Hepatocellular Carcinoma Treated with Percutaneous Radiofrequency Ablation: Evaluated with Sequential Biphasic Helical CT

利用雙相螺旋電腦斷層追蹤評估經皮射頻滅除術對肝細胞癌的治療效果

吳振豪(Chen-Hao Wu) ； 黃振義(Jen-I Hwang) ； 熊小澐(Siu-Wan Hung) ； 周宜宏(Yi-Hong Chou) ； 李覃(Tan Lee) ； 李三剛(San-Kan Lee)

《中華放射線醫學雜誌》 30卷2期 (2005/05) Pp. 65-74

摘要

長期追蹤經皮射頻滅除術治療後的肝細胞癌，並運用雙相螺旋電腦斷層影像上的一系列變化，來評估治療的效果。
有二十七個病人共35個肝細胞癌接受經皮射頻滅除術治療，每位病人均在術前及術後立刻做含動脈相及靜脈相的電腦斷層攝影，並且在3、6及9個月後進行追蹤影像檢查。獲得的影像也將判讀、描述出是否有殘餘或復發的顯影區及比對治療區域大小的改變。
35個肝細胞癌中有32個(91%)在術後的立即及三個月後追蹤的電腦斷層影像中呈現低密度及不顯影，代表腫瘤已成功治療。在立即追蹤的電腦斷層影像中，也發現治療完後周圍組織的充血反應(100%)及一些微小氣泡在治療後的組織內(28%)。其餘的3個腫瘤(9%)呈現周圍的結節顯影，診斷為殘存的肝細胞癌。二十七個病人中有八個(29%)在治療完後，發現在肝臟其他位置有新的復發腫瘤。
用電腦斷層影像來評估，經皮射頻滅除術治療肝細胞癌的結果，確實可提供準確診斷殘餘或復發的腫瘤，並據此為病患做進一步的治療。

關鍵字

電腦斷層 ； 肝細胞癌 ； 肝腫瘤 ； 治療 ； 射頻滅除術

並列摘要

To determine serial changes in hepatocellular carcinomas (HCCs) treated with percutaneous radio- frequency ablation (PRFA) at long-term serial follow-up biphasic helical computed tomography (CT).
Thirty five HCCs (range, 2.1-7.0 cm in diameter; mean ±SD, 3.0 ± 1.5 cm) in 27 patients (mean age, 67.2 years) were enrolled in our study. Every patient will received biphasic spiral CT study before and immediately after PRFA, then follow up 3, 6 and 9 months after PRFA for determining the effectiveness of treatment. The serial changes in attenuation, enhancing pattern, shape, and diameter of the thermal lesions were analyzed.
Thirty-two (91%) of 35 thermal lesions were low attenuation, with absence of contrast enhancement at immediate and 3 month follow-up CT images, which is suggestive of successful treatment. Peripheral rim enhancement was identified in all of the lesions after treatment (100%). Intralesional air bubbles were seen within 10 thermal lesions (28%). The remaining three lesions (9%) showed peripheral nodular enhancement, suggesting residual viable tumor. Hemoperitoneum was demonstrated in one (4%) patient after PRFA. Eight (29%) of 27 patients had recurrent tumors elsewhere in the liver at follow-up CT study.
Biphasic helical CT can provide a diagnostic clue for determining the response of HCC treated with PRFA.

並列關鍵字

Computed tomography ； Hepatocellular carcinoma ； Liver neoplasms ； therapy ； Radiofrequency ablation