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目的通过对射频消融治疗肝癌前后的B超、CT和MRI的比较,探讨不同影像方法对射频消融治疗肝癌疗效评价的意义。方法对100例肝癌患者进行了B超引导下经皮射频消融(PRFA)治疗。患者治疗前行B超、MRI或CT检查;治疗后1个月复查MRI或CT,每个月进行肿瘤标记物和B超检查。结果100例中,PRFA治疗前34例行CT检查;治疗后14例行CT复查,其中5例肿瘤区域呈现较原肿瘤更低的密度,动态增强无强化,9例肿瘤部分区域有强化。66例患者PRFA治疗前行MRI检查,T1加权像为低信号,T2加权像为相对高信号,动态增强扫描后动脉期强化,门脉期强化减弱。治疗后,全组有86例患者复查MRI,44例肿瘤T1加权像为等或高信号,T2加权像为等或低信号,动态增强无异常强化;42例肿瘤T1加权像呈不均匀等低混杂信号,T2加权像部分呈相对高信号,动态增强有强化。结论增强CT扫描可以显示出残存肿瘤;MRI的T1、T2加权像及Gd-DPTA动态增强的信号变化,能够更好地反映肿瘤的坏死或残存状况。血清肿瘤标记物阳性者术后转阴并MRI(或CT)显示肿瘤呈完全凝固性坏死,可作为PRFA治疗肝癌的临床治愈标准。
Objective To compare the radiofrequency ablation before and after the B ultrasound, CT and MRI to explore the different imaging methods of radiofrequency ablation for the evaluation of the therapeutic effect of liver cancer. Methods 100 cases of liver cancer patients underwent B ultrasound guided percutaneous radiofrequency ablation (PRFA) treatment. Patients before treatment B ultrasound, MRI or CT examination; review 1 month after treatment of MRI or CT, tumor markers and B-ultrasound every month. Results Among the 100 cases, 34 cases were examined by CT before the treatment of PRFA. After the treatment, 14 cases were examined by CT, of which 5 cases showed lower density than the original tumor, no dynamic enhancement and no enhancement in 9 cases. Sixty-six patients underwent MRI before PRFA, with T1 weighted images as low signal and T2 weighted images as relatively high signal. After dynamic contrast enhancement, the arterial phase was enhanced and the portal phase was weakened. After treatment, MRI was performed in 86 patients in all the groups. The T1 weighted images of 44 tumors were equal or high signal, T2 weighted images were equal or low signal intensity, and no abnormal enhancement was found in 42 cases. Mixed signal, T2 weighted image was relatively high signal, enhanced dynamic enhancement. Conclusions Enhanced CT scan can show the residual tumor; T1, T2 weighted images of MRI and Gd-DPTA dynamic enhanced signal changes can better reflect the tumor necrosis or residual status. Serum tumor markers were negative after surgery and MRI (or CT) showed complete coagulation necrosis of the tumor can be used as PRFA treatment of liver cancer clinical standard of cure.