Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience

AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemoembolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2(4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2(4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc.CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions. CONCLUSION: CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.     

3.0 Tesla vs 1.5 Tesla breast magnetic resonance imaging in newly diagnosed breast cancer patients

AIM:To compare 3.0 Tesla(T) vs 1.5T magnetic resonance(MR) imaging systems in newly diagnosed breast cancer patients.METHODS:Upon Institutional Review Board approval,a Health Insurance Portability and Accountability Actcompliant retrospective review of 147 consecutive 3.0T MR examinations and 98 consecutive 1.5T MR examinations in patients with newly diagnosed breast cancer between 7/2009 and 5/2010 was performed.Eleven patients who underwent neoadjuvant chemotherapy in the 3.0T group were excluded.Mammographically occult suspicious lesions(BIRADS Code 4 and 5) additional to the index cancer in the ipsilateral and contralateral breast were identified.Lesion characteristics and pathologic diagnoses were recorded,and results achieved with both systems compared.Statistical significance was analyzed using Fisher’s exact test.RESULTS:In the 3.0T group,206 suspicious lesions were identified in 55%(75/136) of patients and 96%(198/206) of these lesions were biopsied.In the 1.5T group,98 suspicious lesions were identified in 53%(52/98) of patients and 90%(88/98) of these lesions were biopsied.Biopsy results yielded additional malignancies in 24% of patients in the 3.0T group vs 14% of patients in the 1.5T group(33/136 vs 14/98,P = 0.07).Average size and histology of the additional cancers was comparable.Of patients who had a suspicious MR imaging study,additional cancers were found in 44% of patients in the 3.0T group vs 27% in the 1.5T group(33/75 vs 14/52,P = 0.06),yielding a higher positive predictive value(PPV) for biopsies performed with the 3.0T system.CONCLUSION:3.0T MR imaging detected more additional malignancies in patients with newly diagnosed breast cancer and yielded a higher PPV for biopsies performed with the 3.0T system.     

18F-FDG PET/CT双时相显像对肺部病灶的定性诊断价值

Objective The aim of this study was to evaluate the value of dual-time point 18F-fluorodeoxyglucose (FDG) PET imaging for the differentiation between pulmonary malignant and benign lesions.Methods Seventy-eight patients with clinically suspected lung cancer underwent dual-time point 18F-FDG PET imaging.The maximum standardized uptake value(SUVmax)was calculated for PET imaging of both time points,and the change in SUVmax(△SUV)was defined as the ratio of the increase in SUVmax between early and delayed scans to the SUVmax in the early scan.The final diagnoses were confirmed by histopathology,bacteriology or clinical follow-up.The t-test was used to compare SUVmax,△SUV of benign and malignant groups.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of SUVmax and △SUV for pulmonary lesions.Results (1)There were 60/78 patients with pulmonary malignant lesions and 18/72 patients with benign lesions including 16 with hyperplasia lesions.There was significant difference in the SUVmax between early scan and delayed scan in both malignant group(7.94±4.17 and 9.92±5.33,respectively,t=10.19,P＜0.01)and benign group(7.21±5.74 and 8.54±6.61,respectively,t=8.23,P＜0.01).There was no significant difference in the SUVmax between malignant group and benign group in both early scan(t=0.60,P＞0.05)and delayed scan(t=0.91,P＞0.05).The △SUV was not significantly difierent between malignant and benigh groups [(26.04± 14.73)%and(18.09±24.09)%,respectively,t=1.67,P＞0.05].The SUVmax decreased in only 2 of 18 benign lesions,and no SUVmax decrease in all of the malignant lesions.(2)The sensitivity,specificity,accuracy,positive predictive value and negative predictive value with a threshold of SUVmax ＞2.5 and △SUV＞20%were respectively 93.33%(56/60),22.22%(4/18),76.92%(60/78),80.00%(56/70)and 50.00%(4/8);and 63.33%(38/60),50.00%(9/18),60.26%(47/78),80.85%(38/47)and 70.97%(22/31).The areas under the ROC curves were 0.61(Z=1.38,P＞0.05)and 0.56(Z=0.65,P＞0.05)according to the SUVmax and △SUV respectively,and the difference was not statistically significant.Condusiom Dual-time point 18F-FDG PET imasing is not useful for differentiating pulmonary malignancy from the benign lesions of hyperplasia.However,if SUVmax decreases on delayed scan,the lesion is more likely to be benign.     

18F-FDG PET/CT显像诊断心包恶性病变的价值

Objective To assess the value of integrated 18 F-fluorodeoxyglucose (FDG) PET/CT in differentiation of malignant and benign pericardial effusion. Methods 18F-FDG PET/CT were performed in 23 patients with pericardial effusion. The detected soft tissue tumor or nodulous lession in pericardium or the thickened pericardium, with the maximum standardized uptake value( SUVmax ) ≥2.5, was defined as PET/CT-positive. The invaded lession in pericardium with SUVmax ≥2.5 was also as the positive. The difference of SUVmax of benign and malignant lesions was analyzed with two-independent-sample test of nonparametric tests. The final diagnosis was confirmed by biopsy or post-operative pathology. Results The diagnosis were confirmed with 14 malignant and 9 benign lesions. The median of SUVmax was 6.0 in malignancy group and 2.2 in benign group (z= -3. 279, P =0.001 ). According to the pathology results, there were one false negative case and two false positive cases with PET/CT imaging interpretation. The sensitivity, specificity,accuracy, positive predictive value ( PPV ) and negative predictive value ( NPV ) of 18 F-FDG PET/CT in diagnosis of benignity or malignance of pericardium effusion were 92.9% ( 13/14), 7/9, 87.0% (20/23),86.7% (13/15) and 7/8, respectively. Conclusion For the patients with pericardium effusion 18F-FDG PET/CT may be a helpful modality for malignancy differentiation     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

18F-FDG PET/CT显像监测胃癌术后复发转移的价值

Objective PET with 18F-fluorodeoxyglucose (FDG) has been used to beth detect and stage a variety of malignancies. The aim of this retrospective study was to evaluate the clinical value of 18F-FDG PET/CT for recurrence and metastasis in gastric carcinoma patients after total gastrectomy. Methods A total of 45 gastric carcinoma patients who underwent total gastrectomy were included. PET/CT scans were obtained for restaging. The " gold standard" of 18F-FDG PET/CT diagnostic accuracy was based on either histopathology or clinical follow-up. By using the t-test from SPSS 11.5, the cut-off of maximum standard-ized uptake values (SUVmax) from 18F-FDG to differentiate benign from malignant lesion at stomach were determined and calculated. Results (1) Of the 45 patients, 22 were suspicion recurrent lesion at stomach. Of the 22 patients, 12 were confirmed to have recurrent lesions. The diagnostic accuracy were 100.0% (12/ 12) for sensitivity, 70.0% (7/10) for specificity, and 86.4% (19/22) for accuracy, respectively. A higher SUVmax in malignant than benign lesion was noted (6.27 ± 3.42 vs 3.92 ± 2.24), though not reached to the significance (t = 1. 862, P > 0.05). (2) For extra-gastric lesion detection, the sensitivity, specificity, and accuracy for region lymph nodes were 78.9% (15/19), 92.3% (24/26), and 86.7% (39/ 45), for peritoneal spreading were 6/9, 97.2% (35/36), 91. 1% (41/45), and for distant sites were 86.7%(13/15), 93.3% (28/30), 91.1% (41/45). (3) False positive were found in eight sites. All were either inflammatory or physiological uptake at intestine. False negative were found in nine sites. Either due to small in size (less than 1.0 cm in diameter), well differentiation of the tumor cell or with a nature of signet ring. Conclusion 18F-FDG PET/CT had a potential to detect local, regional, and distant metastasis in gastric cancer.     

CT引导下射频消融术在肝脏恶性肿瘤治疗中的临床应用

目的评价肝动脉化疗栓塞(TACE)联合全麻下CT引导下经皮穿刺射频消融(RFA)治疗肝脏恶性肿瘤的疗效。资料与方法原发性肝癌患者20例,肿瘤切除术后复发6例,肝转移瘤5例,男23例,女8例,年龄40～74岁。所有患者均先行TACE术(1～2次),然后在全麻CT引导下经皮穿刺行RFA治疗,其中2例联合手术行RFA治疗,2例做了2次RFA治疗。随诊2～36个月,观察并发症和疗效。结果 31例患者共进行43次RFA治疗,未出现任何严重并发症。23个肿瘤完全坏死,11个部分坏死。结论 TACE联合全麻下CT引导下RFA治疗肝脏恶性肿瘤是一种有效的微创治疗方法。     

肝动脉化疗栓塞联合CT引导下射频消融术治疗肝癌的疗效分析

目的 评价肝动脉化疗栓塞(TACE)联合CT引导下射频消融术(RFA)治疗肝癌的疗效.方法 HCC患者200例先行TACE术,然后在CT引导下行RFA术.200例患者共行TACE术495例次.肿瘤病灶共计378个,直径为O.5-16 cm,共行RFA术362人次,663个位点.结果 术前、术后12个月AFP分别为(2 156.79±574.61)ng/ml、(269.53±146.65)ng/ml,两者差异有统计学意义(t=16.11,P<0.01).术前、术后3、6和12个月的肿瘤体积分别是(72.64±24.74)cm3、(46.78±18.95)cm3、(28.27±11.70)cm3和(10.82±8.31)cm3,差异有统计学意义(F=10.77,P<0.01).肿瘤完全坏死率为87.8%.结论 肝TACE联合CT引导下RFA治疗肝癌是一种有效的微创治疗方法.     

TACE+RFA和TACE+MWA应用于早期原发性肝细胞癌的疗效差异

目的探讨肝动脉化疗栓塞联合射频消融术(TACE+RFA)和肝动脉化疗栓塞联合微波消融术(TACE+MWA)应用于早期原发性肝细胞癌(PHC)的疗效差异。方法选取我院接受TACE+RFA或TACE+MWA治疗的68例早期PHC患者资料,其中TACE+RFA组31例,TACE+MWA组37例。比较两组患者的病灶消融率、并发症发生率,并对患者的生存情况进行分析。结果TACE+RFA组和TACE+MWA组病灶完全反应(CR)率差异无统计学意义(P>0.05)。在肿瘤直径≤3cm患者中,TACE+RFA组和TACE+MWA组病灶CR率差异无统计学意义(P>0.05);而在肿瘤直径3~5cm患者中,TACE+MWA组病灶CR率高于TACE+RFA组,差异有统计学意义(P<0.05)。两组患者的并发症(发热、腹痛、恶心&呕吐及额外镇痛)发生率比较,差异无统计学意义(P>0.05)。随访6.0~45.7个月,中位随访时间26.6个月。全组患者1年、2年、3年累积生存率分别为92.3%、85.2%、47.9%。其中,TACE+RFA组患者的1年、2年、3年累积生存率分别为87.1%、80.1%、43.1%,TACE+MWA组为96.8%、89.6%、52.9%,两组生存率差异无统计学意义(Log rankχ^2=3.506,P=0.061)。在肿瘤直径≤3cm患者中,TACE+RFA组患者1年、2年、3年累积生存率分别为90.0%、90.0%、60.0%,TACE+MWA组为88.9%、74.1%、74.1%,两组生存率差异无统计学意义(Log rankχ^2=0.010,P=0.922)。在肿瘤直径3~5 cm患者中,TACE+RFA组患者1年、2年、3年累积生存率分别为85.7%、75.6%、36.3%,TACE+MWA组为100.0%、95.2%、50.8%,TACE+MWA组生存率高于TACE+RFA组(Log rankχ^2=4.485,P=0.034)。结论TACE+RFA和TACE+MWA应用于早期PHC均是安全、有效的。肿瘤直径≤3 cm时,两种疗法疗效相当,而肿瘤直径3~5cm时,TACE+MWA的病灶消融率和生存率优于TACE+RFA。     

TACE联合RFA及 125I放射性粒子植入治疗巨块型肝癌的临床效果

目的：研究肝动脉化疗栓塞术（TACE）联合射频消融（RFA）及¹²⁵I放射性粒子植入治疗直径≥10 cm的巨块型肝癌的临床效果。 方法：选取经我院临床或病理确诊的直径≥10 cm肝癌患者54例,分为对照组28例,行TACE+RFA治疗;联合组26例,行TACE+RFA+¹²⁵I放射性粒子植入治疗;比较两组的治疗有效率和临床控制率;所有患者随访1~37个月,采用Kaplan-Meier方法对两组的生存情况进行分析,Log-rank检验比较生存曲线的差异。 结果：联合组的有效率高于对照组（61.5% vs. 32.1%）,差异有统计学意义（χ²=4.685,P=0.030）。联合组的中位无进展生存期（PFS）为9个月,高于对照组的5个月,差异有统计学意义（P=0.010）。联合组的中位生存时间11个月,对照组中位生存时间6个月,联合组较对照组有延长趋势,但差异无统计学意义（P=0.079）。 结论：对于直径≥10 cm的巨块型肝癌,TACE、RFA和¹²⁵I放射性粒子三者序贯治疗在肿瘤无进展生存期、肿瘤缓解率方面较对照组治疗具有优势,实现了化疗栓塞、消融与局部放疗协同作用,不良反应小。     

肝动脉栓塞化疗联合射频及无水乙醇注射治疗中晚期肝癌的评价

目的 探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)及无水乙醇注射(PEI)治疗中晚期肝癌的评价.方法 78例中晚期肝癌患者随机分为联合组(39例)和对照组(39例),联合组行序贯TACE→RFA+PEI→TACE治疗.对照组仅行TACE治疗2～5次.治疗1个月后全部病例复查肝脏彩色多普勒超声、CT,观察患者肿瘤缩小程度、甲胎蛋白水平变化和随访1、2年生存率.结果 联合组甲胎蛋白转阴率,肿瘤缩小率及1、2年生存率分别为81.3%、87.2%、97.4%、76.9%,明显高于对照组的56.3%、64.1%、79.5%、53.8%(P值均<0.05).结论 TACE联合RFA及PEI治疗中晚期肝癌安全有效.可明显改善疗效并延长生存期.     

肝动脉化疗栓塞联合CT引导射频消融序贯治疗中小肝癌的临床应用

目的探讨肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗原发性中小肝癌的临床应用。方法对59例肝细胞性中小肝癌患者实施TACE联合CT引导RFA序贯治疗。结果 59例患者初次治疗,共80枚病灶,行TACE和RFA序贯治疗技术成功率100%。术后随访6～24个月,21例患者有病灶残余,再次行RFA或序贯治疗,3例再次联合放射性125I粒子植入治疗后,病灶控制良好。并发症有胆汁瘤合并胆道感染1例、门静脉分支血栓1例。结论 TACE联合CT引导RFA序贯治疗中小肝癌是一种微创、有效的方法,同时注意手术操作细节,对提高手术成功率,降低手术并发症有重要意义。     

大剂量热碘油TACE联合射频消融术治疗消化道癌肝转移

目的评价大剂量热碘油肝动脉化疗栓塞术(TACE)联合射频消融术(RFA)治疗消化道癌肝转移的临床疗效。方法将96例消化道癌肝转移患者分为两组,48例(联合组)采用大剂量热碘油TACE联合RFA治疗;48例(对照组)采用常温碘油TACE治疗。结果联合组有效率为75%(36/48),对照组有效率为33%(16/48),两组间差异有统计学意义。两组术后肝功能变化无统计学意义。术后6、12、18、24个月生存率联合组分别为100%、85%、56%、27%,对照组分别为90%、53%、19%、8%。结论大剂量热碘油TACE联合RFA可以有效控制肝转移癌患者肝内病变的进展,延长患者生存期,而肝功能无明显的损害。     

Image-Guided Radiofrequency Ablation (RFA) of Unresectable Hepatic Tumors Using a Triple-Spiral-Shaped Electrode Needle: Initial Experience in 34 Patients

We evaluated the safety and efficacy of image-guided radiofrequency ablation (RFA) using a triple-spiral-shaped electrode needle for unresectable primary or metastatic hepatic tumors. Thirty-four patients with 46 index tumors were treated. Ablation zone, morbidity, and complications were assessed. The lesions were completely ablated with an ablative margin of about 1 cm. Five patients (14.7%) with a lesion larger than 4.5 cm had local tumor progression after 1 month and were retreated. Hemothorax, as a major complication, occurred in 1 of 34 patients (3.0%) or 1 of 46 lesions ablated (2.2%). RFA using this new electrode needle can be effective in the treatment of large unresectable hepatic tumors.     

复方苦参注射液对肝癌动脉化疗栓塞联合射频消融治疗后的影响

目的:分析复方苦参注射液对肝癌动脉化疗栓塞(TACE)联合射频消融(RFA)治疗后的影响.方法:选择接受TACE联合RFA治疗的64例肝癌患者,随机分为研究组和对照组各32例.研究组在TACE联合RFA治疗基础上加用复方苦参注射液治疗,对照组仅接受TACE联合RFA治疗,比较2组治疗后总有效率、免疫功能指标(CD4+、...     

1.5 T MR导向下肝脏恶性肿瘤射频消融治疗技术初探

目的 探讨1.5 T MR引导下对肝脏恶性肿瘤射频消融治疗的可行性.方法 23例44个经病理证实、不能或不愿手术的肝脏恶性肿瘤病灶,其中11例为原发性肝癌、12例为肝转移癌,肿瘤最大径平均(3.3±1.8)cm,均采用MR兼容多极射频针在1.5 T MR引导下进行射频消融治疗.术后MR扫描观察消融情况,消融灶完全覆盖原病灶、范围超出病灶边缘0.5～1.0 cm为消融完全.结果 所有消融均顺利完成,平均手术时间(93±33)min,消融灶均完全覆盖病灶,无胆瘘、膈肌穿孔、黄疸、气胸等并发症发生.射频电极针在MR图像上呈低信号.消融灶在T2WI序列上呈低信号,周围可见薄层高信号环绕;T1WI序列上消融灶呈明显高信号,边界清晰;DWI上消融灶呈等低信号,周围呈环状稍高信号.结论 1.5 T MR引导下肝脏恶性肿瘤射频消融是安全、有效的技术.