摘要
目的 了解肝癌射频治疗后的DSA征象 ,为评价肝癌射频治疗的疗效和选择理想的术后影像学随访手段提供参考。资料与方法 本组共 8例 ,原发性肝癌 7例 ,转移性肝癌 1例 ;6例为单发病灶 ,2例各为 2个病灶 (1例为原发 ,1例为转移 ) ;肿瘤直径 3～ 7.5cm(平均 4 .3cm)。肝总动脉及可疑区域供血动脉超选择性造影。结果 DSA表现 :射频治疗的肿瘤区多为圆形或类圆形无染色的低密度区 ;边缘区可见以下几种征象 :(1)局部染色 ;(2 )肝动脉门静脉瘘 ;(3)边缘区出血 ;(4 )边缘复发 ;(5 )无异常造影征象。肝内异位复发灶造影表现同其原发肿瘤常见造影表现。本组 7例造影发现原位边缘复发和 /或肝内异位复发灶。结论 发现和鉴别射频治疗区域的边缘征象是判断局部复发的关键。 (1)肉芽组织染色为治疗区边缘常见征象 ,多见于治疗后 1个月内。 (2 )局部肝动脉门静脉瘘是射频治疗的并发症 ,常因局部肝动脉灌注不足和门静脉异常灌注 ,掩盖局部复发征象。 (3)边缘出血与局部复发的鉴别要点在于 :前者为片状染色 ,时相更早 ,门静脉显影后仍有对比剂存留 ;边缘复发多为结节状 ,分布不均 ,突出于治疗轮廓以外。 (4 )射频治疗 3个月后 ,原肿瘤病灶边缘应无异常血管征象 ,若有染色应考虑复发。DSA在检出
Objective To study the hepatic DSA manifestations of hepatocarcinoma after radiofrequency ablation (RFA) treatment, and to provide reference for evaluating RFA effect and selecting proper follow up imaging technique. Materials and Methods Eight male patients with primary liver cancer (n=7) or hepatic metastasis (n=1) were enrolled in this study. Solitary lesion was seen in 6 and double lesions in 2 cases. Tumor's diameter varied within 3～7.5 cm with a mean of 4.3 cm. Common hepatic arteriography or super selective angiography of suspicious tumor area were performed in all patients.Results On DSA, most ablated regions presented as round or ovoid low density areas with no stain. At the lesion's peripheral zone the following five signs could be found: (1) stain of localized granulation tissue; (2) arterio portal fistula; (3) hemorrhage; (4) recurrence; (5) no abnormal findings. Local or intrahepatic recurrence occurred in 7 cases.Conclusion Hepatic DSA has great value in detecting local recurrence of hepatic tumor after RFA treatment. (1) Granulation staining at the peripheral zone of treated region is a common finding, usually appeared in one month after RFA. (2) Arteriovenous shunt, as a complication of RFA, can cover local recurrence because of hepatic hypo perfusion and abnormal portal perfusion. (3) Marginal bleeding presents as patch stain in early arterial phase which lasts into portal phase, while marginal recurrence shows signs of nodular shadow which protrudes beyond the outline of the treated area. (4) No abnormal vascularity should be seen at tumor's border three months after RFA, otherwise, recurrence should be considered. DSA is superior to CT in detecting marginal or intrahepatic recurrent nodule below 1cm.
出处
《临床放射学杂志》
CSCD
北大核心
2003年第5期408-411,共4页
Journal of Clinical Radiology
