Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Vasc Interv Radiol. 2012 Oct;23(10):1269-75. doi: 10.1016/j.jvir.2012.06.032.
Recurrence of hepatocellular carcinoma (HCC) is very common even after curative resection or ablation. This retrospective study compared the radiologic features of recurrent HCC seen by computed tomography (CT) to evaluate our empirical protocol of CT surveillance using 4-month intervals.
A total of 113 patients who were diagnosed with a first HCC recurrence after radiofrequency (RF) ablation between January 2005 and December 2006 were enrolled at a single center. Definite HCC was defined as hyperattenuation in the arterial phase with washout in the portal venous phase, and a diagnosis of naive and recurrent HCC was based on dynamic CT findings. Recurrent nodules were classified according to the enhancement patterns of previous CT images. The treatment modality for recurrent HCC and survival were evaluated.
One hundred seventy-seven nodules were diagnosed as recurrent HCC: 31 (17.5%) had already been diagnosed on previous CT images as typical HCC, 72 (40.6%) had arterial hypervascularity without washout in the portal venous phase, 21 (11.9%) showed portal venous phase washout without arterial hypervascularity, and no lesions were noted in the remaining 49 (27.7%). Tumor size at recurrence was smaller than 2 cm in diameter in 98 (86.7%) cases. One hundred four patients were treated for recurrent HCC with RF ablation. The 5-year survival rate after recurrence was 49.8%. There was no significant difference in survival among groups divided by the enhancement pattern on the previous CT examination.
Dynamic CT in 4-month intervals is an acceptable recurrence-monitoring strategy because it detects most recurrent nodules at a stage at which RF ablation is still feasible.
即使在根治性切除或消融后，肝细胞癌（HCC）的复发也非常常见。本回顾性研究比较了 CT 检查中复发性 HCC 的影像学特征，以评估我们使用 4 个月间隔的 CT 监测经验性方案。
在 2005 年 1 月至 2006 年 12 月期间，我们在一家单中心招募了 113 名接受射频（RF）消融治疗后首次诊断为 HCC 复发的患者。动脉期高强化伴门静脉期洗脱定义为明确 HCC，根据动态 CT 表现诊断为单纯性和复发性 HCC。根据既往 CT 图像的强化模式对复发性结节进行分类。评估复发性 HCC 的治疗方式和生存情况。
诊断为 177 个复发性 HCC 结节：31 个（17.5%）在既往 CT 图像上已经被诊断为典型 HCC，72 个（40.6%）表现为动脉期富血供但无门静脉期洗脱，21 个（11.9%）表现为门静脉期洗脱但无动脉期富血供，49 个（27.7%）未见病灶。98 例（86.7%）复发性 HCC 结节的肿瘤直径均＜2cm。104 例患者接受 RF 消融治疗复发性 HCC。复发后 5 年生存率为 49.8%。按既往 CT 检查的强化模式分组，各组之间的生存率无显著差异。
4 个月间隔的动态 CT 是一种可接受的复发监测策略，因为它可以在 RF 消融仍然可行的阶段检测到大多数复发性结节。
