MRI引导技术在氩氦刀消融治疗肿瘤中的临床应用

目的探讨MRI引导氩氦刀冷冻消融治疗肿瘤的临床价值。方法对90例肿瘤患者行MRI引导氩氦刀冷冻消融治疗,包括肝脏肿瘤52例,肾脏肿瘤10例,胸壁肿瘤6例,盆腔肿瘤12例,四肢骨及软组织肿瘤9例,坐骨肿瘤1例。术中采用SE T1WI、FSE T2WI、SPGR T1WI监测穿刺及消融情况。观察术中MRI表现、并发症情况,术后随访复查增强MRI评价消融效果。结果消融术中MRI均可清晰显示病灶,快速扫描SPGR T1WI可显示冷冻针全长。24例因病灶较大(最大径10.80～15.06 cm),以消融作为减瘤治疗,平均消融(2.96±0.76)次,其中17例末次氩氦刀冷冻消融术后1个月增强MRI示消融时冰球覆盖区域病灶无强化,病灶整体有所减小;7例病灶边缘可见强化,病灶不同程度增大。66例单次消融时冰球完全覆盖病灶,术后1个月增强MRI示47例病灶完全消融,19例病灶部分消融。术中11例穿刺部位出血,未发生严重并发症。结论 MRI引导氩氦刀冷冻消融可用于治疗不同部位肿瘤,多可获得满意疗效。

Clinical application of MRI-guided argon-helium cryoablation of tumors

Objective To investigate the clinical value of MRI-guided argon-helium cyoablation in the treatment of tumors. Methods MRI-guided argon helium cyoablation was performed in 90 tumor patients, including 52 cases of liver tumor, 10 of kidney tumor, 6 of chest wall tumor, 12 of pelvic tumor, 9 of limb tumors and 1 case of sciatic tumor. SE T1W, FSE T2W and SPGR T1W sequences were used to monitor the process of puncture and cyoablation. MRI findings and the complications during cyoablation were observed. Enhanced MRI was performed after cyoablation to evaluate the therapeutic efficacy. Results All lesions could be clearly displayed with MRI during cyoablation, and the whole probes could be clearly showed on SPGR T1WI. A total of 24 patients with large lesions (maximum diameter 10.80-15.06 cm) underwent tumor cytoreduction therapy, the average times of cytoreduction therapy was 2.96±0.76. Among them, the part of lesion covered by ice-ball during cyoablaion showed no enhancement in 17 patients, while in the rest 7 patients, enhancement could be observed at the edge of lesions which became larger on enhanced MRI 1 month after the last treatment. In 66 patients underwent single time cyoablation, the lesions were all covered by the ice-ball during cyoablation treatment, and enhanced MRI showed complete ablation of lesions in 47 cases and partial ablation in 19 cases 1 month after cyoablation. Local bleeding around puncture point was observed in 11 patients, no serious complication occurred. Conclusion MRI-guided argon-helium cyoablation can be used as an effective method in the treatment of tumor on different sites.