3.0T闭合式大孔径MR引导下肝癌微波消融15例

3.0T closed wide-bore MR-guided microwave ablation for hepatocellular carcinoma:preliminary experience in 15 cases

目的探讨3.0T闭合式大孔径MR引导原发性肝癌微波消融的可行性和有效性。方法回顾性分析15例原发性肝癌患者(24个病灶)采用3.0T闭合式大孔径MR引导行微波消融术。记录病灶大小、扫描序列、消融参数、并发症,比较术前、术后2个月生化指标和甲胎蛋白(AFP),采用mRECIST评价肿瘤局部消融情况。结果肿瘤最大径均值2.6 cm,扫描序列T1 Vibe fs 16 s,T2 haste fs 16 s。单病灶平均功率/时间:62.0W/14.8 min。次要并发症发生率20%,无大出血、感染、胆瘘、肝功能衰竭等主要并发症。术前术后2个月血常规、肝肾功能无明显变化(P>0.05),甲胎蛋白明显下降,(944.9±602.0)μg/L比(40.2±37.1)μg/L,差异有统计学意义(P<0.05)。病灶评价完全缓解率(CR)95.8%(23/24),部分缓解率(PR)4.2%(1/24),局部控制率(LCR)100%。结论3.0T闭合式大孔径MR引导下肝癌微波消融术安全可行有效。

Objective To investigate the feasibility and effectiveness of 3.0T closed wide-bore MRguided microwave ablation(MWA)in treating hepatocellular carcinoma(HCC).Methods The clinical data of 15 patients with HCC(24 lesions in total),who received MWA under 3.0T closed wide-bore MR guidance,were retrospectively analyzed.The lesion size,scan sequence,ablation parameters(power and time)and complications were recorded.The pre-MWA and post-MWA 2-month alpha-fetoprotein(AFP)levels were compared.Modified response evaluation criteria in solid tumor(mRECIST)was used to evaluate local tumor response.Results The average maximum diameter of tumors was 2.6 cm.The scan sequences of T1 Vibe fs and T2 haste fs were adopted.The scanning time was 16 s for both scan sequences.The average power/time used for single lesion was 62.0 W/14.8 min.The incidence of minor complications was 20%.No serious complications such as massive haemorrhage,infection,biliary fistula,liver failure,etc.occurred.The post-MWA 2-month blood routine test,liver function and kidney function showed no obvious changes when compared with pre-MWA ones.The post-MWA 2-month AFP level was strikingly decreased when compared with pre-MWA one(40.2±37.1 versus 944.9±602.0),and the difference was statistically significant(P<0.05).After MWA,95.8%(23/24)of HCC lesions achieved complete remission(CR)and 4.2%(1/24)of HCC lesions achieved partial remission(CR),the local control rate(LCR)of HCC was 100%.Conclusion For the treatment of HCC,3.0T closed wide-bore MRguided MWA is safe,feasible and effective.