Bartolozzi C, Lencioni R, Caramella D, Mazzeo S, Ciancia E M
Department of Radiology, University of Pisa, Italy.
AJR Am J Roentgenol. 1994 Apr;162(4):827-31. doi: 10.2214/ajr.162.4.8141000.
The aim of this study was to investigate the usefulness of unenhanced and enhanced MR imaging in evaluating the response of hepatocellular carcinoma to percutaneous injection of ethanol.
Thirty-one patients with 40 hepatocellular carcinomas less than 5 cm in diameter were examined with MR imaging before and after percutaneous injection of ethanol. Unenhanced T1- and T2-weighted and contrast-enhanced T1-weighted spin-echo images were obtained. CT and percutaneous biopsy were performed 1 month after the final injection of ethanol and repeated at 6-month intervals to establish the outcome of treatment: complete tumor necrosis was shown in 36 lesions and incomplete tumor necrosis was seen in four lesions.
Of the 36 proved necrotic lesions, 31 showed homogeneously low signal intensity on T2-weighted MR images obtained after treatment, owing to coagulative necrosis of the tumor. In the remaining five necrotic lesions, hypointense and hyperintense areas coexisted; the hyperintense areas were caused by liquefactive necrotic material in two cases and by chronic inflammatory tissue along the boundary of the necrotic area in three cases. None of the 36 necrotic lesions showed contrast enhancement on T1-weighted images obtained after IV injection of gadopentetate dimeglumine. In the four lesions with incomplete necrosis, the viable portion of the tumor was identified as a hyperintense area on T2-weighted images and as an enhancing area on contrast-enhanced T1-weighted images. No correlation was found between lesion features on unenhanced T1-weighted images and outcome of therapy.
Contrast-enhanced T1-weighted MR images allow a reliable evaluation of the effectiveness of treatment and are more accurate than unenhanced MR studies. Contrast-enhanced MR imaging may be considered a valuable alternative to contrast-enhanced CT in the follow-up of hepatocellular carcinomas treated with percutaneous injection of ethanol.
本研究旨在探讨平扫及增强磁共振成像（MR）在评估肝细胞癌经皮注射乙醇后的反应中的作用。
对31例患有40个直径小于5 cm肝细胞癌的患者在经皮注射乙醇前后进行MR检查。获得平扫T1加权和T2加权以及增强T1加权自旋回波图像。在最后一次注射乙醇1个月后进行CT和经皮活检，并每隔6个月重复一次以确定治疗结果：36个病灶显示完全肿瘤坏死，4个病灶显示不完全肿瘤坏死。
在36个经证实坏死的病灶中，31个在治疗后获得的T2加权MR图像上显示均匀低信号强度，这是由于肿瘤的凝固性坏死所致。在其余5个坏死病灶中，低信号和高信号区域并存；高信号区域在2例中由液化坏死物质引起，在3例中由坏死区域边界处的慢性炎症组织引起。36个坏死病灶在静脉注射钆喷酸葡胺后获得的T1加权图像上均未显示对比增强。在4个不完全坏死的病灶中，肿瘤的存活部分在T2加权图像上表现为高信号区域，在增强T1加权图像上表现为强化区域。平扫T1加权图像上的病灶特征与治疗结果之间未发现相关性。
增强T1加权MR图像可对治疗效果进行可靠评估，且比平扫MR研究更准确。在经皮注射乙醇治疗的肝细胞癌随访中，增强MR成像可被视为对比增强CT的一种有价值的替代方法。
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