氩氦刀联合经肝动脉化疗栓塞术治疗肝癌疗效的MRI评价

The evaluation with MRI in combined treatment of hepatocellular carcinoma with cryoablation and transcatheter arterial chemoembolization

目的探讨氩氦刀联合经肝动脉化疗栓塞术(TACE)治疗原发性肝癌的MRI诊断价值。方法对49例肝癌患者行氩氦刀联合TACE治疗共56个病灶的MRI图像进行回顾性分析,评价其疗效,探讨肿瘤残留的MRI特点。结果 56个病灶先TACE后氩氦刀治疗病灶24个,肿瘤完全坏死21个(87.5%),先氩氦刀后TACE治疗病灶32个,肿瘤完全坏死11个(34.3%);5cm以下病灶完全坏死率为78.8%(26/33),5cm以上病灶完全坏死率为26.1%(6/23);全部病灶完全坏死率为57.1%(32/56)。肿瘤消融完全的MRI表现为消融范围覆盖全部肿瘤、肿瘤区无强化;T2WI肿瘤边缘高信号,增强扫描肿瘤不规则强化是肿瘤残留的可靠征象。结论 MRI评价氩氦刀联合TACE治疗肝癌的疗效准确、及时,特异性高,T2WI及增强扫描仍是评价疗效的关键。

Objective To study the value of MRI in the effect of combined treatment with cryoablation and TACE.Methods 49 cases of hepatocellular carcinoma(HCC)include 56 tumors were retrospectively analysised with MRI.Results 24 tumors were treated by cryoablation after TACE and 21 tumors(87.5%)were coagulative necrosis finally,32 cases were treated by the reverse order and 11 tumors(34.3%)were coagulative necrosis.26 tumors in 33 lesions with the diameter under 5 cm were coagulative necrosis finally.Only 6 tumors in 23 lesions with the diameter beyond 5 cm were coagulative necrosis.MRI performance with tumor necrosis include the ablation range and the non-enhanced feature of tumor.The high signal in T2WI and tumor enhanced are the surely features in MRI.Conclusions MRI can evaluate the effect accurately,timely and sensitively in the treatment of HCC with cryoablation and TACE cryoablation.