25:145614-62.
[16]Hinshaw JL,Lubner MG,Ziemlewicz TJ,et al.Percutaneous tumor ablation tools:microwave,radiofrequency,or cryoablation-what should you use and why?[J].Radiographics,2014Sep-Oct,34:1344-1362.
[17]Bruix J,Sherman M.Management of hepatocellular carcinoma[J].Hepatology,2005 Nov,42:1208-1236.
[18]Gao W,Guo Z,Zhang X,et al.Percutanenous cryoabla-tion of ovarian cancer metastasis to the liver:initialexperience in 13patients[J].Int J Gynecol Cancer,2015 Jun,25:802-808.
[19]Fischbach F,Lohfink K,Gaffke G,et al.Magnetic resonanceguided freehand radiofrequency ablation of malignant liver lesions:a new simplified and time-efficient approach using an interactive open magnetic resonance scan platform and hepatocyte-specific contrast agent[J].Invest Radiol,2013 Jun,48:422-428.
[20]Fischbach F,Bunke J,Thormann M,et al.MR-guided freehand biopsy of liver lesions with fast continuous imaging using a 1.0-T open MRI scanner:experience in 50 patients[J].Cardiovasc Intervent Radiol,2011 Feb,34:188-192.
[21]Hu KQ.Advances in clinical application of cryoablation therapy for hepatocellular carcinoma and metastatic liver tumor[J].J Clin Gastroenterol,http://nc.yuntsg.com/one1.do,2014 Nov-Dec,48:830-6.
[22]程立华,吴波波,贾中芝,等.规范化射频消融在特殊部位肝恶性肿瘤中的应用[J].肝癌电子杂志,2016,3(2):31-35.
[23]Moche M,Heinig S,Garnov N,et al.Navigated MRI-guided liver biopsies in a closed-bore scanner:experience in 52patients[J].Eur Radiol,2016 Aug,26:2462-2470.
[24]Aghayev AI,Tatli S.The use of cryoablation in treating liver tumors[J].Expert Rev Med Devices,2014 Jan,11:41-52.
[2]Jemal A,Bray F,Center MM,et al.Global cancer statistics[J].CA Cancer J Clin,2011 Mar–Apr,61:69-90.
[3]Wu B,Xiao YY,Zhang X,et al.Magnetic resonance imagingguided percutaneous cryoablation of hepatocellular carcinoma in special regions[J].Hepatobiliary Pancreat Dis Int,2010 Aug,9:384-392.
[4]李成利,宋吉青,柳明,等.MR实时导引与监控肿瘤冷冻消融治疗肝肿瘤16例[J].中华放射学杂志,2007,41:750-752.
[5]Wang CC,Kao JH.Artificial ascites is feasible and effective for difficult-to-ablate hepatocellular carcinoma[J].Hepatol Int,2015 Oct,9:514-519.
[6]Ali AM,Lizhi N,Jialiang L,et al.Cryoprotective therapy for hepatocellular carcinoma:Study of 51 patients with a single lesion[J].Cryobiology,2014 Aug,69:61-67.
[7]Toshimori J,Nouso K,Nakamura S,et al.Local recurrence and complications after percutaneous radiofrequency ablation of hepatocellular carcinoma:a retrospective cohort study focused on tumor location[J].Acta Med Okayama,2015,69:219-226.
[8]Wang LG,Jiang WJ,Fan WJ,et al.Microwave ablation:the differences between biliary cirrhosis and normal porcine liver using a cooled-tip electrode[J].Anticancer Res,2016 Mar,36:1221-1226.
[9]Asvadi NH,Anvari A,Uppot RN,et al.CT-guided percutaneous microwave ablation of tumors in the hepatic dome:assessment of efficacy and safety[J].J Vasc Interv Radiol,2016 Apr,27:496-502.
[10]Gao F,Wang GB,Xiang ZW,et al.A preoperative mathematic model for computed tomographic guided microwave ablation treatment of hepatic dome tumors[J].Oncotarget,2016 May 3,7:25949-2559.
[11]Iwai S,Sakaguchi H,Fujii H,et al.Benefits of artificially induced pleural effusion and/or ascites for percutaneous radiofre quency ablation of hepatocellular carcinoma located on the liver surface and in the hepatic dome[J].Hepatogas-troenterolo gy,2012 Mar-Apr,59:546-550.
[12]Wang C,Wang H,Yang W,et al.A multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma[J].Hepatology,2015 May,61:1579-1590.
[13]Wu S,Hou J,Ding Y,et al.Cryoablation versus radiofrequency ablation for hepatic malignancies:a systematic review and literature-based analysis[J].Medicine(Baltimore),2015 Dec,94:e2252.
[14]李晓光.CT和MRI用于肝癌消融术后疗效评价和随访的研究进展[J].肝癌电子杂志,2016,3(1):19-21.
[15]Liu S,Ren R,Liu M,et al.MR imaging-guided percutaneous cryotherapy for lung tumors:initial experience[J].J Vasc Interv Radiol,2014 Sep,25:145614-62.
[16]Hinshaw JL,Lubner MG,Ziemlewicz TJ,et al.Percutaneous tumor ablation tools:microwave,radiofrequency,or cryoablation-what should you use and why?[J].Radiographics,2014Sep-Oct,34:1344-1362.
[17]Bruix J,Sherman M.Management of hepatocellular carcinoma[J].Hepatology,2005 Nov,42:1208-1236.
[18]Gao W,Guo Z,Zhang X,et al.Percutanenous cryoabla-tion of ovarian cancer metastasis to the liver:initialexperience in 13patients[J].Int J Gynecol Cancer,2015 Jun,25:802-808.
[19]Fischbach F,Lohfink K,Gaffke G,et al.Magnetic resonanceguided freehand radiofrequency ablation of malignant liver lesions:a new simplified and time-efficient approach using an interactive open magnetic resonance scan platform and hepatocyte-specific contrast agent[J].Invest Radiol,2013 Jun,48:422-428.
[20]Fischbach F,Bunke J,Thormann M,et al.MR-guided freehand biopsy of liver lesions with fast continuous imaging using a 1.0-T open MRI scanner:experience in 50 patients[J].Cardiovasc Intervent Radiol,2011 Feb,34:188-192.
[21]Hu KQ.Advances in clinical application of cryoablation therapy for hepatocellular carcinoma and metastatic liver tumor[J].J Clin Gastroenterol,http://nc.yuntsg.com/one1.do,2014 Nov-Dec,48:830-6.
[22]程立华,吴波波,贾中芝,等.规范化射频消融在特殊部位肝恶性肿瘤中的应用[J].肝癌电子杂志,2016,3(2):31-35.
[23]Moche M,Heinig S,Garnov N,et al.Navigated MRI-guided liver biopsies in a closed-bore scanner:experience in 52patients[J].Eur Radiol,2016 Aug,26:2462-2470.
[24]Aghayev AI,Tatli S.The use of cryoablation in treating liver tumors[J].Expert Rev Med Devices,2014 Jan,11:41-52.