高场开放式MR自由手透视技术导引冷冻消融37例膈顶部肝细胞癌临床实践

MR fluoroscopy with free-hand techinique guided Cryoablation of 37 HCC On Hepatic Dome Using 1.0-T Open High-field Scanner

目的分析及评价1.0T开放性MR自由手透视技术导引下经皮穿刺冷冻消融膈顶部肝细胞癌的安全性、可行性及有效性。方法对37例近膈顶部肝细胞癌病人行1.0T开放式磁共振导引经皮穿刺冷冻消融治疗,病变最大直径范围为8~38mm。穿刺过程中,采用自由手透视技术序列(T1-FFE,采集时间1.6 s或Breath-hold THRIVE,采集时间4.8s)进行实时扫描、导引与监控。术后随访至少12个月或至病人死亡。如果局部肿瘤进展,则再次行冷冻消融手术治疗。记录病人生存期、局部肿瘤控制情况及并发症。结果 37例病人均成功施行MR导引下经皮冷冻消融手术,技术成功率为100%。平均随访时间为21.0个月(10个月~26个月)。在第6个月时,局部肿瘤进展率和整体生存率分别为2.7%(1/37)和100%(37/37),1年时分别为5.4%(2/37)和97.3%(36/37);2例局部肿瘤进展病人于手术后第4个月、第11个月进行2次补充冷冻治疗。1名病人在术后第10个月因上消化道出血而死亡。有2例病人术后需要胸腔引流;无其他严重并发症。结论 1.0 T开放式磁共振自由手透视技术导引下经皮穿刺冷冻消融治疗近膈顶部肝细胞癌是一种安全、可行和有效的方法。

Objective To prospectively evaluate the feasibility, safety and effectiveness of 1.0T open MR fluoroscopy with flee-hand techinique guided percutaneous cryoablation of hepatic dome hepatocellular carcinomas. Methods 37 cases of HCC on hepatic dome underwent MR guided percutaneous cryoablations using 1.0 T open MR scanner. MR fluoroscopy with free-hand techinique（T1-FFE, acquisition time 1.6s or Breath-hold THRIVE, acquisition time 4.8s） was applied to guidance in the puncture procedure. The lesions were 8 to 38 mm in the maximum diameter. Patients were followed for at least 12 months or until death. The supplementary cryoablation was performed if local tumor progression was found. Survival period, local tumor control and complications were recorded. Results MR- guided percutaneous cryoablation procedures were successfully performed in all the 37 lesions. The technical success rate was 100%. The median follow-up time was 21.0 months （from 10 to 26 months）. Two patients with local tumor progression at the 4th and llth month after the procedure were retreated with two supplementary cryoablations. One patient died from upper gastrointestinal hemorrhage at the 10th month postcryoablation. Local tumor progression and overall survival rates were 2.7% （1/37） and 100% （37/37） at 6 months, and 5.4% （2/37） and 97.3% （36/37） at 1 year, respectively. There were 2 patients with postoperative hydrothorax needing chest tube drainage, no other severe complications occurred. Conclusions Under 1.0T open MR fluoroscopy with flee-hand techinique, Cryoablation of hepatic dome hepatocellular carcinomas is a feasible, safe and effective therapy method.