肝癌电磁波热凝治疗消融术后的CT表现分析

目的:分析肝癌电磁波热凝治疗(微波固化或射频消融)后的常见和特殊CT表现,提高对电磁波热凝治疗消融后肝脏形态改变和局部并发症的认识。方法:26例消融治疗后的肝癌患者,术后2周行CT扫描,3个月内复查CT,结合临床症状和实验室检查指标,分析射频消融治疗后肝脏形态的一般变化和出现局部并发症时的特殊征象。结果:电磁波热凝治疗消融后18例病灶呈术后正常改变,CT平扫为边界清楚、均质的低密度区,增强扫描无强化,而坏死区周边可见薄的环形强化,病灶范围较治疗前稍大,随治疗后的时间延长坏死区周边的环形强化逐渐减弱至消失,而中心坏死区仍为低密度,无强化,病灶较前逐渐缩小。消融后复发4例,CT表现为消融治疗区域周边的新发低密度灶。胆道损伤2例,CT表现为消融治疗区域周边肝内胆管扩张。肝内假性囊肿形成1例,CT示消融治疗区旁边缘锐利无强化的囊性灶;皮肤瘘道形成并胸腔积液1例,CT表现为消融治疗的针道不愈合,肝脏内病灶坏死区与体表相连通。结论:CT可准确地反映原发性肝癌电磁波热凝治疗消融后肝脏的形态学改变,有效观察局部并发症的发生情况,有助于提高对电磁波热凝治疗术后征象的认识。

CT Appearances of Malignant Liver Tumors after Local Electromagnetic Wave Thermal Ablation

Objective:To analyze CT appearances of malignant liver tumors after local electromagnetic wave thermal ablation microwave thermal ablation (MTA) or radiofrequency ablation (RFA).Methods:CT scans were performed for twenty-six patients with malignant liver tumors 2 weeks after local electromagnetic wave thermal ablation.The examination was repeated within 3 months.CT features of liver morphological changes and of local complications after the thermal ablation were analyzed,combined with clinical symptoms and lab dada.Results:In 18 cases without abnormal changes,the first postoperative CT scan 2 weeks after the thermal ablation showed well-outlined low density area which appeared bigger than the original size of the tumors,and there was no enhancement in the area.The margin of the low density area showed a faint rim-like enhancement.After a few months,the low density area became smaller and its size was similar to that of the original tumor,the rim-like enhancement of the margin faded gradually and disappeared.In 4 cases of recurrence,CT scans showed the low density lesions of recurrence adjacent to the area of thermal ablation.In 2 cases of bile duct injury,CT scans showed dilation of bile duct near the area of thermal ablation.In 1 case of pseudocyst (biloma),CT scans showed a cyst-like low density area without enhancement adjacent to the area of electromagnetic wave thermal ablation.In 1 case of fistula between liver and skin with pleural effusions,CT scans showed a fistulous tract with air communicating the liver and skin.Conclusion:CT scans can accurately demonstrate the morphological changes of liver and local complications after electromagnetic wave thermal ablation of malignant liver lesions.