肺部肿瘤氩氦刀冷冻治疗后影像学评价

目的研究CT导向经皮穿刺氩氦刀靶向治疗肺部肿瘤后影像学变化及临床疗效和预后评价。方法采用CT引导下,经皮肺穿刺氩氦刀靶向治疗肺癌及肺转移瘤。结果96例患者中肺癌82例、肺转移瘤14例,共110病灶,单发病灶89例,多发病灶7例。氩氦刀共治疗103次,平均每次治疗1.06个病灶,每次最多治疗2病灶。肿瘤直径最小1.2cm,最大15cm,平均(4.0±2.5)cm。其中瘤灶直径小于2cm的12个,直径在2~4cm之间的51个,直径在4~6cm之间的24个,直径大于6cm的23个。冰球彻底覆盖瘤灶达其边缘外lcm者25例。直径小于4cm的肺内63个肿块显效率100%,直径4~6cm的肺内24个肿块,显效率95.8%,直径大于6cm的23个肺内肿块,显效率69.6%。肺部肿瘤冷冻后CT表现病灶处开始可见逐渐增大的低密度类圆形冷冻区,与非冷冻区有明显的界线。冷冻区中心CT值为负值,术后即刻CT检查病灶CT值平均下降30~50Hu(P<0.001)。随着氩氦刀冷冻治疗后时间延续,大部分肿块有不同程度的缩小或消失,同组治疗前后比较P<0.001。以直径小于4cm最明显,特别是直径小于2cm病灶,观察3个月后均已消失。个别原体积比较大(本研究>6cm)的肿块反而增大,且见新病灶出现。术后12个月追踪了81病灶,复查CT示:81个被消融肿块完全消失的16个(19.8%);缩小的42个(51.9%);稳定的17个(20.9%);增大的6个(7.4%);总有效率为92.6%。结论研究肺部肿瘤氩氦刀靶向治疗后CT影像学表现对其疗效的评价及预后判断有重要参考价值。

Imaging evaluation of lung neoplasm treated with argon-helium cryoablation

Objective To evaluate the imaging changing, clinical effect and prognosis of lung neoplasm after treatment with CT-guided argon-helium cryoablation. Methods Lung cancer and lung metastasis were treated with CT-guided percutaneous argon-helium targeted cryoablation. Results Among total 96 cases,82 cases of lung cancer and 14 cases with lung metastasis, total 110 lesions (89 cases with single lesion, 7 cases with multiple lesions). Total 103 times treated with Ar-He cryoablation (average 1.06 lesions at a time, maximal 2 lesions). The diameter from 1.2 cm to 15 cm, mean (4.0±2.5) cm (12 lesions diameter less than 2 cm, 51 lesions diameter between 2-4 cm, 24 lesions between 4-6 cm, 23 lesions over 6 cm). Twenty-five with iceball cover the whole lesion and 1 cm over it's margin 100% efficacy rate among the 63 lesions with diameter less than 4 cm, 95.8% efficacy rate among the 24 lesions with 4-6 cm diameter, 69.6% efficacy rate amount 23 lesions with over 6 cm diameter. The post-treatment CT show progressively enlarged round refrigerant low density have a clear margin with non-refrigerant area. The center of refrigerant area show negative CT value, the mean decreased CT value of lesion instantly treatment were about 30-50 Hu with P<0.001. Most of lesions appear different smaller or disappear with the processing after Ar-He cryoablation (P<0.001). The lesions with less than 4 cm diameter have the largest efficacy rate, especially the lesion with diameter less than 2 cm, all of them disappear after 3 months. Several lesions (with over 6 cm diameter) enlarged and new lesion appears. Follow up 81 lesions within 12 months, recheck CT show: Among the 81 lesions, 16 (19.8%) with complete response (CR), 42 lesions (51.9%) with partial response (PR), 17 lesions (20.9%) without change (NC), 6 lesions (7.4%) enlarged (PD). The total efficacy rate was 92.6%. Conclusion The study of imaging manifestation of lung neoplasm treated with CT-guided Ar-He cryoablation is very important in the evaluation of clinical effect and prognosis.