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目的探讨块状型肝癌经动脉导管灌注化疗栓塞术(TACE)术后透视下经皮穿刺瘤内注入碘油化疗药物乳剂(CALE)弥散方式的影像表现。方法临床诊断为块状型肝癌患者114例,所有患者均为TACE术后病灶内已有碘油乳剂存积者。本次行经皮穿刺瘤内注入CALE治疗的术前常规CT和动脉造影显示靶区为少血供或不能找到供血动脉,且透视下能明确病灶位置。透视下完成经皮穿刺到靶区后注入CALE,并观察CALE弥散的影像学表现。结果全部患者共经皮穿刺瘤内注药180例次,技术成功率为100%。乳剂在靶区内弥散方式影像表现有蛋壳状54例次(30%),平均注药量(12±1.34)ml;团或片状24例次(13.3%),平均注入药量(9.17±1.39)ml;细密网格状90例次(50%),其中经动脉血管网弥散4例次(2.2%),平均注入药量(20.49±1.85)ml;油珠状12例次(6.7%),平均注入药量(7.86±0.74)ml,4组间比较差异具有统计学意义(F=24.9,P<0.05)。混合型16例(8.9%),均出现在团或片状患者和细密网格状患者中。靶区外弥散发生率达97.8%,主要为瘤周正常组织和管道系统。结论透视下经皮瘤内注入CALE影像表现有特征性,表现为蛋壳样、团或片状、细密网格状和油珠状等,并以细密网格状弥散者瘤内注入CALE的量为多。
Objective To investigate the imaging manifestations of intraluminal transcatheter arterial chemoembolization (CIOI) with transcatheter arterial chemoembolization (TACE) in patients with massive hepatocellular carcinoma (HCC). Methods One hundred and fourteen patients with lumpy hepatocellular carcinoma were diagnosed clinically, all of whom had lipiodol emulsion in the lesion after TACE. The routine percutaneous puncture into CALE preoperative conventional CT and arterial angiography showed that the target area for blood supply or can not find the blood supply artery, and fluoroscopy can be clear lesions location. Percutaneous puncture to the target area after completion of the injection of CALE, and to observe the CALE diffuse imaging findings. Results All patients received percutaneous intratumoral injection of 180 cases, the technical success rate was 100%. There were 54 cases (30%) of the eggshell-like shape in the dispersive image of the emulsion in the target area, with an average injection volume of 12 ± 1.34 ml, 24 cases (13.3% ± 1.39) ml; 90 cases (50%) were densely meshed, of which 4 cases were infiltrated by arterial vascular network (2.2%) and the average injection dose was 20.49 ± 1.85 ml; %), Mean injection dose (7.86 ± 0.74) ml, the difference between the four groups was statistically significant (F = 24.9, P <0.05). Mixed 16 cases (8.9%), were found in the group or sheet patients and patients with dense grid. Dispersion outside the target area was 97.8%, mainly for the peritumoral normal tissue and ductal system. CONCLUSION: The CALE images in percutaneous neoperitoneal tumors are characterized by the appearance of eggshell, clusters or flakes, fine grids and oil beads, etc., and the amount of CALE injected into the tumors of the dense grid-like diffusers As much.