1.5 T MR导向下肝脏恶性肿瘤射频消融治疗技术初探

Preliminary study of 1.5 T MR guided radio-frequency ablation for hepatic malignant tumors

目的 探讨1.5 T MR引导下对肝脏恶性肿瘤射频消融治疗的可行性.方法 23例44个经病理证实、不能或不愿手术的肝脏恶性肿瘤病灶,其中11例为原发性肝癌、12例为肝转移癌,肿瘤最大径平均（3.3±1.8）cm,均采用MR兼容多极射频针在1.5 T MR引导下进行射频消融治疗.术后MR扫描观察消融情况,消融灶完全覆盖原病灶、范围超出病灶边缘0.5～1.0 cm为消融完全.结果 所有消融均顺利完成,平均手术时间（93±33）min,消融灶均完全覆盖病灶,无胆瘘、膈肌穿孔、黄疸、气胸等并发症发生.射频电极针在MR图像上呈低信号.消融灶在T2WI序列上呈低信号,周围可见薄层高信号环绕;T1WI序列上消融灶呈明显高信号,边界清晰;DWI上消融灶呈等低信号,周围呈环状稍高信号.结论 1.5 T MR引导下肝脏恶性肿瘤射频消融是安全、有效的技术.

Objective To explore the technique and feasibility of using 1.5 T MR guided radiofrequency ablation （RFA） of hepatic malignant tumor. Methods Twenty three patients with 44 malignant lesions in liver confirmed by pathology were treated with 1.5 T MR guided RFA using MR compatible multipolar RF electrode. Only patients refusing open surgery or suffering from unresectable lesions were included. Of these, 11 patients had primary hepatic carcinoma and 12 patients had hepatic metastases. The mean maximal diameter of lesions was （3.3 ± 1.8）cm. Postoperative MR was performed; the ablation zone covered and exceeded 0.5 to 1.0 cm to the margin of initial tumor was considered successful. Results All ablations were successful and lesions created by radio frequency were large enough to cover the initial tumor volume in all cases. No severe complications such as biliary fistula, perforation of diaphragmatic muscle,postoperative jaundice and pneumothorax were encountered. The mean operative time was （93 ± 33 ） min.The RF electrodes appeared in MRI as low signal structure. The ablation lesions were well-defined hyperintensity in T1 WI and hypo-intensity with a thin rim of high signal intensity on T2WI and DWI. Conclusion 1.5 T MR guided RFA of hepatic malignant tumor is an effective and safe technique.