Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Cardiovasc Intervent Radiol. 2010 Jun;33(3):532-40. doi: 10.1007/s00270-009-9728-y. Epub 2009 Oct 22.
The purpose of this study was to compare the ability of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) to evaluate treatment results after transarterial chemoembolization (TACE), with a special focus on the influence of Lipiodol on calculation of tumor necrosis according to EASL criteria. A total of 115 nodules in 20 patients (17 males, 3 females; 69.5 +/- 9.35 years) with biopsy-proven hepatocellular carcinoma were treated with TACE. Embolization was performed using a doxorubicin-Lipiodol emulsion (group I) or DC Beads loaded with doxorubicin (group II). Follow-up included triphasic contrast-enhanced 64-row MDCT (collimation, 0.625 mm; slice, 3 mm; contrast bolus, 120 ml iomeprol; delay by bolus trigger) and contrast-enhanced MRI (T1 native, T2 native; five dynamic contrast-enhanced phases; 0.1 mmol/kg body weight gadolinium-DTPA; slice thickness, 4 mm). Residual tumor and the extent of tumor necrosis were evaluated according to EASL. Contrast enhancement within tumor lesions was suspected to represent vital tumor. In the Lipiodol-based TACE protocol, MDCT underestimated residual viable tumor compared to MRI, due to Lipiodol artifacts (23.2% vs 47.7% after first, 11.9% vs 31.2% after second, and 11.4% vs 23.7% after third TACE; p = 0.0014, p < 0.001, and p < 0.001, respectively). In contrast to MDCT, MRI was completely free of any artifacts caused by Lipiodol. In the DC Bead-based Lipiodol-free TACE protocol, MRI and CT showed similar residual tumor and rating of treatment results (46.4% vs 41.2%, 31.9 vs 26.8%, and 26.0% vs 25.6%; n.s.). In conclusion, MRI is superior to MDCT for detection of viable tumor residuals after Lipiodol-based TACE. Since viable tumor tissue is superimposed by Lipiodol artifacts in MDCT, MRI is mandatory for reliable decision-making during follow-up after Lipiodol-based TACE protocols.
本研究旨在比较多层螺旋 CT（MDCT）和磁共振成像（MRI）在经动脉化疗栓塞（TACE）后评估治疗效果的能力，特别关注碘化油对 EASL 标准下肿瘤坏死计算的影响。共对 20 例经活检证实的肝细胞癌患者的 115 个结节（17 名男性，3 名女性；69.5 +/- 9.35 岁）进行 TACE 治疗。栓塞采用阿霉素-碘化油乳剂（I 组）或载阿霉素的 DC Beads（II 组）进行。随访包括三期对比增强 64 排 MDCT（准直，0.625mm；层厚，3mm；对比剂 bolus，120ml 碘普罗胺；bolus trigger 延迟）和对比增强 MRI（T1 自然，T2 自然；5 个动态对比增强期；0.1mmol/kg 体重钆喷替酸葡甲胺；层厚，4mm）。根据 EASL 标准评估残留肿瘤和肿瘤坏死范围。肿瘤病变内的对比增强被怀疑代表有活力的肿瘤。在碘化油为基础的 TACE 方案中，由于碘化油伪影，MDCT 对残留存活肿瘤的评估低于 MRI（第一次 TACE 后分别为 23.2%比 47.7%，第二次 TACE 后分别为 11.9%比 31.2%，第三次 TACE 后分别为 11.4%比 23.7%；p=0.0014，p<0.001 和 p<0.001）。与 MDCT 相反，MRI 完全没有任何由碘化油引起的伪影。在基于 DC Beads 的无碘化油 TACE 方案中，MRI 和 CT 显示相似的残留肿瘤和治疗效果评分（46.4%比 41.2%，31.9 比 26.8%，26.0 比 25.6%；无统计学差异）。总之，MRI 优于 MDCT 检测基于碘化油的 TACE 后残留的有活力的肿瘤。由于在 MDCT 中，有活力的肿瘤组织被碘化油伪影叠加，因此在基于碘化油的 TACE 方案的随访中，MRI 是可靠决策的必要手段。
