Chung Dong Jin, Sung Kyunghyun, Osuagwu Ferdnand C, Wu Holden H, Lassman Charles, Lu David S K
Departments of Radiological Sciences and Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095; Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Departments of Radiological Sciences and Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA 90095.
J Vasc Interv Radiol. 2016 Jan;27(1):104-11. doi: 10.1016/j.jvir.2015.09.005. Epub 2015 Nov 4.
To analyze ablated tissue zones after irreversible electroporation (IRE) of porcine liver using computed tomography (CT) perfusion imaging with histopathologic correlation.
Under ultrasound and CT guidance, 10 IRE ablations were performed percutaneously in three Yorkshire pigs using a single bipolar electrode. CT perfusion imaging was performed in all pigs immediately after ablation and on day 2. Pathologic sections were prepared for correlation with histopathology (hematoxylin-eosin and terminal deoxynucleotidyl transferase dUTP nick end labeling stains, 5-mm-thick slices). The short diameter of different enhancing zones on CT was correlated with the gross specimen.
CT perfusion images showed three differently enhancing zones: zone 1, inner nonenhancing zone; zone 2, middle well-defined progressive internal enhancement zone; and zone 3, outer ill-defined arterial enhancement zone with rapid washout. On histopathology, zone 1 showed a strong correlation with a pale zone, and zone 2 correlated with a red zone, together accounting for the extent of cell death. Zone 3 was outside of the ablation zone and contained inflammatory cells. Each enhancing zone had different perfusion parameters.
CT perfusion imaging in the acute setting effectively demonstrates histopathologic tissue zones after IRE ablation. Zone 2 is unique to IRE not seen in thermal ablation, characterized by progressive intra-zonal enhancement, and its outer boundary defines the extent of cell death.
采用计算机断层扫描（CT）灌注成像并结合组织病理学相关性分析猪肝脏不可逆电穿孔（IRE）术后消融组织区域。
在超声和CT引导下，使用单极双极电极对3头约克夏猪经皮进行10次IRE消融。所有猪在消融后即刻和第2天进行CT灌注成像。制备病理切片以与组织病理学（苏木精-伊红染色和末端脱氧核苷酸转移酶dUTP缺口末端标记染色，5毫米厚切片）进行相关性分析。CT上不同强化区域的短径与大体标本进行相关性分析。
CT灌注图像显示三个不同强化区域：区域1，内部无强化区；区域2，中间边界清晰的渐进性内部强化区；区域3，外部边界不清的动脉期强化区且有快速廓清。组织病理学上，区域1与苍白区有很强的相关性，区域2与红色区相关，两者共同构成细胞死亡范围。区域3在消融区外，含有炎性细胞。每个强化区域有不同的灌注参数。
急性情况下的CT灌注成像能有效显示IRE消融术后的组织病理学区域。区域2是IRE特有的，在热消融中未见，其特征为区域内渐进性强化，其外边界界定细胞死亡范围。
