开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

目的:探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法进行肝癌冷冻消融治疗的可行性、疗效和安全性.方法:采用新奥博为0.3-T 开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗.冷冻探针通过实时监视被置于消融病灶中,冷冻消融术采取氩氦刀(Cryo-Hit),对临床体征、症状、实验室检验和影像学结果进行评估,并术后随访.结果:在MRI引导下经皮穿刺冷冻探针均成功置于病灶内,共对20例病人22个肝肿瘤进行了冷冻消融治疗(共24次治疗),手术期间MRI显示冰球扩展并包裹整个肿瘤,包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区.使用一个冷冻探针形成最大的冰球为 5.0cm×2.5cm×2.5cm、使用4个冷冻探针形成的冰球最大为7.6cm×5.5cm×5.0cm.冷冻消融治疗有血清肝酶水平临床上的改变,没有引起严重的并发症.术后随访1-6月,肿瘤经影像检查体积缩小者5例,增大3例,无变化12例.手术切除肿瘤1例,病情进展死亡2例,死于消化道出血.结论:MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

开放式磁共振引导肝癌的冷冻消融治疗疗效分析

目的 探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法 进行肝癌的冷冻消融治疗的疗效.方法 对60例HCC的肝肿瘤进行了冷冻消融治疗.采用新奥博为0.3-T开放式MRI系统,冷冻探针通过实时监视被置于消融病灶中.评估其临床体征、症状和实验室检验结果 ,并对冷冻消融治疗的疗效进行分析.结果 MRI引导下经皮穿刺冷冻消融治疗能精确到达肿瘤、彻底消融的目的 ,有血清肝酶水平临床上的改变,没有引起严重的并发症.结论 MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

射频消融治疗肝癌

射频消融治疗肝癌是近十余年来发展起来的介入导向治疗方法之一，近年对其工作原理、适应证、禁忌证、术中方法学、随访观察、并发症及面临的问题等研究有较大进展。现就此作一综述。     

射频消融治疗肝癌

射频消融治疗肝癌是近十余年来发展起来的介入导向治疗方法之一,近年对其工作原理、适应证、禁忌证、术中方法学、随访观察、并发症及面临的问题等研究有较大进展.现就此作一综述.     

CT引导下经皮穿刺射频消融治疗特殊部位肝癌

目的 探讨CT引导下经皮穿刺射频消融（RFA）治疗特殊部位肝癌（直径≤3cm）的疗效及安全性。方法 回顾性分析2008年5月至2012年4月行CT引导下经皮穿刺RFA治疗47例肝癌患者,共消融63个特殊部位（指距离大血管、大胆管或肝外脏器5mm以内）病灶。所有患者术后均行增强CT复查及随访,统计肿瘤完全坏死率、肿瘤局部进展率、肿瘤肝内新生率、生存率及并发症。结果 所有患者均成功接受经皮穿刺RFA治疗。RFA术后1个月特殊部位肝癌完全坏死率为88.89％（56／63）;RFA术后3、6、12个月及1年以上的肿瘤局部进展率分别为4.77％（3／63）、3.17％（2／63）、3.17％（2／63）、1.59％（1／63）,肿瘤肝内新生率分别为15.87％（10／63）、4.76％（3／63）、12.70％（8／63）、3.17％（2／63）。至随访截止时间,47例患者的1、3、5年生存率分别为82.98％（39／47）、63.83％（30／47）、36.17％（17／47）。RFA术后,未出现任何严重并发症,6例（12.77％）出现肝包膜下少量血肿,10例（21.28％）术后发热,经对症处理后症状改善。结论 CT引导下经皮穿刺RFA治疗特殊部位肝癌是安全、有效的方法。     

CT引导下原发性肝癌的化学消融治疗

自上世纪八十年代中期日本学者Sugiura（杉浦）首次报告超声引导下行肝癌化学消融术有效后,该方法迅速在世界范围内开展起来。经大量的临床实践证实,化学消融术确是一种简便易行、疗效较好的治疗肝癌的方法。但是该方法也存在一定缺陷,在具体操作时,由于病灶注药后的超声显像多表现为强回声,对于药物弥散的程度和对个体应该给予的剂量均难以判定,影响治疗效果。近年来,人们开始利用CT、MRI等断层影像设备进行化学消融治疗。CT的优势在于断层图像清晰,可提供完整的给药后肿瘤局部及周围的影像,医生可根据图像的提示,决定消融针的操作方向、药量的多少等,这对于提高疗效起关键作用。我科自2004年4月引进该项技术,在改进了定位与穿刺方法后,在2年多的时间里,完成该项手术50例次,取得了较好的成果,现报告如下：     

CT引导下经皮微波消融治疗膈顶部复发性小肝癌15例疗效观察

目的:回顾性分析经肝脏CT引导下经皮微波消融（CT-MWA）治疗膈顶区域复发性小肝癌的临床疗效及安全性。方法:对2009年8月至2015年2月共15例位于膈顶部位复发性小肝癌患者的小病灶（<3 cm）进行CT引导下经皮微波消融术治疗的临床资料进行回顾性分析。分析总结微波消融治疗膈顶复发性小肝癌的1、3年生存率、完全消融率、局部进展率、术中及术后并发症、不良反应。结果:本研究15个小病灶进行CT-MWA治疗成功率和完全消融率分别为93.33%(14/15)和86.67%(13/15)。术中疼痛发生率为46.67%(7/15)。术后常见不良反应为肝区疼痛(33.33%)、胃肠道反应(46.67%)、发热(13.33%)、肝功能异常(13.33%),无肝功能衰竭、胆瘘、感染、出血等严重并发症,无围手术期死亡病例。15例患者平均存活时间为42个月。术后3个月、6个月、1年及1年以上的肿瘤局部进展率分别为6.67%(1/15)、6.67%(1/15)、13.33%(2/15)、13.33%(2/15)。1、2、3年生存率分别为86.67%(13/15)、66.67%(10/15)、46.67%(7/15)。结论:经皮CT-MWA 治疗膈顶区域复发性小肝癌是一种安全有效的微创治疗方法,值得扩大样本量进一步研究。     

肝癌射频消融治疗技术进展

<正>射频消融(radiofrequency ablation,RFA)是将射频电极针(或电极导管)直接插入到肿瘤组织中,利用460kHz射频电流在组织中产生的热效应(90℃¹10℃)直接杀灭肿瘤细胞的一种微创治疗技术。RFA应用于肝癌的治疗已有近20年的历史,随着治疗设备的不断改进和临床技术的不断提高,RFA在肝癌治疗中的应用范围不断扩展,疗效确切、微创安全,正发挥越来越大的作用。一、肝癌病灶原位灭活消融技术RFA治疗时,射频电极针直接插入肝癌病灶中。射频电极针的构造、输出功率、消融时间与消融体积及消融效果密     

SD大鼠移植性肝癌模型的建立及其磁共振表现

目的探讨在SD大鼠上建立一种理想的、适用于介入治疗和MRI观察的移植性肝癌模型的可行性。方法用腹腔肝癌移植种鼠（W256-2k）含癌细胞之腹腔液注入SD雄性幼鼠腹腔内行保种传代;同时行SD雄性幼鼠腋下及腹股沟皮下注射种植,7天后将皮下种植成功的大小约1cm^3实体瘤组织,切成0．2cm×0．2cm×0．2cm大的组织块,并植入40只SD成年雄性大鼠左肝包膜下制成移植性肝癌模型,于8d时利用MRI观察肿瘤体积及其特征,并取肿瘤标本做病理切片检查。结果移植术后8d时,MR检查37只SD大鼠肝内长出单个结节状肿瘤,腹水形成2只,肿瘤平均体积为（0．18±0．09）cm^3。在所有被移植成功大鼠中,病灶在T1WI上呈低信号,在T2WI上呈高信号。病理切片检查示肿瘤内无明显坏死和出血,其周围血管丰富。结论SD大鼠实验模型经济,其模型建立成功率高,MR检查效果良好,适用于肝癌的介入治疗的研究。     

经皮穿刺氩氦刀冷冻治疗转移性肝癌22例

目的:探讨氩氦刀冷冻治疗转移性肝癌的疗效及临床意义.方法:2001年7月～2002年12月转移性肝癌患者22例在B超引导下行经皮穿刺氩氦刀冷冻治疗肝脏肿瘤术.术后患者定期复查血清肿瘤标记物、B超检查及CT或MRI.结果:术后12个月存活率为81.8%,术后18个月存活率为63.6%,术后24个月存活率为22.7%,术后并发症包括1例急性肾功能衰竭,4例胸腔积液,1例腹腔局部积液,全部病例均有一过性肝功能损害.结论:美国CryocareTM氩氦刀冷冻治疗中晚期转移性肝癌是一种微创、相对安全、疗效可靠的新方法.对于失去手术治疗机会且TAE疗效不好的中晚期转移性肝癌是一种有效的治疗方法.     

Clinical applications for magnetic resonance guided high intensity focused ultrasound (MRgHIFU): Present and future

It has been well known for decades that high intensity focused ultrasound (HIFU) generates heat in tissues resulting in coagulative necrosis. Implementation, however, has been slow, due to difficulties with finding an appropriate imaging modality that could not only guide treatment, but also provide real‐time thermal feedback. These problems have been overcome with the newest magnetic resonance‐guided high intensity focused ultrasound systems (MRgHIFU). With its superior spatial resolution enabling accurate image guidance coupled with its ability to provide real‐time thermography during treatments, MRI is moving further into the realm of therapeutics for oncologic patient care. This article will discuss the implementation of an MR‐guided HIFU system, current clinical indications and touch on future directions.     

Follow up of coiled intracranial aneurysms with standard resolution and higher resolution magnetic resonance angiography

Time-of-flight magnetic resonance angiography is a non-invasive alternative to digital subtraction angiography (DSA) for follow up of coiled intracranial aneurysms. Standard cranial MRA protocols are a compromise between spatial resolution and imaging time. This study compares a standard resolution MRA protocol with a protocol at higher spatial resolution MRA (HR-MRA) in 21 follow-up occasions in 17 coiled aneurysms in 15 patients. Images were reviewed for presence of residual or recurrent aneurysm and compared with DSA as the gold standard. Aneurysm flow signal on standard resolution MRA differed significantly from HR-MRA in 6/21 cases (P = 0.02) and DSA in 6/21 cases (P = 0.02). HR-MRA had 100% concordance with DSA (P = 1.0). In this study, three-dimensional time-of-flight magnetic resonance angiography carried out at standard resolution is inadequate for follow up of coiled intracranial aneurysms. HR-MRA is comparable to DSA for detection of aneurysm recurrence.     

Imaging characteristics following 90yttrium microsphere treatment for unresectable liver cancer

Selective internal radiation therapy (SIRT) with (90)yttrium microspheres - also known as radioembolisation - is a relatively new interventional radiology technique offering symptomatic and survival advantages for patients with unresectable liver cancer. However, in delivering both beta-particle brachytherapy and embolisation of tumour vasculature, SIRT produces biological sequelae and imaging characteristics distinct from other treatment modalities. Current CT interpretation criteria consistently under-report pathological responses to radioembolisation, diminishing both the prognosis and subsequent treatment choices for responding patients. However, newer criteria incorporating both tumour dimensions and enhancement characteristics improve the correlation with histopathology and provide substantially earlier confirmation of response. CT following radioembolisation may also identify parenchymal features that are often benign but may be mistaken for tumour progression. This review outlines imaging criteria specific to SIRT, including assessment of tumour response and interpretation of both lesion and parenchymal characteristics. The adjunctive role of additional modalities such as positron emission tomography is also addressed.     

经皮肝穿刺注射无水乙醇配合肝动脉化疗栓塞术治疗原发性肝癌

目的：研究ＣＴ引导下经皮肝穿注射无水乙醇配合肝动脉化疗栓塞术治疗原发性肝癌的疗效。方法：对６８例肝癌进行肝动脉化疗栓塞术和ＣＴ引导下经皮肝穿刺注射无水乙醇治疗,并与同期５３例单纯肝动脉化疗栓塞术组（对照组）比较疗法。结果：治疗组的肿瘤缩小率,ＡＦＰ下降,累计生存率及局部复发率显优于对照组。结论：ＣＴ引导下经皮肝穿刺注射无水乙醇配合肝动脉化疗栓塞术为肝癌较好的一种综合治疗方法。     

Three-dimensional movement of a liver tumor detected by high-speed magnetic resonance imaging

Objective: Three-dimensional (3D) movement of a spherical liver tumor during respiration was investigated with magnetic resonance imaging (MRI) using a high-speed sequence.

Methods: A marker was placed on the surface of the patient as a reference of distance. Repetition time (TR) was 7.7 ms, echo time (TE) was 4.2 ms, flip angle was 20°, section thickness was 8 mm, and a 256×128 matrix was used. The acquisition time was 1.0 s followed by an interval of 0.5 s. The 20 tumor contours extracted during 30 s were superimposed on sagittal and coronal MR images.

Results: The maximum value of tumor edge location was 3.9 cm in the cranio–caudal direction, 2.3 cm in the ventro–dorsal direction, and 3.1 cm in the lateral direction. The mean length of tumor displacement observed was 2.1 cm in the cranio–caudal direction, 0.8 cm in the ventro–dorsal and 0.9 cm in the left–right direction, respectively. The locus of the center of the tumor contour in the sagittal cross section was inclined at 23° and in the coronal cross section was inclined at 18° to the cranio–caudal axis of body.

Conclusion: In conclusion, 3D movement of a spherical liver tumor was detected using rapid MRI sequential examinations. Magnetic resonance imaging has a potential to improve the accuracy of the planning target volume of a liver tumor.     

Contrast‐enhanced magnetic resonance angiography of the peripheral arteries: Technique,tips, pitfalls and problems

Contrast‐enhanced magnetic resonance angiography is a reliable way to assess peripheral vascular disease. This article reviews the basic physics behind this technique and discusses our institution's experience with regard to the clinical role, recent advances in image acquisition and use of contrast agents. Problems that can affect image quality and interpretation are also highlighted.     

A prognostic nomogram for colorectal cancer liver metastases after percutaneous thermal ablation

Purpose: To assess the efficacy of percutaneous thermal ablation in treating colorectal cancer liver metastases (CRCLM), and to propose a prognostic nomogram for overall survival (OS).

Materials and methods: Seventy-one patients with CRCLM undergoing thermal ablation at our institute from 2009 to 2013 were identified and analysed to formulate a prognostic nomogram. The concordance index (C-index) and calibration curve were calculated to evaluate the predictive accuracy of the nomogram. The nomogram was compared with two current prognostic nomograms for patients with CRCLM who had undergone hepatectomy (Kattan) and selective internal radiation therapy (Fendler). Predictive validity was assessed in the validation cohort of 25 patients who had undergone thermal ablation from 2014 to 2016.

Results: The median OS in the primary cohort was 26.4?months, whereas the 1-, 3- and 5-year OS rates were 72.2%, 37.2% and 17%, respectively. The median progression-free survival was 4.2?months. After univariate and multivariate analysis, a prognostic nomogram was formulated based on four predictors, including the number of tumours, maximum diameter of the tumour, CA19–9 level and ablation margin. The C-index of the nomogram was 0.815. Based on the patients of this study, the C-index was significantly higher than that of the Fendler nomogram (C-index, 0.698) and Kattan nomogram (C-index, 0.514, p?Conclusions: Thermal ablation was an effective therapy for CRCLM. Moreover, the nomogram was effective and simple for CRCLM patients undergoing thermal ablation.     

The role of magnetic resonance imaging in early breast cancer

Despite recent evidence that fails to detect a benefit in surgical and local recurrence outcomes in those who receive optimal surgery and adjuvant systemic and radiotherapy, magnetic resonance imaging (MRI) is still being employed. We review the recent literature to clarify the role in the use of MRI in early breast cancer. A literature search using the Medline and Ovid databases was conducted between 2004 and 2011 using the terms "magnetic resonance imaging' and 'early breast cancer'. Only articles with clinical trials published in English in adult humans with available abstracts were included. Articles on high-risk women, response to neoadjuvant therapy, advanced breast cancer, the occult primary, the contralateral breast and technical articles were excluded. Articles examining the role of MRI in the staging of early breast cancer were retained. Over 260 articles regarding breast MRI have been published in the last 5 years. Additional foci may be found in 16% of patients but the impact on the extent of surgery and local recurrence rate is yet to be defined. Certain sub-groups who may benefit include those with invasive lobular carcinoma and mammographically dense breasts and those for consideration of partial breast irradiation. With standard adjuvant radiotherapy, there is no benefit in routine MRI with respect surgical extent and local recurrence. Should MRI be used, pre-operative biopsy to confirm additional disease must be undertaken prior to a change in surgical extent of resection. However, MRI may be useful in the evaluation of those who can be considered for partial breast irradiation. Centres undertaking breast MRI must have MRI-biopsy capabilities and constantly audit the reporting of MRI with correlation to the final pathology.     

Preoperative breast magnetic resonance imaging in early breast cancer

BACKGROUND:

Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi‐institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B‐39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI.

METHODS:

Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast‐enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early‐stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound ± biopsy.

RESULTS:

A total of 260 patients met eligibility criteria for NSABP B‐39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI.

CONCLUSIONS:

Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI. Cancer 2009. © 2009 American Cancer Society.