原发性肝癌肝动脉化疗碘油栓塞后的MRI诊断价值

目的 研究MRI检查技术，尤其是FSET2WI和多时相快速动态增强扫描评价原发性肝癌动脉化疗碘油栓塞后（TACE）的影像学表现，探讨其临床应用价值。方法收集2000年9月至2004年7月肝癌病例30例（共37个病灶），于TACE后2～6个月行GE1．5TMRI检查，并于MRI检查后2～6d行DSA检查。研究肝癌TACE后肿瘤的坏死或存活的MRI信号特点，以及MRI和DSA在显示肿瘤存活结果的符合情况。结果37个肝癌TACE术后病灶中，MRI明确判断21个病灶有肿瘤残存，16个病灶凝固坏死明显。MRI判断病灶残存的敏感性为91．3％，特异性100％，准确性94．6％。与DSA相比无明显统计学差异（P〉0．05）。结论FSET2WI和多时相快速动态增强扫描序列相结合，同时观察病灶周围的完整与否，可以准确地判断肝癌TACE后肿瘤的坏死或残存。作为一种无创伤性检查。可以作为评价肝癌TACE术后疗效的首选检查。

MR imaging of primary hepatocellular carcinoma after transcatheter arterial chemoembolization with lipiodol

Objective To study the applied value of MR imaging,in particular,FSE T2WI and FMPSPGR dynamic contrast scanning in evaluating hepatocellular carcinoma(HCC)and visualizing its viable tumor after transcatheter arterial chemoembolization(TACE)with lipiodol.Methods Thirty patients with primary HCC(37 lesions)were collected from September 2000 to July 2004.MR imaging in all patients was performed by using GE magnetic resonance scanner at 2 to 6 months after TACE,and then all patients underwent additional digital subtraction angiography(DSA)at 2 to 6 days after MR imaging.Following TACE,the signal features of tumoral necrosis and survival on MR images and coincident rate between MRI and DSA for visualizing viable tumors were investigated.Results Among 37 lesions of 30 cases,MRI definitely identified 21 lesions of tumoral survival and 16 lesions of obviously coagulative necrosis.Compared with DSA or clinical follow-up,MRI whose sensitivity,specificity,and accuracy for identifying tumoral survival were 91.3%,100%,and 94.6%,respectively.There was not statistic difference between MRI and DSA(P > 0.05).Conclusion The integration of FSE T2WI and FMPSPGR sequence can simultaneously observe whether the presence of complete peritumoral capsule and accurately identify the tumoral necrosis or survival after TACE.As a non-invasive examination,MR imaging can be taken as an optimal protocol for evaluating therapeutic effects after TACE for HCC.