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MRI对评价肝癌Lp-TACE治疗的价值 被引量:5

The Role of MRI in Evaluating HCC after Transcatheter Arterial Chemoembolization with Lipiodol
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摘要 目的 通过影像 病理对照研究 ,探讨MRI尤其是动态增强MRI(D MRI)在肝癌Lp TACE治疗随诊中的价值以及协助临床确定Lp TACE治疗间隔的可行性。材料与方法  10例Lp TACE治疗后手术切除的肝癌患者 ,术前行CT扫描、MR平扫及早期动态增强扫描、增强晚期和延迟期扫描。术后肿瘤标本作MRI、CT扫描和软X线照相 (8例 ) ,作影像 病理对照研究。结果  (1)病理表现 :10例均发现残留的肝癌细胞。肿瘤坏死率 >80 % 7例 ,存活肿瘤细胞主要分布在包膜下 ;坏死率 <5 0 % 3例。其他病理表现包括出血、炎症细胞浸润、粘液样变、纤维组织与玻璃样变以及碘油沉积。 (2 )CT扫描、钼靶X线相 :术前CT扫描示碘油致密者 4例 ,碘油有缺损或分布稀疏者 6例。 10例标本钼靶X线相均发现有碘油缺损区。(3)MRI与病理对照 :术前T2 WI信号不均匀且以中高信号为主者 7例 ,病理示肿瘤坏死率 >80 %者 4例 ,<5 0 %者 3例 ,其中 4例见瘤内出血 ;均匀等信号、略高信号或低信号为主者 3例 ,肿瘤坏死率 >90 %。标本T2 WI与病理对照示高信号区病理表现包括 :存活肿瘤 (7例 )、出血 (5例 )、炎症细胞浸润 (4例 )、粘液样变性 (2例 ) ;8例瘤内低信号区多为凝固性坏死区或玻璃样变区 (7例 ) ,仅 1例含少许存活肿瘤。D MRI见肿瘤内大片强化 (3例 ) Objective To assess the role of MRI, including dynamic MRI after intravenously administration of Gd DTPA, in monitoring the efficacy of trascatheter arterial chemoembolization with lipiodol (Lp TACE) for patients with advanced HCC, therefore, to provide a guideline of suitable time interval between TACE procedures.Materials and Methods MRI was performed with a 0.5T MR unit in 10 patients with advanced HCC after receiving Lp TACE. Pre surgery MR and CT findings were compared with MRI (n=8), CT, soft radiographs and pathologic findings of the resected HCC specimens. MR sequences included SE T 1W, FSE T 2W, FSE T 2W/SPIR scanning, pre and post CE and D MRI, T 1WI at 3 and 6 min, after CE. The interval between MRI and surgery was 6~113 days (median 22 days).Results (1) Pathologically, all resected specimens (n=10) demonstrated viable tumor cells microscopically. Areas of necrosis ranged from 10% to 90%. Besides, hemorrhage (n=5), inflammation (n=6) mucoid degeneration (n=2), fibroblast proliferation, collagen and hyalinization, and lipiodol retention (n=10) were found within the tumors. (2) In 4 cases, pre surgery CT scans showed dense lipiodol retention in the lesions, while lipiodol defected areas were found on soft X ray films of the resected specimen. In the remaining 6 cases, the lipiodol defected areas showed on soft X ray films were larger than those showed on CT scans. (3) On T 2WI, 7 tumors with different proportion of necrosis showed moderate or hyper intensity, while the other 3 tumors with over 90% areas of necrosis displayed homogeneous, iso , or moderate, or hypo intensity. On T 2WI of 8 resected specimens, hyper intense areas corresponded to viable tumor (n=7), hemorrhage (n=5), inflammatory infiltration (n=4) and mucoid degeneration (n=2), while hypo intense areas corresponded histologi cally to coagulation necrosis or hyalinization (n=7). On D MRI T 1WI, peripheral small enhanced nodules (n=5) and large sheet like area of enhancement (n=3) corresponded to viable tumor. In 2 tumors which showed no marked enhancement, the necrotic areas overtook 90%, and tumor cells were found at the rim of tumor and/or adjacent hepatic tissue.Conclusion (1) On T 2WI, hypo intense area represents necrosis and hyalini zation, whereas hyper intense area represents various pathological components. (2) D MRI is a reliable method for detecting viable HCC after Lp TACE, though it is difficult for D MRI to detect small, scattered tumor cells. (3) Residual viable tumor cannot be excluded just because dense lipiodol retention is seen on CT scans, D MRI should be performed in order to prevent misdiagnosis and delaying treatment.
机构地区 中国医学科学院
出处 《临床放射学杂志》 CSCD 北大核心 2000年第10期629-632,共4页 Journal of Clinical Radiology
关键词 肝癌 Lp-TACE 灌注化疗 碘化油 磁共振成像 Hepatocellular carcinoma Lipiodol Chemotherapeutic infusion MRI
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