肺部恶性肿瘤射频消融治疗后CT影像学改变

目的:观察分析肺部恶性肿瘤射频消融治疗后CT影像学改变。方法:搜集因肺部恶性肿瘤行CT引导下射频消融治疗的患者226例(共计消融灶233个),分析评价治疗后病灶CT影像学改变。患者中原发性肺癌201例,肺转移癌25例。接受射频消融的病灶直径1.00～10.60cm,平均(4.36±2.45)cm。平均随访时间13.61个月(1～30个月)。结果:215例患者(95.13%)治疗后立即出现消融灶周围肺组织内毛玻璃样改变,多在1个月内吸收;191患者(84.51%)治疗后肿瘤立即出现增大,127例患者(56.19%)出现消融灶内多发小空泡形成。术后51例患者(22.57%)出现空洞,恶性胸水多发生在治疗3个月以后。121例患者(65.05%)在术后第一个月随访时胸部CT提示病灶有增大,46.15%和50.89%的患者在3个月及6个月复查时病灶缩小,之后这一比例开始降低,至12个月时,只有33.64%的患者病灶较上一次评估时缩小,到24个月时这一比例降低到4.35%。结论:病变周围的毛玻璃样改变、空洞形成、多发小空泡形成和胸膜改变是射频消融后最常见的CT改变。体积较大的病灶更可能出现空洞改变,射频消融术后1个月内病灶多出现增大表现,治疗后6个月是病灶缩小最明显的时期,6个月后出现的病灶较上一评估周期增大提示患者肿瘤进展。CT是射频术后疗效评估的有效手段之一。     

Assessment of liver tissue after radiofrequency ablation: findings with different imaging procedures.

Our goal was to assess the typical appearance of normal liver tissue immediately after radiofrequency ablation (RF-ablation) when imaged with contrast-enhanced ultrasound, CT, MRI, 18F-FDG PET, and PET/CT. METHODS: Nineteen RF-ablation sessions were performed on nontumorous liver tissue of 10 G?ttingen Mini Pigs. CT, ultrasound, MRI, 18F-FDG PET, and PET/CT were performed immediately after the intervention. All imaging procedures were evaluated qualitatively for areas of increased contrast enhancement (morphologic imaging) and regions of elevated tracer uptake (functional imaging). Images were assessed quantitatively by determination of ratios (r(p/p)) comparing contrast enhancement/tracer uptake in the periphery of the necrosis with contrast enhancement/tracer uptake of normal liver parenchyma. RESULTS: On morphologic imaging, an increase in contrast enhancement surrounding the ablative necrosis was detected in all lesions. Quantification of this area of increased contrast enhancement revealed ratios of r(p/p) = 1.57 +/- 0.2 for CT and r(p/p) = 1.57 +/- 0.19 for MRI. On PET and PET/CT, homogeneous tracer utilization was found surrounding all lesions. There were no areas of a focal or rim-like increase in glucose metabolism. The ratio r(p/p) was found to be 1.05 +/- 0.08 for functional data. Histologic examination revealed pooling of blood in the sinusoids of the lesion's periphery that was caused by outflow obstruction due to the central necrosis. CONCLUSION: On morphologic imaging, a rim-like increase of contrast enhancement was found immediately after RF-ablation resembling peripheral hyperperfusion. This area of contrast enhancement may hamper detection of residual tumor. On the basis of homogeneous tracer distribution surrounding the area of necrosis, PET and PET/CT may serve for early assessment of patients after RF-ablation.     

Tumor recurrence after radiofrequency thermal ablation of hepatic tumors: spectrum of findings on dual-phase contrast-enhanced CT.

OBJECTIVE: We conducted this study to determine the spectrum of CT findings of tumor recurrence after radiofrequency ablation of primary and secondary malignant hepatic tumors. MATERIALS AND METHODS: Twenty-five patients, 10 with hepatocellular carcinoma (HCC) and 15 patients with metastases who developed tumor recurrence after radiofrequency ablation of hepatic neoplasms, formed the study population. Three observers reviewed the CT scans of these patients and evaluated the location (local intrahepatic, remote intrahepatic, or extrahepatic) of all recurrent lesions and the morphology and enhancement characteristics of local intrahepatic recurrences. RESULTS: Local intrahepatic recurrences were seen in nine patients (90%) and 11 patients (73%); remote intrahepatic recurrences, in five patients (50%) and seven patients (45%); and extrahepatic recurrences, in zero and six patients (40%) with recurrent HCC and recurrent metastases, respectively. Of the 12 nodules of local intrahepatic recurrences in HCC and the 24 in metastases, the patterns of local intrahepatic recurrences were of nodular, halo, and gross enlargement types in eight (67%) and nine (38%), four (33%) and six (38%), and zero and nine (37%) nodules in HCC and hepatic metastases, respectively. The number of local intrahepatic recurrent lesions enhancing in the arterial phase was significantly greater in HCC. CONCLUSION: Tumor recurrences occurred at intra- and extrahepatic sites after radiofrequency ablation of hepatic neoplasms. The local intrahepatic recurrences appeared in three patterns: nodular, halo, or gross enlargement. The sites of recurrence and the morphologic patterns of local intrahepatic tumor recurrence differed between primary and secondary hepatic neoplasms.     

肝脏恶性肿瘤射频消融术后PET-CT早期复查的临床价值

目的 探讨肝脏恶性肿瘤射频消融术后早期行18F脱氧葡萄糖(18F-FDG)PET-CT复查的临床应用价值.方法 15例行射频消融术的肝脏恶性肿瘤患者均在术前2周内行全身PET-CT检查,并于术后24 h内行肝区PET-CT复查(早期PET-CT复查),了解消融效果.术后早期PET-CT复查,原病灶区影像上所显示的完全放射性缺损、局部核素浓聚及病灶周围环形核素浓聚分别代表肿瘤彻底坏死、局部肿瘤残留及病灶周围正常肝组织炎症反应.然后分别于术后1、3、6个月行PET-CT复查,6个月以后每隔半年复查一次.以最终的PET-CT检查结果为参考.结果 PET-CT早期复查影像显示,12例患者在原肿瘤病灶区表现为完全性放射性缺损,影像随访证实均无肿瘤组织残留;2例表现为病灶边缘结节状的核素浓聚,影像随访证实为残余瘤,并再次治疗干预;1例可见环形轻微核素浓聚,影像随访证实为炎症反应.结论 早期PET-CT复查影像,可以避开术后炎症反应的干扰、明确消融范围,能够及时、准确地评价肝脏恶性肿瘤射频消融术的效果,帮助临床制定进一步的治疗方案.     

兔VX2肝癌射频消融后CT与病理对照分析

射频消融(RFA)作为肝癌局部治疗的常用方法,已取得了显著疗效[1-3].影像检查作为随访判断肝癌RFA后疗效的常用手段之一,对于肿瘤的残存和复发、肿瘤浸润的早期发现具有非常重要的作用.笔者旨在通过对兔VX2肝癌RFA后病灶的CT影像和病理的对照分析,以早期鉴别肿瘤残存与术后炎性反应.     

肺肿瘤射频消融治疗的并发症分析

目的：探讨肺肿瘤行射频消融治疗中的并发症及其防治措施。 方法：选取2010年4月至2017年12月广东省人民医院肿瘤介入科收治的150例接受射频消融治疗的肺恶性肿瘤患者,其中原发性肺癌99例,转移性肺癌51例。99例原发性肺癌包括非小细胞肺癌87例、小细胞肺癌8例及癌肉瘤4例;51例转移性肺癌中来自肝癌的22例,来自软组织肉瘤12例、大肠癌9例、鼻咽癌6例、纵膈卵黄囊瘤及血管平滑肌脂肪肉瘤各1例。所有患者均为单个病灶,肿瘤直径8~47 mm（26±3.6）mm。射频消融均在CT引导下穿刺,其中行1次消融者133例,2次者17例;2次射频消融之间的间隔时间1~4（2±0.5）周。消融功率40~60（51.1±3.9）W,消融时间3~12（6.3±2.7）min。 结果：常见并发症包括气胸29例（19.3%）,肺实质出血35例（23.3%）,咯血12例（8%）,胸腔积液3例（2%）;少见并发症包括肺脓肿并支气管瘘1例（0.7%）,以往未见文献报道,胸部皮下气肿1例（0.7%）。无严重并发症或围手术期死亡病例发生。 结论：肺肿瘤射频消融的并发症多为轻中度,但均应给予足够重视,只有及时诊断并及时处理,才能减少和避免严重并发症及死亡的发生。     

肺恶性肿瘤热消融治疗后的CT影像学演变

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。     

Hepatocellular carcinoma after radiofrequency ablation therapy: Dynamic CT evaluation of treatment

The aim of this study is to analyze the dynamic CT findings after radiofrequency (RF) ablation for hypervascular hepatocellular carcinoma (HCC). RF ablation was used for 22 tumors in 20 patients. Peripheral enhancement was noted in 89% of regions within 1 month in the arterial phase. In 1–3 months, peripheral enhancement remained at 56% and was reduced to 22% by 3–6 months. It is difficult to determine the therapeutic result within 3 months due to continued peripheral enhancement in the arterial phase.     

Percutaneous radiofrequency ablation of pulmonary malignancies: combined treatment with brachytherapy

OBJECTIVE: The purpose of this article is to report the clinical experience and technical feasibility of percutaneous radiofrequency ablation in conjunction with brachytherapy, a novel approach in the treatment of lung neoplasms. Data from three patients with lung malignancies illustrate the expanding therapeutic indications of this minimally invasive intervention. CONCLUSION: Percutaneous radiofrequency ablation in conjunction with brachytherapy is a promising minimally invasive combination modality. It may be a treatment option for patients with primary, recurrent, or metastatic malignancies of the lung that are not amenable to surgery or further external beam radiation therapy.     

肺肿瘤CT引导下经皮射频消融后的影像评估进展

近年来,CT引导下经皮射频消融术在无法手术切除或转移性肺肿瘤的治疗中备受推崇。但因术后病理改变的复杂性,不同影像检查的表现既存在重叠,又存有差异,使得评估充满挑战。就不同影像方法(CT、PET/CT、MRI)对肺肿瘤病人术后不同时期的评估进展予以综述,以期更好地指导临床。     

Percutaneous radiofrequency ablation of renal tumors: midterm results in 16 patients

PURPOSE: To evaluate the outcome of 16 patients after percutaneous radiofrequency ablation of renal tumors. MATERIALS AND METHODS: Sixteen patients (nine women, seven men; mean age, 61+/-9 years) with 24 unresectable renal tumors (mean volume, 4.3+/-4.3 cm3) underwent CT-guided (n=20) or MR imaging-guided (n=4) percutaneous radiofrequency ablation using an expandable electrode (Starburst XL, RITA Medical Systems, Mountain View, CA) with a 150-W generator. The initial follow-up imaging was performed within 1-30 days after RF ablation, then at 3-6 month intervals using either CT or MRI. Residual tumor volume and coagulation necrosis was assessed, and statistical correlation tests were obtained to determine the strength of the relationship between necrosis volume and number of ablations. RESULTS: Overall, 97 overlapping RF ablations were performed (mean, 3.5+/-1.5 ablations per tumor) during 24 sessions. Five or more RF ablations per tumor created significant larger necrosis volumes than 1-2 (p=.034) or 3-4 ablations (p=.020). A complete ablation was achieved in 20/24 tumors (primary technical success, 83%; mean volume of coagulation necrosis: 10.2+/-7.2 cm3). Three of four residual tumors were retreated and showed complete necrosis thereafter. Three major complications (one percuatneous urinary fistula and two ureteral strictures) were observed after RF ablation. No further clinically relevant complications were observed and renal function remained stable. During a mean follow-up of 11.2 months (range, 0.2-31.5), 15/16 patients (94%) were alive. Only one patient had evidence of local recurrent tumor. CONCLUSION: The midterm results of percutaneous RF ablation for renal tumors are promising and show that RF ablation is well-suited to preserve renal function.     

原发性肝细胞癌经动脉导管栓塞化疗联合射频消融术后的CT及MRI表现

目的:回顾性评价原发性肝细胞癌(hepatocellular carcinoma,HCC)经肝动脉导管化疗栓塞(transcatheter ar-terial chemoembolizstion,TACE)联合射频消融术(radiofrequencr ablation,RFA)后的CT及MR表现。方法:回顾性收集2004年6月～2009年6月的肝癌病例42例(共49个病灶)进行了TACE联合RFA治疗。术后随访为3～24个月。用CT及MR评价肝内病灶的密度(信号)、强化方式、边界和大小等变化。结果:TACE联合RFA完全的病灶CT表现为不规则致密碘油沉积(高密度)和消融区域(低密度无强化)混合存在。MRI表现为T1WI等、高信号,T2WI等、低信号,增强扫描无强化。TACE联合RFA1个月之内行CT扫描的患者中,7个病灶术后存在片状或环行强化,复查消失。随访中,5例CT及3例MR表现为病灶体积增大或出现不规则强化,提示复发。结论:用CT或MRI对TACE联合RFA术后患者进行评价可以了解栓塞和射频消融是否完全或是否存在残留或复发。     

CT灌注成像在肺部肿瘤诊断中的应用进展

本文通过总结螺旋CT灌注成像的原理和技术要求,评价其在肺部肿瘤影像诊断中所提供的肿瘤微循环状况、血流动力学变化及其它参数,从而显示CT灌注成像不但能显示肿瘤形态学方面的改变,还能了解其功能、代谢变化的信息,因而在肺部肿瘤的影像诊断与鉴别诊断、生物学行为和严重度评价等方面具有重要作用,拥有较好的临床应用前景。     

Detection of residual tumor after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results

The aim of this study was to determine the accuracy of dual-modality positron emission tomography(PET)/computed tomography (CT) in the detection of residual tumor after radiofrequency ablation (RFA) of liver metastasis of colorectal cancer. Eleven patients with 16 hepatic metastases (mean size 2.9 cm) from colorectal cancer were enrolled in this study, and 19 RFA procedures and 32 PET/CT examinations were performed. The patients had PET/CT before and after RFA using [¹⁸F]-2-fluoro-2-deoxy-D-glucose. CT images alone were read by two radiologists, PET images alone were evaluated by two nuclear physicians. Fused images were read by one physician of each speciality in consensus. The accuracy for detection of residual tumor by the different imaging modalities following RFA was assessed. Eleven patients with a mean age of 63 (range 55–71) years were evaluated. The mean follow-up period was 393 days. The overall procedure-based sensitivity for detection of residual tumor was 65% for PET and PET/CT and 44% for CT alone. The accuracies were 68% and 47%, respectively. Four patients had residual tumor after RFA, six patients total developed local recurrence. PET/CT therefore possibly proved superior to CT alone when assessing the liver for residual tumor after RFA.     

Histopathologic evaluation of tissue extracted on the radiofrequency probe after ablation of liver tumors: preliminary findings

OBJECTIVE: Our aim was to evaluate the histologic characteristics of tissue extracted on the probe immediately after radiofrequency ablation of malignant tumors in the liver. MATERIALS AND METHODS: From April to December 2001, 20 radiofrequency ablations were performed in 19 patients with primary (n = 17) and metastatic (n = 2) liver masses. Track ablation according to device protocol was performed after each ablation. Tissue was adherent to the probe after all radiofrequency probe passes. All pieces of tissue found on the probe were collected and preserved in formalin. RESULTS: Tissue was examined by the study pathologist. In eight (40%) of 20 specimens, coagulation necrosis was present. In five (25%) of 20 specimens, possibly nonviable tissue was extracted, although some cell characteristics were identified. In seven (35%) of 20 specimens with hepatocellular carcinoma, possibly viable tissue was found. Five specimens were identified as hepatocellular carcinoma, and two, as cirrhotic nodules. CONCLUSION: Histopathologic evaluation of the tissue extracted on the radiofrequency probe after ablation is feasible. This study showed that coagulation necrosis was clearly present in at least 40% of the patients, which proves that nonviable tissue can be seen immediately after ablation. Whether this pathologic finding has prognostic value is not known.     

射频治疗肝脏恶性肿瘤的CT评价(附35例分析)

目的 :应用螺旋CT评价射频治疗肝癌的近期疗效。方法 :对 35例肝癌 35个病灶射频治疗术前、后肿瘤大小、密度的变化、肿瘤凝固性坏死的形态、范围及术后CT增强扫描的特征进行观察。其中术前进行肝动脉碘油及明胶海绵碎块栓塞 2 3例。结果 :35例肝癌射频术后 5min均有增大 ,术前、后肿块最大径分别为 5 .75± 2 .84cm和 6 .2 2± 1 .1 2cm ,统计学无显著性差异 (P >0 .0 5)。病灶CT值术后 5min均减低 ,术前、后病灶CT值分别为 45 .3± 6 .33Hu和 32 .8± 7.83Hu,均有显著性差异 (P <0 .0 5)。术后 5min 94.2 8% (33/ 35)的病灶呈不同程度凝固性坏死。随访 1～ 1 1个月 ,平均随访 4个月 ,71 % (2 5/ 35)病灶较原病灶缩小 ,2 9% (1 0 / 35)病灶扩大 ,病灶CT值减低 1 1Hu±。CT增强 1 0例 ,其中 5例坏死区表现为无强化 ,5例残留灶 /复发灶显示为结节状或花环状强化。结论 :螺旋CT可准确评价肝癌射频治疗的效果 ,并提示射频结合肝动脉栓塞治疗有助于提高疗效