多层螺旋CT扫描在肺部恶性肿瘤射频毁损治疗中的价值

Value of Multi-slice Spiral CT in the Radio-frequency Ablation Therapy of Lung Cancer

目的评价多层螺旋CT在肺部恶性肿瘤射频毁损治疗中的价值。方法对20例肺部恶性肿瘤患者(32个病灶)行16层螺旋CT引导下射频毁损治疗。治疗中,利用多层CT软件功能,对病灶处进行二维多层面和三维重组,观察治疗针在病灶所处位置以及与周围组织结构之间的关系。治疗后1月或半年后再行CT扫描复查,评价治疗效果。结果20例患者中,治疗针在病灶所处位置以及与周围组织结构之间的关系显示明确,特别是利用三维重组技术更能清晰观察针尖所处的位置,病灶毁损较为完全。治疗后即行CT扫描,32个病灶周边都有渗出;有25个病灶密度减低;7个病灶密度变化不大。有18个病灶内部呈单个或多个小气泡影。1月或半年后CT复查显示,有2个病灶完全消失,25个病灶有不同程度的缩小,2个无变化,3个増大。8例有肺部症状及体征者治疗后消失或减轻好转。结论射频毁损治疗肺部恶性肿瘤有确切疗效,16层螺旋CT二维及三维重组图像能准确引导治疗针进入目的位置,特别是对靠近心脏主动脉等重要器官的病灶射频毁损治疗比普通CT定位更精确、效果更佳。

Objective：To evaluate the value of multi-slice spiral CT in the radio-frequency （RF） ablation therapy of lung cancer. Methods：20 patients with lung cancer （32 lesions） were treated with 16-slice spiral CT guided RF ablation. During the treatment procedure,two- or three-dimension reconstruction images were obtained by using the software of the multi-slice CT scanner （GE Lightwpeed）. The relationship between the location of RF needle,the lesion and the surrounding tissue could be clearly demonstrated. The effects of therapy were evaluted by CT 1- 6 months after treatment. Results： For all of these 20 patients,especially using 3-dimension reconstruction DT software,the relationship between the position of the needle tip,lesion,and the surrounding tissue could be displayed clearly, thus the focus could be ablated much more completely. Immediately after the treatment procedure, the 32 lesions were re-scanned. Peripheral exudation could be revealed in all of these lesions,with decreased lesion density （n= 25） ,little change of density （n= 7） and solitary or multiple air bubble within the lesion （n=18）. Re-examination 1- 6 months after treatment, there were complete disappearance of lesion （n= 2）,shrinkage of lesion with different extent （n： 25）, stableness of tumor size （n： 2） and enlargement of tumor （n=3）. Vanishing or diminution of pulmonary signs or symptoms （n= 8）. Conclusion： RF ablation showed a reliable effect in treating lung cancer. 2-or 3-dimension multi-slice CT reconstruction technique is very helpful in guiding the approach of needle puncture,especially in the lesion located adjacent to the important organs such as heart or aorta and more precise and accurate measure is needed.