经动脉导管灌注化疗栓塞术后经皮穿刺肝癌注入碘油化疗药物乳剂弥散方式的观察

The Diffusion Observation of the Percutaneous Intratumoral Injection of CALE Under Fluoroscopy of Patients with Liver Cancer After TACE

目的探讨块状型肝癌经动脉导管灌注化疗栓塞术(TACE)术后透视下经皮穿刺瘤内注入碘油化疗药物乳剂(CALE)弥散方式的影像表现。方法临床诊断为块状型肝癌患者114例,所有患者均为TACE术后病灶内已有碘油乳剂存积者。本次行经皮穿刺瘤内注入CALE治疗的术前常规CT和动脉造影显示靶区为少血供或不能找到供血动脉,且透视下能明确病灶位置。透视下完成经皮穿刺到靶区后注入CALE,并观察CALE弥散的影像学表现。结果全部患者共经皮穿刺瘤内注药180例次,技术成功率为100%。乳剂在靶区内弥散方式影像表现有蛋壳状54例次(30%),平均注药量(12±1.34)ml;团或片状24例次(13.3%),平均注入药量(9.17±1.39)ml;细密网格状90例次(50%),其中经动脉血管网弥散4例次(2.2%),平均注入药量(20.49±1.85)ml;油珠状12例次(6.7%),平均注入药量(7.86±0.74)ml,4组间比较差异具有统计学意义(F=24.9,P<0.05)。混合型16例(8.9%),均出现在团或片状患者和细密网格状患者中。靶区外弥散发生率达97.8%,主要为瘤周正常组织和管道系统。结论透视下经皮瘤内注入CALE影像表现有特征性,表现为蛋壳样、团或片状、细密网格状和油珠状等,并以细密网格状弥散者瘤内注入CALE的量为多。

Objective To investigate the diffusion imaging findings of the percutaneous intratumoral injection of CALE under fluoroscopy of patients with massive liver cancer after TACE. Methods The 114 patients with massive liver cancer（ 106 men,8 women; aged 17- 71 years,mean age： 47 ± 3. 1） were retrospectively analyzed. All lesions were deposited with lipiodol after TACE. Preoperative CT and arteriography displayed that target lesions were hypovascular or the feeding arteries of the target lesions could not be found and catheterized. The location of the lesions can be defined by the deposited lipiodol under fluoroscopy. Percutaneous intratumoral injection of CALE was carried out in the target lesions under fluoroscopic guidance and the imaging performance was evaluated. Results Percutaneous intratumoral injections of CALE were successfully performed in all 180-target lesions with 100% technique success rate. The fluoroscopic imaging findings were as follows： eggshell-like（ n = 54,30. 0%） with average injection dose of（ 12 ± 1. 34） ml,massive or patchy（ n = 24,13. 3%） with average injection dose of（ 9. 17 ± 1. 39） ml,densely-grid（ n = 90 50%） with average injection dose of（ 20. 49 ± 1. 85） ml,granular（ n = 12,6. 7%） with average injection dose of（ 7. 86 ± 0. 74） ml. There was significant difference among the 4 groups（ F = 24. 9,P〈0. 05）. The mixed type was found in 16 cases（ 8. 9%） in the group of the massive or patchy and the densely-grid. The incidence of diffusion beyond the target area was 97. 8% including diffusion in the paraneoplastic normal tissue and piping system. Conclusion The diffusion imaging findings of the percutaneous intratumoral injection of CALE shows fluoroscopic features such as eggshell-like,massive or patchy,densely-grid and granular.The most consistent diffusion-imaging finding was the densely-grid.