肝脏恶性肿瘤射频消融术后早期FS-T2WI消融区周围水肿环评价消融疗效的应用
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摘要
目的探讨肝脏恶性肿瘤射频消融(RFA)术后早期FS-T2WI消融区周围水肿环形态用于评价RFA疗效的价值。方法收集接受RFA治疗的18例肝癌及4例肝转移瘤患者,于术后第3天行MR平扫,观察FS-T2WI中消融区周围水肿环的形态特点;随访复查MR平扫、多期增强扫描及肿瘤标志物,评价根据FS-T2WI水肿环连续性判断RFA疗效的价值。结果消融后,22例病灶FS-T2WI消融区周围均出现高信号水肿环。19例水肿环连续,其中11例厚薄均匀,8例厚薄不均匀但形态规整、边界清晰;术后随访均无异常强化,肿瘤标志物稳定,提示消融完全。3例水肿环不连续,局部可见外凸稍高信号结节,术后1个月增强MRI可见结节状动脉期强化,血清甲胎蛋白升高,提示消融区域未完全覆盖肿瘤区域,消融不完全。结论肝脏恶性肿瘤RFA后早期FS-T2WI消融区周围水肿环对评价疗效具有一定价值,尤其对于判断短期疗效意义重大。
Objective To explore the value of edema ring around the ablation zone on FS-T2 WI for early phase effect evaluation of radiofrequency ablation(RFA) for treatment of malignant hepatic tumors. Methods Totally 18 patients with liver cancer and 4 with liver metastasis who underwent RFA therapy were enrolled. Plain MR images were obtained to observe the morphological features of the edema ring around the ablation zone on FS-T2 WI on the third day after RFA. Plain and multiphase enhanced MRI were obtained after RFA to observe the effect, as well as tumor markers. The value of continuity of edema ring on FS-T2 WI for evaluating the effect of RFA was assessed. Results High-signal edema ring was seen around the ablation zone on FS-T2 WI in all 22 cases. The edema rings were continuous in 19 cases, among them the thickness of the edema rings were uniform in 11 cases, while were uneven but with regular shape and clear boundary in the other 8 cases. No abnormal enhancement was detected on the following enhanced MRI after RFA, and the tumor markers were stable in above 19 cases, both suggesting completed ablation. The edema rings were discontinuous in 3 cases of liver cancer, with protruding slightly high signal nodule which enhanced on MRI 1 month after RFA, and the serum alpha-fetoprotein were elevated, suggesting that the ablation area did not completely cover the tumor area, and the ablations were not complete. Conclusion The edema ring around the ablation zone on plain FS-T2 WI early phase after RFA has certain value in assessing the effect of RF for malignant liver tumors, especially for short-term effect of RFA.
Objective To explore the value of edema ring around the ablation zone on FS-T2 WI for early phase effect evaluation of radiofrequency ablation(RFA) for treatment of malignant hepatic tumors. Methods Totally 18 patients with liver cancer and 4 with liver metastasis who underwent RFA therapy were enrolled. Plain MR images were obtained to observe the morphological features of the edema ring around the ablation zone on FS-T2 WI on the third day after RFA. Plain and multiphase enhanced MRI were obtained after RFA to observe the effect, as well as tumor markers. The value of continuity of edema ring on FS-T2 WI for evaluating the effect of RFA was assessed. Results High-signal edema ring was seen around the ablation zone on FS-T2 WI in all 22 cases. The edema rings were continuous in 19 cases, among them the thickness of the edema rings were uniform in 11 cases, while were uneven but with regular shape and clear boundary in the other 8 cases. No abnormal enhancement was detected on the following enhanced MRI after RFA, and the tumor markers were stable in above 19 cases, both suggesting completed ablation. The edema rings were discontinuous in 3 cases of liver cancer, with protruding slightly high signal nodule which enhanced on MRI 1 month after RFA, and the serum alpha-fetoprotein were elevated, suggesting that the ablation area did not completely cover the tumor area, and the ablations were not complete. Conclusion The edema ring around the ablation zone on plain FS-T2 WI early phase after RFA has certain value in assessing the effect of RF for malignant liver tumors, especially for short-term effect of RFA.
引文
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[11] Koda M,Tokunaga S,Miyoshi K,et al.Assessment of ablative margin by unenhanced magnetic resonance imaging after radiofrequency ablation for hepatocellular carcinoma.Eur J Radiol,2012,81(10):2730-2736.
[12] 陈锦,陈群林,林征宇,等.射频消融治疗肝脏恶性肿瘤急性热损伤的MRI表现及疗效判定.中国介入影像与治疗学,2013,10(12):713-716.
[13] Koda M,Tokunaga S,Fujise Y,et al.Assessment of ablative margin after radiofrequency ablation for hepatocellular carcinoma;comparison between magnetic resonance imaging with ferucarbotran and enhanced CT with iodized oil deposition.Eur J Radiol,2012,81(7):1400-1404.
[14] 谢璐璐,廖锦堂,李悦怡,等.肝脏恶性肿瘤射频消融术后即刻超声造影的临床价值.中国普通外科志,2017,26(2):228-234.
[2] 江柳,王霄英.肝脏恶性肿瘤射频消融术后的影像学评价.中国介入影像与治疗学,2013,10(12):726-729.
[3] 陈敏山.肝癌射频消融治疗规范的专家共识.临床肝胆病杂志,2011,27(3):236-244.
[4] 李冰清,刘再毅,梁长虹.肝癌射频消融术疗效的影像学评估.临床放射学杂志,2015,34(5):841-844.
[5] Sainani NI,Gervais DA,Mueller PR,et al.Imaging after percutaneous radiofrequency ablation of hepatic tumors:Part 1,Normal findings.AJR Am J Roentgenol,2013,200(1):184-193.
[6] Shady W,Petre EN,Gonen M,et al.Percutaneous radiofrequency ablation of colorectal cancer liver metastases:Factors affecting outcomes—a 10-year experience at a single center.Radiology,2016,278(2):601-611.
[7] 朱楠,鲁东,肖景坤,等.肝动脉化疗栓塞联合射频消融术治疗中晚期肝癌的疗效.中国介入影像与治疗学,2017,10(4):195-199.
[8] Bilchik AJ,Wood TF,Allegra D,et al.Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms:A proposed algorithm.Arch Surg,2000,135(6):657-662.
[9] D’Onofrio M,Cardobi N,Ruzzenente A,et al.Unenhanced magnetic resonance imaging immediately after radiofrequency ablation of liver malignancy:Preliminary results.Abdom Radiol (NY),2018,43(6):1379-1385.
[10] 杨正强,王建华,干育红,等.螺旋CT对射频消融治疗肝脏恶性肿瘤的疗效评价.实用放射学杂志,2003,19(10):906-909.
[11] Koda M,Tokunaga S,Miyoshi K,et al.Assessment of ablative margin by unenhanced magnetic resonance imaging after radiofrequency ablation for hepatocellular carcinoma.Eur J Radiol,2012,81(10):2730-2736.
[12] 陈锦,陈群林,林征宇,等.射频消融治疗肝脏恶性肿瘤急性热损伤的MRI表现及疗效判定.中国介入影像与治疗学,2013,10(12):713-716.
[13] Koda M,Tokunaga S,Fujise Y,et al.Assessment of ablative margin after radiofrequency ablation for hepatocellular carcinoma;comparison between magnetic resonance imaging with ferucarbotran and enhanced CT with iodized oil deposition.Eur J Radiol,2012,81(7):1400-1404.
[14] 谢璐璐,廖锦堂,李悦怡,等.肝脏恶性肿瘤射频消融术后即刻超声造影的临床价值.中国普通外科志,2017,26(2):228-234.