Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
Jpn J Radiol. 2012 Jul;30(6):533-9. doi: 10.1007/s11604-012-0074-7. Epub 2012 Apr 18.
To evaluate the feasibility and safety of CT-guided radiofrequency (RF) ablation by caudal-cranial oblique insertion using multiplanar reformation (MPR) images for hepatocellular carcinomas (HCCs).
Twenty-two HCCs in 19 patients that were difficult to demonstrate on ultrasound (mean tumor diameter was 17.5 mm) were treated with CT-guided RF ablation by caudal-cranial oblique insertion to avoid pneumothorax, using MPR images after transcatheter arterial chemoembolization. The insertion point and direction of insertion, avoiding aerated lung parenchyma, bones, large vessels, and intestine, were sought on the MPR images. Technical success was defined as complete eradication of tumor enhancement in the contrast-enhanced CT. Local tumor progression was defined by the appearance of enhanced tumor adjacent to the zone of ablation. The technical success rate, local tumor progression, and complications were investigated.
The coronal plane was used for insertion in 18 tumors, the sagittal plane in 3 tumors, and the oblique plane in 1 tumor. RF electrode placement was successful and complete necrosis was obtained in all cases. During the mean follow-up period of 38.0 months, local tumor progression was not detected in any of the patients. There were no major complications, including pneumothorax.
CT-guided RF ablation by caudal-cranial oblique insertion using MPR images is a feasible and safe therapeutic option.
评估 CT 引导下经尾-头斜向插入多平面重建（MPR）图像行射频（RF）消融治疗肝细胞癌（HCC）的可行性和安全性。
19 例 22 个 HCC 患者（平均肿瘤直径 17.5mm）因超声显示困难而行 CT 引导下经尾-头斜向插入以避免气胸的 RF 消融治疗，使用经导管动脉化疗栓塞后的 MPR 图像。在 MPR 图像上寻找避开充气肺实质、骨骼、大血管和肠的插入点和插入方向。技术成功定义为增强 CT 上肿瘤完全消除增强。局部肿瘤进展定义为消融区域旁出现增强肿瘤。研究了技术成功率、局部肿瘤进展和并发症。
18 个肿瘤采用冠状面插入，3 个肿瘤采用矢状面插入，1 个肿瘤采用斜位面插入。所有病例均成功放置 RF 电极并获得完全坏死。在平均 38.0 个月的随访期间，所有患者均未发现局部肿瘤进展。无气胸等严重并发症。
CT 引导下经尾-头斜向插入 MPR 图像引导 RF 消融是一种可行且安全的治疗选择。
