摘要
目的：分析经导管动脉内化疗栓塞（TACE）治疗后临床长期稳定肝癌（HCC）的MRI表现，为临床可以长期随访或11期手术的肝癌患者提供指导。方法：42例HCC患者（86个病灶）TACE治疗后，经临床随访1年以上并证实为病灶稳定。28例54个病灶于治疗前行MRI检查，所有患者分别于治疗后3个月、12个月行MRI检查。常规行SE T1WI、T2WI和3期动态增强扫描。回顾性分析各个时间点HCC的MRI表现及变化情况。结果：SE序列：T1WI上所有病灶在治疗前后不同时期信号改变无特异性。T2WI上治疗前52个病灶（52／54）为高信号，2个为等信号；治疗后3个月46个为等低信号，8个仍为高信号且信号强度高于治疗前；治疗后12个月所有病灶为等低信号。另14例32个病灶治疗后3个月T2WI上12个为高信号，20个为等低信号；治疗后12个月27个为等低信号，5个仍为高信号，但信号强度较前降低。动态增强扫描：治疗前54个（54／54）病灶增强早期均明显强化；所有病灶（86个）治疗后不同时期动态增强早期均未见强化，34个（34／86）病灶显示有完整和清楚的包膜。所有病灶均有不同程度的缩小，其中20个缩小〉75％，44个缩小50％～75％，22个缩小25％～50％。结论：经TACE治疗后临床长期稳定的HCC病灶可靠的MRI表现为动态增强早期病灶无强化，包膜清楚、完整。体积缩小。T2WI呈等、低信号，高信号转变为等低信号或信号强度降低能提示病灶稳定。MRI平扫对病灶稳定性的判断需要密切随访和结合动态增强扫描。MRI能为适合临床长期随访或Ⅱ期切除的肝癌患者提供有价值的影像学信息。
Objective：To analyze the MRI manifestations of hepatocellular carcinoma （HCC） with long term clinical stability after transcatheter arterial chemoembolization （TACE） with Lipiodol, and to provide guidance for patients suitable for long-term follow-up or Ⅱ-stage resection. Methods：42 patients with 86 HCC lesions which achieved long-term stability for at least 12 months after TACE were included in this study. 28 patients with 54 lesions underwent MRI before TACE, and all patients underwent MRI 3 months and 12 months after the last TACE procedure. SE T1WI,TzWI and triphasic dynamic enhanced MRI were performed routinely. The MR1 manifestations of HCC in various period were analyzed retrospectively. Results： The changes of signal intensities of HCC on SE images were as follows： on T1WI images, no specific changes before and after TACE could be revealed;on T2WI images,52 lesions showed hyperintensity and 2 iso-intensity before TACE;46 lesions became iso-or hypo-intense 3 months after TACE,8 remained hyperintense and even higher than that before treatment, However, the signal intensities of all lesions changed to iso-or hypointense 12 months after TACE. Of the other 14 patients （32 lesions） which did not have MRI before treatment, 12 showed hyperintense and 20 showed iso or hypointense 3 months after TACE;27 lesions were iso- or hypointense 12 months after treatment,5 still remained hyperintense but showed decreased intensity when compared to that of the previous images 9 months before. The signal intensities on dynamic enhanced images were as follows： all of the 54 lesions enhanced obviously on early phase images before TACE, but showed no early enhancement on images in different period during the follow up after treatment. There were 34 lesions had complete and well-defined capsule on MRI images. All of the lesions reduced in size with various degree after TACE,including≥75% （n=20）,50%-75% （n=44） and 25%-50% （n=22）.Conclusion：Of the HCCsafterTACE with long term clinical follow u
出处
《放射学实践》
2006年第9期928-932,共5页
Radiologic Practice
基金
2004年卫生部部属(管)医疗机构临床学科重点项目
上海市医学重点学科项目资助
关键词
磁共振成像
化疗栓塞
治疗性
癌
肝细胞性
Magnetic resonance imaging
Chemoembolization,therapeutie
Carcinoma,hepatocellular
