肝动脉化疗、栓塞治疗中、晚期肝癌

目的 通过对原发性肝癌（ＰＨＣ）两种介入治疗方法的疗效比较，评估其应用价值。材料和方法 从１９８５年４月－１９９７年１２月，我院用肝动脉化疗、栓塞术治疗１７２例中、晚期肝癌，根据不同的治疗方法，分为两组。Ａ组：１０７例，为动脉内抗癌药灌注（ＴＡＩ）；Ｂ组：６５例，为碘化油与抗癌经再加明胶海棉动脉栓塞（ＴＡＥ）。对两组的肿瘤直径缩小率、甲胎蛋白下降情况及生存期进行观察对比，结果 ＴＡＥ组肿瘤直径缩小     

不能切除的肝癌动脉内治疗：方法选择和疗效分析

随访了２１３例不能切除的原发性肝癌动脉内治疗的病例。采用以下三种方式：（１）化疗药物灌注（ＨＡＩ组）；（２）碘油抗癌药乳剂栓塞（Ｌｐ－ＴＡＥ组）；（３）碘油乳剂加明胶海绵栓塞（Ｌｐ－ＴＡＥ＋ＧＳ组）。Ｌｐ－ＴＡＥ＋ＧＳ组、Ｌｐ－ＴＡＥ组和ＨＡＩ组，各组１年生存率分别为４２．４％、２７．５％和６．４％（Ｐ＝０．００４７），合并门静脉瘤栓的病例其半年、１年生存率分别为６８．９％和１８．０％。     

不能切除的肝癌动脉内治疗：方法选择和疗效分析

随访了２１３例不能切除的原发性肝癌动脉内治疗的病例。采用以下三种方式：（１）化疗药物灌注（ＨＡＩ组）；（２）碘油抗癌药乳剂栓塞（Ｌｐ－ＴＡＥ组）；（３）碘油乳剂加明胶海绵栓塞（Ｌｐ－ＴＡＥ＋ＧＳ组）。Ｌｐ－ＴＡＥ＋ＧＳ组、Ｌｐ－ＴＡＥ组和ＨＡＩ组，各组１年生存率分别为４２．４％、２７．５％和６．４％（Ｐ＝０．００４７），合并门静脉瘤栓的病例其半年、１年生存率分别为６８．９％和１８．０％。     

原发性肝癌患者肝动脉化疗栓塞治疗后T细胞亚群改变及临床意义

目的：了解原发性肝癌患者经肝动脉化疗栓塞术（ＴＡＣＥ）后免疫功能状态。方法：我们应用流式细胞仪检测了１６例原发性肝癌患者ＴＡＣＥ术前后Ｔ细胞表面抗原标志（ＣＤ３、ＣＤ４、ＣＤ８）,并与良性病变患者进行对比分析。结果：原发性肝癌患者术前ＣＤ３＋、ＣＤ４＋、ＣＤ４＋／ＣＤ８＋均低于对照组,ＣＤ８＋高于对照组,ＴＡＣＥ术后ＣＤ８＋降低,ＣＤ３＋、ＣＤ４＋、ＣＤ４＋／ＣＤ８＋均升高。结论：原发性肝癌患者治     

肝动脉化疗栓塞结合B超引导下注射无水酒精治疗原发性肝癌的研究

肝动脉化疗栓塞结合Ｂ超引导下注射无水酒精治疗原发性肝癌的研究黎乐群李航曾健林进令原发性肝癌（ＨＣＣ）目前首选的治疗方法仍为手术切除。对因各种原因不能手术切除的病人，经皮肝动脉化疗栓塞术（ＴＡＥ）和Ｂ超引导下肿瘤无水酒精注射术（ＰＥＩ）已被广泛应用。但...     

肝动脉化疗栓塞及注射无水乙醇,^32P—玻璃微球治疗原发性？…

目的 评价肝动脉化疗栓塞（ＴＡＥ）结合Ｂ超引导下注射无水乙醇（ＰＥＩ）、＾３２Ｐ－玻璃微球（＾３２Ｐ－ＧＭＳ）治疗原发性肝癌的临床价值。方法 ８３例中、晚期肝癌分为２组，４３例综合应用ＴＡＥ＋ＰＥＩ＋＾３２Ｐ－ＧＭＳ治疗，４０例单纯应用ＴＡＥ治疗。结果 综合治疗组手术切除１４例（３３％），有９例肿瘤组织完全坏死，５例有残存的肿瘤细胞，单纯ＴＡＥ组手术切除４例（１０％），肿块及周边有肿瘤细胞，血清Ａ     

暂时阻断肝静脉后行肝动脉化疗栓塞术治疗肝癌的药代动力学研究

目的对照单纯经肝动脉化疗栓塞术（ＴＡＣＥ），研究暂时阻断肝静脉后行肝动脉化疗栓塞术（ＴＡＣＥＴＨＶＯ）治疗原发性肝癌的药代动力学变化。方法为了进行药代动力学研究，随机将病人分为两组，ＴＡＣＥ组和ＴＡＣＥＴＨＶＯ组。采用高效液相色谱仪测定肝静脉和外周静脉血中５氟尿嘧啶（５Ｆｕ）的血药浓度，进行药代动力学分析。结果肝静脉和外周静脉血中５Ｆｕ的曲线下面积比值，ＴＡＣＥＴＨＶＯ组明显大于ＴＡＣＥ组；肝静脉血中５Ｆｕ的峰浓度，ＴＡＣＥＴＨＶＯ组明显高于ＴＡＣＥ组。同组中肝静脉和外周静脉的５Ｆｕ浓度趋向一致时间，ＴＡＣＥＴＨＶＯ组３０分钟，ＴＡＣＥ组为６分钟。结论暂时阻断肝静脉后行肝动脉化疗栓塞术可明显提高肿瘤局部的药物浓度，延长作用时间，加倍提高了抗肿瘤的效果，该法在临床上有很好的应用价值     

肝癌介入治疗中的门静脉和肝动脉造影CT检查及其意义

目的 评价肝动脉造影ＣＴ扫描（ＣＴＨＡ）和动脉性门脉造影ＣＴ扫描（ＣＴＡＰ）在肝癌介入治疗中的应用价值和意义。方法 １２例接受重复肝动脉化辣栓塞治疗的肝癌患者,利用双导管技术同时进行ＣＴＡＰ和ＣＴＨＡ检查。 ＣＴＡＰ和ＣＴＨＡ发现２９个直径地１０ｍｍ的新病灶;ＣＴＡＰ明确显示了栓塞后肿瘤周这部的不同改变;ＣＴＨＡ显示了病灶的血供状况,提示了侧支供血、扫绘出肝硬化结节的形态学改变及其演为过程中血供业     

肝癌门静脉瘤栓的经肝动脉碘油化疗栓塞

２０例原发性肝癌，门静脉瘤栓位于右支者７例、左支１例、主于４例、主干＋右支８例。经肝动脉碘油化疗栓塞（Ｌｐ－ＴＡＣＥ）后，肝区平片和ＣＴ平扫显示瘤栓内Ｌｐ积聚呈Ａ型者９例、Ｂ型６例和Ｃ型５例。全组瘤栓缩小有效率４０％，平均生存期８．２个月，累积生存率６个月４５％、１年２０％、２年１０％。Ａ型瘤栓缩小有效率７７．８％，平均生存期１２．７个月，累积生存率６个月７７．８％、１年４４．４％和２年２２．２％明显高于Ｂ型和Ｃ型。表明Ｌｐ－ＴＡＣＥ对部分肝癌门静脉瘤栓病人特别是Ｌｐ呈Ａ型积聚者是较有效的方法。     

瘤内注射32P胶体结合肝动脉化疗栓塞治疗巨块肝癌的研究

原发性肝癌（ＨＣＣ）多数发现较晚，已失去手术切除机会。我们试用超声引导下经皮肝穿刺瘤内注射３２Ｐ胶体结合肝动脉化疗栓塞（ＴＡＥ）治疗巨块ＨＣＣ，取得一定疗效，现报道如下。资料与方法１临床资料。３５例巨块ＨＣＣ患者行３２Ｐ胶体＋ＴＡＥ治疗，其中男２８...     

肝癌药物碘油栓塞术常见并发症

本文报道44例肝癌行82次药物碘油栓塞术所见的并发症及处理。一般反应有术中迷走神经反射,术后栓塞综合征。严重的并发症主要有术后消化道大出血3例:肝癌破裂引起腹腔内及消化道大出血1例;严重感染3例。对消化道及肝癌破裂出血者,作者采用导管动脉灌注血管收缩剂或动脉栓塞止血获得良好效果。     

Liver transplant rejection and cholestasis: comparison of technetium 99m-diisopropyl iminodiacetic acid hepatobiliary imaging with liver biopsy

To determine whether the scintigraphic evaluation of technetium-99m diisopropyl iminodiacetic acid (DISIDA) uptake and excretion can distinguish among liver transplant patients with biopsy evidence for rejection, cholestasis or neither condition, we reviewed scintigrams and biopsies in 36 patients. There were 76 scintigrams with corresponding biopsies. Uptake and excretion were graded from image data on scales reflecting normal through severely abnormal values. Biopsies were evaluated for findings of cholestasis and rejection. The majority of scintigrams demonstrated normal uptake (60/75, 80%) and delayed excretion (65/76, 85%), which was most marked immediately after transplantation. One-way analysis of variance showed that the mean excretion values significantly differed between patients with normal biopsies and those with cholestasis and/or rejection (P =0.0003). However, mean uptake scores demonstrated no statistically significant difference between these two groups of patients (P =0.1). These findings suggest that ^99mTc-DISIDA scintigraphy can differentiate between transplants with and without rejection/cholestasis but not between rejection and cholestasis. If ^99mTc-DISIDA excretion is normal, rejection and cholestasis are unlikely. Offprint requests to: C.M. Engeler     

Uptake of technetium 99m MDP by hepatoblastoma

Focal uptake of ^99mTc-MDP was seen in a case of hepatoblastoma. The focal uptake corresponded to an area of calcification on CT, which was shown histologically to consist of osteoid with mineralization. The mechanism of uptake by the tumor in this case is likely to be the same as for skeletal uptake.     

Hypereosinophilic Syndrome: CT Findings in Patients with Hepatic Lobar or Segmental Involvement

Objective

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved.

Materials and Methods

Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation.

Results

CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis.

Conclusion

Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.     

Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastasis: Report of Two Cases

We present two cases of solitary necrotic nodules of the liver which on radiologic images mimicked hepatic metastasis. Solitary necrotic nodule of the liver is a rare but benign entity which histopathologically consists of an outer fibrotic capsule with inflammatory cells and a central core of amorphous necrotic material. The lesion was seen on contrast-enhanced CT as an ovoid-shaped hypoattenuating nodule; on CT during hepatic arteriography as enhancing nodule; on intraoperative US as a target-appearing hypoechoic nodule; on T2WI as a hyperintensity nodule, and on dynamic MR as a subtle peripheral enhancing nodule. Although the radiologic features are not specific, solitary necrotic nodule of the liver should be included in the differential diagnosis of hepatic metastasis.     

Assessment of vascular physiology of tumorous livers: comparison of two different methods

RATIONALE AND OBJECTIVES: To evaluate liver and liver tumor perfusions by using two different modelling methods: gamma-variate fitting and a single-compartment model. MATERIALS AND METHODS: 5 New Zealand White rabbits with VX2 tumor implanted into the liver via portal injections were studied. Contrast-enhanced functional CT (fCT) examinations with temporal resolution of 200-500 milliseconds were conducted before tumor inoculation. Thereafter, two or three follow-up studies were conducted. A gamma-variate fitting method was used to determine fractional blood volumes (BV), and a single-compartment model method was used to determine fractional blood volumes (BV), blood flows (BF), and mean transit times (MTT) for normal and tumorous liver regions. RESULTS: For tumorous regions in liver, the gamma-variate fitting and the single-compartment model methods showed statistically significant increases in arterial perfusions (P < 0.01) and decreases in portal perfusions (P < 0.01 with single-compartment model, and P < 0.05 with gamma-variate fitting) when compared with normal liver regions. The single-compartment model showed statistically significant increases (P < 0.01) in MTTs in tumorous regions. In normal liver regions, portal BFs decreased and MTTs increased after tumor inoculation, but the changes were statistically not significant. CONCLUSION: The gamma-variate fitting and the single-compartment model methods showed definite differences in perfusions between normal and tumorous regions in liver. The single-compartment model showed slightly more distinction and was faster. More importantly, both methods can easily be applied in the clinical environment in the assessment of liver perfusion.     

Discrimination of benign from malignant hepatic lesions based on their T2-relaxation times calculated from moderately T2-weighted turbo SE sequence

The differentiation of hemangioma from other hepatic neoplasms using MRI usually relies on the evaluation of heavily T2-weighted images. The aim of this study was to assess the value of T2-relaxation times calculated from moderately T2-weighted turbo spin-echo (TSE) sequence in characterization of focal hepatic lesions, including hepatic malignancies, focal nodular hyperplasia (FNH), hemangioma, and cyst. Fifty-two patients with 114 proven lesions (61 malignant masses, 6 focal nodular hyperplasias, 28 hemangiomas, 19 cystic lesions) were examined on 1.5-T system using a double-echo TSE sequence (TR=1800 ms; TE(eff) 1=40 ms; TE(eff) 2=120 ms). Signal intensities (SI) of the liver as well as SI of all lesions were measured, and then the T2-relaxation times were calculated. The mean T2 time for the liver was 54 ms (+/-8 ms), for FNH 66 ms (+/-7 ms), for malignant hepatic lesions 85 ms (+/-17 ms), for hemangiomas 155 ms (+/-35 ms), and for cystic lesions 583 ms (+/-369) ms. Most malignant hepatic lesions were best differentiated between the thresholds of 67 and 116 ms, generating a sensitivity of 90% and a specificity of 94%. There were six false-negative diagnoses of malignant tumor and three false-positive cases (two hemangiomas and one FNH). Calculation of the T2-relaxation times obtained from the double-echo TSE sequence with moderate T2-weighting allowed differentiation between malignant and benign hepatic lesions with high sensitivity and specificity.     

Extrahepatic spread of hepatocellular carcinoma: a pictorial review

Although extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon, it can be found anywhere in the body. Most extrahepatic metastases of HCC occur in patients with advanced-stage intrahepatic tumor, but incidental extrahepatic lesions have also occasionally been found in patients with early-stage intrahepatic HCC. The detection of extrahepatic metastatic disease is crucial when planning therapy for patients with HCC and should be used to avoid unnecessary surgical intervention. In this study we illustrate the radiologic findings of extrahepatic metastases of HCC involving various sites. The presumed mechanism of extrahepatic extension of HCC is also discussed. Electronic Publication     

Focal liver lesions: MR imaging-pathologic correlation

Magnetic resonance signal intensity of focal liver lesions is affected by numerous pathologic factors. Lesion histologic features, such as cellularity, vascularity, stromal component, and intratumoral necrosis or hemorrhage, strongly affect T1 and T2 relaxation times. Additionally, intracellular content of certain substances, such as glycogen, fat, melanin, iron, and copper, may also have a substantial role in determining MR signal behavior. In this review we discuss the correlations between MR imaging features and pathologic findings in benign and malignant focal liver lesions. Knowledge of imaging-pathology correlations greatly assist in charac terizing focal lesions. Moreover, in certain tumor histotypes, such as hepatocellular carcinoma, careful analysis of lesion signal intensity may help predict the degree of tumor differentiation.