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目的评价MRI平扫和动态增强对肝癌伽玛刀治疗后表现和疗效随访的价值。方法回顾性分析57例肝癌伽玛刀治疗后MRI表现,并与AFP结果进行对照。结果肝癌伽玛刀治疗后平扫主要有4种表现:(1)T1WI稍低信号,T2WI稍高信号。(2)T1WI和T2WI均呈稍低信号。(3)T1WI稍高信号,T2WI等稍高混杂信号。(4)T1WI和T2WI均呈稍高信号。坏死病灶动态增强扫描表现为:(1)持续环形强化;(2)蜂窝状强化;(3)病灶本身无强化,周围肝组织斑片状强化。复发癌灶或新发癌灶在动态增强时早期强化,延迟期造影剂退出。小肝癌组(<5 cm)肿瘤完全坏死率93.5%,大肝癌组肿瘤(≥5 cm)完全坏死率81.8%。2组疗效比较差异无统计学意义(P=0.244)。结论MRI平扫和动态增强评价伽玛刀的疗效可靠、准确,伽玛刀术后定期MRI随访具有重要意义。
Objective To evaluate the value of MRI plain scan and dynamic enhancement in the follow-up of gamma knife treatment and follow-up of gamma knife therapy. Methods Retrospectively analyze the MRI performance of 57 cases of liver cancer after Gamma Knife treatment, and compare them with AFP results. Results There were mainly four manifestations of plain scan after gamma knife treatment: (1) slightly lower signal on T1WI and slightly higher signal on T2WI. (2) T1WI and T2WI showed slightly lower signal. (3) slightly higher signal on T1WI, slightly higher mixed signal on T2WI. (4) T1WI and T2WI showed slightly higher signal. Dynamic enhancement scans of necrotic lesions showed: (1) continuous annular enhancement; (2) cellular enhancement; (3) no enhancement of the lesion itself and patchy enhancement of the surrounding liver tissue. Recurrent foci or new foci were intensified early during dynamic enhancement and contrast agents withdrew during late phase. The complete tumor necrosis rate was 93.5% in the small hepatocellular carcinoma group (<5 cm) and 81.8% in the large hepatocellular carcinoma group (≥5 cm). There was no significant difference in the efficacy of the two groups (P=0.244). Conclusion The MRI plain scan and dynamic enhancement evaluation of gamma knife is reliable and accurate. Regular MRI follow-up after gamma knife surgery is of great significance.