摘要
应用影像学方法及时准确诊断肝脏转移瘤后,由多学科综合治疗协作组讨论制定个体化治疗方案,病人总生存期可能会得到显著提高。多排螺旋CT(MDCT)是临床常规使用的结直肠癌肝转移瘤筛选和确诊方法。正电子发射断层显像/X线计算机体层扫描(PET/CT)主要用于诊断肝脏及肝脏以外的其他器官转移瘤。相比较而言,多参数磁共振成像(MRI)并用肝脏细胞特异造影剂是诊断结直肠癌肝转移瘤的优选影像学检查方法,特别是对于直径<10mm的肝脏转移瘤及脂肪肝背景下肝脏转移瘤诊断准确性明显高于MDCT以及PET/CT。术中超声(IOUS)微泡造影是诊断肝脏转移瘤的有益补充,临床可能因其新发现肿瘤而改变手术决策。影像学检查依据实体肿瘤疗效评价(RECIST)和世界卫生组织(WHO)标准对肿瘤大小及数目进行判断,是评价结直肠癌肝转移化疗效果的重要手段。而且,PET/CT、扩散加权MRI以及动态增强MRI通过判断肿瘤代谢、细胞密度及血管灌注特征能够早期监测肿瘤化疗效果,并预测病人生存期。
When colorectal liver metastases （CRLM） can be early and accurately diagnosed by using imaging modalities, it is crucial for muhidisciplinary team to decide strategy of treatment and patients who may be gotten benefit from personalized therapy. Muhi-row detector computed tomography （MDCT） is an useful imaging test for screening and initial diagnosis of CRLM. Positron emission tomography/ computed tomography （PET/CT） has a problem-solving role in the detection of hepatic and extrahepatic sites metastasis. Magnetic resonance imaging （MRI） with multi-parameters and hepatocellular specific contrast is considered superior in identifying liver metastases compared with MDCT and PET/CT, especially for lesion smaller than 10 mm and lesions on the liver with fatty infiltration. Intraoperative ultrasonography （IOUS） with microbubble contrast has been increasingly used to determine newly liver metastases, which may be altered the planned surgical approach. The advanced imaging methods serve a major role in monitoring response to conventional and novel therapies based on Response Evaluation Criteria of Solid Tumor and World Health Organization. Furthermore, PEC/CT, diffusion weighted MRI and dynamic enhanced MRI are able to monitor tumor chemotherapy effect in early stage by judging tumor metabolism, cell density and blood vessel perfusion characteristics, and predict the survival period of patients.
出处
《中国实用外科杂志》
CSCD
北大核心
2016年第4期391-396,共6页
Chinese Journal of Practical Surgery
关键词
结直肠癌
影像学
肝转移
治疗效果监测
colorectal cancer
imaging
liver metastasis
treatment response monitonng
