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目的探讨MRI增强及弥散加权成像(DWI)在经皮肾癌冷冻消融诊疗中的应用价值。方法对10例单侧肾癌患者进行常规肾脏MRI平扫加增强检查及DWI检查,测出肾癌病灶区域大小,并直接测量不同b值(b=0.400、800s/mm2)下正常肾脏及肾癌病灶的平均表观弥散系数(ADC)值。随后进行经皮肾癌冷冻消融治疗,并分别于术后1周和术后1、3、6个月进行MRI平扫加增强及DWI检查,测量病灶大小及ADC值,并进行量化分析。结果冷冻消融术前,10例肾癌病灶明显增强;冷冻消融后肾癌病灶增强扫描无明显增强。10例肾癌在DWI上表现肿瘤的实质部分呈高信号,坏死部分呈低信号。术前肾癌病灶ADC值低于肾脏正常部分(P<0.05);同一b值下,术后1周和术后1个月时病灶ADC值较术前明显升高(P<0.05)。结论 MRI增强在判断肾癌消融是否毁损完全或复发有独特意义。MRI增强、DWI和ADC值可用于肾癌的诊断和冷冻消融术后短期内疗效评估。
Objective To investigate the value of MRI-enhanced and diffusion-weighted imaging (DWI) in the diagnosis and treatment of percutaneous renal cell carcinoma (CRF) by cryoablation. Methods Ten patients with unilateral renal cell carcinoma underwent routine MRI scan and DWI examination, and the size of renal cell carcinoma was detected. The normal kidneys and kidneys with different b values (b = 0.400, 800 s / mm2) Mean apparent diffusion coefficient (ADC) values of cancer lesions. Subsequently, percutaneous renal cell carcinoma was treated by cryoablation and ablation. MRI and DWI were performed at 1 week and 1, 3 and 6 months after operation respectively. The lesion size and ADC value were measured and quantified. Results Before cryoablation, the lesions of 10 cases of renal cell carcinoma were significantly enhanced. The enhancement of renal cell carcinoma was not significantly enhanced after cryoablation. Ten cases of renal cell carcinoma in the DWI showed a substantial part of the tumor was high signal, necrosis part was low signal. The ADC value of preoperative renal cell carcinoma lesion was lower than that of the normal part of kidney (P <0.05). At the same b value, ADC value of lesion in preoperative renal cell carcinoma was significantly higher than that before operation (P <0.05) at 1 week and 1 month after operation. Conclusions MRI enhancement is of unique significance in determining complete or recurrent renal cell ablation. MRI enhancement, DWI and ADC values can be used for the diagnosis of renal cell carcinoma and short-term curative effect assessment after cryoablation.