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目的分析原发性肝癌(HCC)碘油栓塞(TACE)后的磁共振成像(MRI)表现及其病理学基础。方法23例TACE后手术切除的HCC患者,共31个病灶。于术前1周内行MRI检查,包括SE 序列T1WI,FSET2WI和FMPSPGR多回合动态增强扫描。术后沿MRI扫描平面作5-10 mm层厚肿瘤连续切面和HE染色病理大切片,行MRI影像一病理对照研究。结果(1)MRI表现:SE序列上病灶信号多样,且多为不均匀的混杂信号。FMPSPGR平面扫描:3个为不均匀高信号,28个为等低信号。增强早期22 个强化,9个无强化。增强晚期6个部分强化。(2)病理结果:2个病灶无明显坏死,6个100%凝固性坏死, 其余23个有不同程度坏死。其它病理改变包括肿瘤内坏死伴出血(10个)、纤维间隔形成(5个)、纤维包膜(12个)、炎性细胞浸润(28个)、局限性粘液样变(2个)、玻璃样变(2个)、碘油沉积(6个)。(3)MRI 表现与病理埘照:T1WI高信号为凝固性坏死伴(或不伴)出血、肿瘤残存;等、低信号为凝固性坏死或肿瘤残存。T2WI高信号为肿瘤残存、凝固性坏死伴出血;等信号为凝固性坏死、少量肿瘤残存、纤维间隔, 低信号为凝固性坏死、纤维间隔。增强早期强化为肿瘤残存,无强化为凝固性坏死、出血、纤维间隔或少量肿瘤残存;增强晚期强化为肿瘤残存,纤维间隔,无强化为肿瘤残存、凝固性坏死、出血。MRI各种信号区均可见炎性细胞浸润。结论(1)由于碘油栓塞后肝癌病灶的不同病理改变导致SE序列上病灶信号多种多样。T2WI低信号有特异性,代表凝固性坏死。(2)多回合动态增强扫描判断肿瘤坏死和残存较SE 序列更有优势,增强早期有强化区为肿瘤残存,包膜早期明显强化可提示包膜下残存。(3)MRI能较准确的显示TACE后HCC的肿瘤坏死和残存及评价肝TACE疗效。
Objective To analyze the magnetic resonance imaging (MRI) and its pathological basis of primary hepatocellular carcinoma (HCC) after lipiodol embolization (TACE). Methods Twenty-three HCC patients undergoing TACE resection were enrolled in this study. There were 31 lesions. MRI examinations were performed within 1 week before surgery, including SEWI T1WI, FSET2WI and FMPSPGR multi-pass dynamic contrast-enhanced scans. Postoperative MRI scan plane for 5-10 mm layer thick tumor continuous section and HE staining of pathological large slices, line MRI image a pathological control study. Results (1) MRI manifestations: SE sequence of lesions on the signal diversity, and mostly heterogeneous mixed signal. FMPSPGR plane scan: 3 for the uneven high signal, 28 for the low signal. Enhanced early 22 strengthen, 9 no strengthen. Enhanced late six-part enhancement. (2) pathological results: no significant necrosis of two lesions, six 100% coagulation necrosis, and the remaining 23 have varying degrees of necrosis. Other pathological changes include necrosis with bleeding in the tumor (10), fibrin septa formation (5), fibrocartilage (12), inflammatory cell infiltration (28), localized mucinous changes Sample changes (2), lipiodol deposition (6). (3) MRI manifestations and pathological findings: T1WI high signal coagulation necrosis with (or not) bleeding, tumor remnants; and so on, low signal for coagulation necrosis or tumor remnants. T2WI high signal for the residual tumor, coagulation necrosis with bleeding; signal coagulation necrosis, a small amount of residual tumor, fiber spacing, low signal coagulation necrosis, fiber spacing. Enhanced early enhancement of residual tumor, no enhancement of coagulation necrosis, hemorrhage, fiber septum or a small amount of residual tumor; enhance advanced enhancement of residual tumor, fiber spacing, no enhancement of tumor remnants, coagulation necrosis, bleeding. Inflammatory cell infiltration can be seen in various signal areas of MRI. Conclusion (1) Due to the different pathological changes of liver cancer lesions caused by iodized oil embolization, the lesions of SE signal are diverse. T2WI low signal specificity, on behalf of coagulation necrosis. (2) Multiple-round dynamic contrast-enhanced scan to determine the tumor necrosis and residual more advantages than the SE sequence, enhance the early enhanced area for the residual tumor, early significantly enhanced envelope can remind the residual envelope. (3) MRI can more accurately show the tumor necrosis and remnant of HCC after TACE and evaluate the efficacy of hepatic TACE.