肺恶性肿瘤热消融治疗后的CT影像学演变

CT imaging changes after thermal ablation of pulmonary malignancies

目的探讨肺恶性肿瘤热消融术后的CT影像学演变,以便准确评估其疗效和预后,及时发现肿瘤残存或复发。方法搜集2015年1月~2018年12月于浙江省肿瘤医院行CT引导下肺肿瘤热消融治疗的72例患者85个病灶,分析对比其消融术后即时、1个月、3个月、6个月、12个月的CT影像学特征。结果所有患者热消融术后病灶周围即刻出现磨玻璃样改变,其中3个病灶(3.5%)出现小空泡影;术后1个月62个病灶(88.5%)体积较消融前增大,1个病灶(2.2%)出现厚边强化;术后3个月,51个病灶(72.9%)较上一次评估时缩小,5个病灶(11.1%)出现厚边强化;术后6个月,40个病灶(59.7%)较上一次评估时缩小,8个病灶(17.0%)出现厚边强化;术后12个月,30个病灶(55.6%)较上一次评估时缩小,12个病灶(32.5%)出现厚边强化。最终39个病灶(45.9%)完全消融,26个病灶(30.6%)不完全消融。结论肺肿瘤热消融术后3个月以后病灶体积开始持续缩小或保持稳定,且无厚边强化,提示肿瘤完全消融;病灶体积持续增大或先缩小后增大,并伴厚边强化,提示肿瘤不完全消融。

Objective To explore the CT imaging changes after thermal ablation of pulmonary malignancies,so as to evaluate the efficacy and prognosis accurately and to find the tumor survival or recurrence in time.Methods 85 pulmonary neoplasms in 72 patients admitted to Zhejiang cancer hospital from January 2015 to December 2018 underwent CT-guided thermal ablation,and the CT imaging characteristics of the neoplasms were analysed immediately,1,3,6 and 12 months after ablation.Results In all patients,ground-glass changes immediately appeared around the lesions after thermal ablation,and 3 lesions(3.5%)showed small empty bubbles.One month after the treatment,62 lesions(88.5%)showed increased volume compared with that pre-treatment,and 1 lesion(2.2%)showed thick-edge enhancement;Three months after the treatment,51 lesions(72.9%)were reduced compared with the previous assessment,and 5 lesions(11.1%)showed thick-edge enhancement;Six months after the treatment,40 lesions(59.7%)were smaller than the previous assessment,and 8 lesions(17.0%)showed thick-edge enhancement;Twelve months after the treatment,30 lesions(55.6%)were smaller than the previous assessment,and 12 lesions(32.5%)showed thick-edge enhancement.Finally,39 lesions(45.9%)were completely ablated,and 26 lesions(30.6%)were not completely ablated.Conclusion After thermal ablation of lung tumor,the lesion volume continued to shrink or remain stable without thick-edge enhancement on beyond three-month follow-up,indicating the complete ablation.On the contrary,the lesion volume continued to increase or first decreased and then increased with thick-edge enhancement,suggesting the tumors were not completely ablated.