De Cobelli F, Castrucci M, Sironi S, Livraghi T, Venturini M, Salvioni M, Del Maschio A
Radiologia Diagnostica, Istituto Scientifico H San Raffaele, Milano.
Radiol Med. 1994 Dec;88(6):806-17.
The purpose of this study was to assess Magnetic Resonance Imaging (MRI) patterns of hepatocellular carcinoma (HCC) treated with percutaneous ethanol injection (PEI) or Transarterial Chemoembolization (TACE) and, consequently, the potential role of MR Imaging in the follow-up of these lesions. HCC treated with PEI. Thirty-one patients with a single small HCC lesion underwent MR Imaging at 0.5 T before and after PEI. In all cases before and after treatment contrast enhanced Computed Tomography (CT) and US-guided fine-needle biopsy were performed. Twenty-seven of 31 HCC lesions in which complete tumor necrosis was obtained with PEI showed homogeneous hypointensity on SE T2-weighted MR images. This feature corresponded to an unenhanced and low-attenuation area on follow-up contrast-enhanced CT scans. All these lesions were negative for malignant cells at fine-needle biopsy follow-up. In four HCCs, high-signal areas on SE T2-weighted images and high-attenuation areas on contrast-enhanced CT scans were observed, suggesting the presence of residual tumor tissue; these lesions were positive for malignant cells at 6-month fine-needle biopsy. In each case, incomplete tumor necrosis was confirmed at pathologic examination of the surgical specimen. HCC treated with TACE. Twenty-one patients with a total of 36 HCC lesions underwent plain and Gadolinium-enhanced MR Imaging before and after TACE. 10 HCC lesions were later surgically resected; 26/36 lesions underwent MR, CT and angiographic follow-up. At short-term follow-up exams (15-30 days), hypointensity was present on enhanced SE T1 weighted sequences in those lesions (5/10) in which complete tumor necrosis was histologically confirmed. In the remaining 5/10 HCC lesions, persistent viable tumor portions were found at pathology. These areas corresponded to areas on hyperintensity of Gadolinium-enhanced SE T1-weighted images. Hypointensity on both SE T2-weighted and enhanced SE T1-weighted images was a characteristic pattern on long-term follow-up MR images in 21/26 unresected lesions; this finding was correlated with devascularization at angiography; the presence of hyperintense areas on SE T2 weighted and enhanced SE T1-weighted images corresponded to the persistence of hypervascular (viable) areas at angiography.
本研究的目的是评估经皮乙醇注射（PEI）或经动脉化疗栓塞（TACE）治疗的肝细胞癌（HCC）的磁共振成像（MRI）模式，进而探讨MRI在这些病变随访中的潜在作用。
接受PEI治疗的HCC。31例患有单个小HCC病变的患者在PEI治疗前后接受了0.5T的MR成像检查。在治疗前后的所有病例中，均进行了对比增强计算机断层扫描（CT）和超声引导下细针活检。31个HCC病变中有27个通过PEI实现了完全肿瘤坏死，在SE T2加权MR图像上表现为均匀低信号。这一特征在随访的对比增强CT扫描中对应于无强化的低衰减区域。在细针活检随访中，所有这些病变的恶性细胞均为阴性。在4个HCC中，在SE T2加权图像上观察到高信号区域，在对比增强CT扫描中观察到高衰减区域，提示存在残留肿瘤组织；在6个月的细针活检中，这些病变的恶性细胞为阳性。在每个病例中，手术标本的病理检查均证实肿瘤坏死不完全。
接受TACE治疗的HCC。21例共有36个HCC病变的患者在TACE治疗前后接受了平扫和钆增强MR成像检查。10个HCC病变随后接受了手术切除；36个病变中的26个接受了MR、CT和血管造影随访。在短期随访检查（15 - 30天）中，组织学证实完全肿瘤坏死的病变（5/10）在增强SE T1加权序列上表现为低信号。在其余5/10的HCC病变中，病理检查发现有存活的肿瘤部分。这些区域对应于钆增强SE T1加权图像上的高信号区域。在26个未切除病变的长期随访MR图像中，SE T2加权和增强SE T1加权图像上均为低信号是一种特征性表现；这一发现与血管造影中的血管减少相关；SE T2加权和增强SE T1加权图像上高信号区域的存在对应于血管造影中高血管（存活）区域的持续存在。
