Catalano O, Esposito M, Nunziata A, Siani A
Department of Radiology, S. Maria delle Grazie Hospital, via Domitiana loc. La Schiana, Pozzuoli, Naples, I-80078, Italy.
Abdom Imaging. 2000 Nov-Dec;25(6):607-14. doi: 10.1007/s002610000076.
Multiple-phase helical computed tomography (CT) has been regarded as the method of choice in the evaluation of patients with hepatocellular carcinoma (HCC) treated by nonsurgical procedures. The aim of this article was to report our experience in the assessment of nodular and parenchymal changes recognizable after various percutaneous ablation therapies.
We reviewed the studies of 116 consecutive patients with HCC treated with multisession percutaneous ethanol injection (56 patients, 98 nodules), single-session percutaneous ethanol injection (14 patients, 31 nodules), radiofrequency thermal ablation (32 patients, 48 nodules), and interstitial laser photocoagulation (14 patients, 25 nodules). CT had been performed 3-28 days after the last session (mean = 18 days) with unenhanced helical acquisition and with contrast-enhanced double- or triple-phase helical acquisition.
Persisting neoplastic tissue was identified within 54.5% of the nodules. It was located centrally in 4.5% of these nodules, peripherally in 11%, and eccentrically in 84.5%, and its shape was crescent in 58%, globular in 24.5%, and other in 16%. On arterial phase scans, viable tumor was hyperdense in 97% of the lesions and isodense in 3%; on portal phase scans, the tumor was hyperdense in 20%, isodense in 28%, and hypodense in 52%; on delayed phase scans, the tumor was consistently hypodense. Tumor necrosis was always hypodense on contrast-enhanced scans. On unenhanced images, 7.4% of the nodules were undetectable. Nodule diameter appeared as unchanged in 53% of the nodules and as larger in 47%; its shape was unchanged in 54% and modified in 46%; its margins were unchanged in 36% and modified in 64%. A rim of granulation tissue was detected around 15% of the nodules, and a perilesional transient attenuation difference was detected in 21%. Perihepatic effusion was seen in 13% of the patients, segmental biliary duct dilation and local atrophy each in 9%, arterioportal fistula in 6%, portal vein thrombosis, subcapsular collection and pleural effusion each in 7%, hepatic infarction in 5%, and inferior vena cava thrombosis in 2%.
Percutaneous ablation of HCC may cause several changes. Knowledge of their CT appearance is mandatory to correctly assess and manage this tumor.
多期螺旋计算机断层扫描（CT）已被视为评估接受非手术治疗的肝细胞癌（HCC）患者的首选方法。本文旨在报告我们在评估各种经皮消融治疗后可识别的结节和实质变化方面的经验。
我们回顾了116例连续接受多疗程经皮乙醇注射治疗的HCC患者（56例，98个结节）、单疗程经皮乙醇注射治疗的患者（14例，31个结节）、射频热消融治疗的患者（32例，48个结节）以及间质激光光凝治疗的患者（14例，25个结节）的研究。在最后一次治疗后3 - 28天（平均 = 18天）进行CT检查，采用平扫螺旋采集以及增强双期或三期螺旋采集。
在54.5%的结节内发现有残留肿瘤组织。其中4.5%的结节位于中央，11%位于周边，84.5%为偏心分布，其形状呈新月形的占58%，球形的占24.5%，其他形状的占16%。在动脉期扫描中，97%的病灶内可见存活肿瘤呈高密度，3%呈等密度；在门静脉期扫描中，肿瘤呈高密度的占20%，等密度的占28%，低密度的占52%；在延迟期扫描中，肿瘤始终呈低密度。在增强扫描中，肿瘤坏死灶始终呈低密度。在平扫图像上，7.4%的结节无法检测到。53%的结节直径无变化，47%增大；54%的结节形状无变化，46%有改变；36%的结节边缘无变化，64%有改变。15%的结节周围可见肉芽组织环，21%可见病灶周围短暂性衰减差异。13%的患者可见肝周积液，9%的患者可见节段性胆管扩张和局部萎缩，6%可见动静脉瘘，7%的患者可见门静脉血栓形成、包膜下积液和胸腔积液，5%可见肝梗死，2%可见下腔静脉血栓形成。
经皮消融HCC可能会引起多种变化。了解其CT表现对于正确评估和处理这种肿瘤至关重要。
