多层螺旋CT多平面重建技术在肝癌射频消融术中的应用

Application of multiplanar reconstruction technique of multi- slice spiral CT scan in the radiofrequency ablation of hepatocellular carcinoma

目的探讨多层螺旋CT多平面重建(MPR)技术在射频消融(RFA)治疗晚期肝癌中的应用。方法 114例晚期肝癌患者行RFA治疗,常规轴位扫描引导组(简称非MPR组)83例,MPR组31例。对两组调整进针方向的次数、穿刺角度和深度差、术前术后CT均值差、操作总时间、术后并发症发生率、平均剂量·长度积(DLP)及瘤体毁损率进行统计学分析。结果穿刺成功时MPR组进针次数较非MPR组少1.42次(P<0.001)。两组穿刺角度和深度误差分别是0.33°和0.23 mm(P>0.05)。术前术后两组CT均值差为0.36 Hu(P>0.05)。MPR组较非MPR组操作时间平均缩短8 min(P=0.001)。MPR组仅5例(16.1%)出现并发症,而非MPR组有33例(39.8%)出现并发症(P<0.05)。RFA治疗成功后MPR组的平均DLP较非MPR组少131.75 m Gy·cm(P<0.001)。术后复查1、3个月的三期CT/MRI,两组患者的瘤体毁损情况均无明显统计学意义(P>0.05)。结论多层螺旋CT MPR技术更清晰显示射频针与病变及其周围解剖结构的位置关系,减少了进针次数,缩短了操作时间,降低了并发症发生率与辐射剂量,提高了手术效率,因此对RFA治疗肝癌具有重要指导价值。

Objective To discuss the application of muhiplanar reconstruction technique of multislice spiral CT scan in the radiofrequency ablation （RFA） of advanced hepatocellular carcinoma. Methods RFA was employed in 114 patients with advanced hepatocellular carcinoma. The patients were divided into routine axial scan guided group （non-MPR group, n=83） and multiplanar reconstruction group （MPR group, n=31 ）. The number of adjusting needle orientation, the puncture angle and depth difference, the difference between the preoperative and postoperative mean CT values, the total time of operation, the postoperative complications, the average dose length product （DLP） and the rate of tumor destruction were determined, and the results were statistically analyzed. Results The times of needle puncturing in MPR group was 1.42 times less than that in non-MPR group （P〈0.001）. The puncture angle and depth deviations of the two groups were 0.33° and 0.23 mm respectively （P〉0.05）, respectively. The difference between the preoperative and postoperative mean CT values of the two groups was 0.36 Hu （P〉0.05）. The average operation time of MPR group was 8 min less than that of non-MPR group （P=0.001）. In MPR group only 5 patients （16.1%） had complications, while in non-MPR group 33 patients （39.8%） developed complications （P〈0.05）. After RFA, the average DLP in MPR group was 131.75 mGy.cm less than that in non-MPR group （P〈0.001）. CT/MRI scan performed at one and 3 months after RFA showed that no statistically significant difference in the extent of tumor destruction existed between the two groups （P〉0.05）. Conclusion Multi-slice spiral CT scan and MPR reconstruction can more clearly display the position of RF needle, the lesion, and their relationship with the surrounding anatomical structures. For this reason, the times of puncturing can be reduced, the operation time can be shortened, the incidence of complications and the radiation dose can be effectively reduced, and the surgery efficacy can be improved. Therefore, muhiplanar reconstruction technique of multi-slice spiral CT scan is of great value in guiding radiofrequency ablation for advanced hepatocellular carcinoma.