CAJ | 학술논문

目的观察兔VX2肝癌射频消融(RFA)后的MRI动态变化,并与病理所见相对照,探讨MRI评价肝癌RFA疗效的价值.方法采用生理盐水与VX2瘤块混悬液注射法复制肝肿瘤动物模型24只.开腹直视下对24只兔肝癌进行RFA,并将其随机分为4组,分别于术后即刻、术后1周、2周和4周进行MR平扫及增强扫描检查;之后处死实验兔,进行大体病理和光镜检查.结果 MRI表现为病灶T1WI中央低信号,外周高信号,T2WI中央高信号,外周低信号,增强扫描病灶外周环形强化,中央无强化.光镜下消融灶呈凝固性坏死,术后即刻组外周见少许中性粒细胞、巨噬细胞浸润,肝窦扩张充血;术后1周组外周见炎性细胞浸润及少许纤维肉芽组织增生;MRI表现为病灶T1WI呈稍低信号,T2WI呈稍高信号,增强扫描病灶周边呈环状强化,中央无强化.术后2周组外周见淋巴细胞、浆细胞、多核巨细胞浸润及梭形纤维组织增生;MRI表现为病灶T1WI稍低信号,T2WI混杂信号影,向外为等低信号包膜,增强扫描病灶周边环状强化,中央无强化.术后4周组外周见大量纤维肉芽组织增生;MRI表现为病灶T1WI低信号,T2WI由内向外呈低信号-稍高信号-线状高信号环,增强扫描病灶周边环状强化,中央无强化.本组实验中17只实验兔病理学发现有肿瘤残留,MRI表现为T1WI稍低信号,T2WI高信号,增强扫描呈结节状或厚度不均的环状强化.结论 MRI可全面评价RFA后病灶的变化,及时发现肝癌残存与复发.
목적 관찰토VX2간암사빈소융(RFA)후적MRI동태변화,병여병리소견상대조,탐토MRI평개간암RFA료효적개치.방법 채용생리염수여VX2류괴혼현액주사법복제간종류동물모형24지.개복직시하대24지토간암진행RFA,병장기수궤분위4조,분별우술후즉각、술후1주、2주화4주진행MR평소급증강소묘검사;지후처사실험토,진행대체병리화광경검사.결과 MRI표현위병조T1WI중앙저신호,외주고신호,T2WI중앙고신호,외주저신호,증강소묘병조외주배형강화,중앙무강화.광경하소융조정응고성배사,술후즉각조외주견소허중성립세포、거서세포침윤,간두확장충혈;술후1주조외주견염성세포침윤급소허섬유육아조직증생;MRI표현위병조T1WI정초저신호,T2WI정초고신호,증강소묘병조주변정배상강화,중앙무강화.술후2주조외주견림파세포、장세포、다핵거세포침윤급사형섬유조직증생;MRI표현위병조T1WI초저신호,T2WI혼잡신호영,향외위등저신호포막,증강소묘병조주변배상강화,중앙무강화.술후4주조외주견대량섬유육아조직증생;MRI표현위병조T1WI저신호,T2WI유내향외정저신호-초고신호-선상고신호배,증강소묘병조주변배상강화,중앙무강화.본조실험중17지실험토병이학발현유종류잔류,MRI표현위T1WI초저신호,T2WI고신호,증강소묘정결절상혹후도불균적배상강화.결론 MRI가전면평개RFA후병조적변화,급시발현간암잔존여복발.
Objective To evaluate the effect of MRI in reflecting the pathological changes of VX2 carcinoma in rabbits after radiofrequency ablation (RFA) . Methods RFA was performed in the livers of 24 rabbits with planted VX2 carcinoma. The rabbits were divided into 4 groups. After RFA, the rabbits were killed after MR imaging on 0, 1, 2, and 4 weeks, respectively. The correlation between MRI and pathological findings was analyzed. Results In the acute phase, coagulative necrosis of the ablated tumors and inflammatory reaction with hyperemia around were detected at microscopic examination. The ablated tumor showed as hypointensity on T1WI and hyperintensity on T2WI, while rim of high signal intensity on T1WI and low signal intensity on T2WI was found. Gadolinium-enhanced MRI showed a thin high signal rim surrounding the central coagulative necrosis. In the subacute phase, extensive coagulative necrosis and marked infiltration by neutrophils, lymphocytes, macrophages and a peripheral fibrous generation rim were observed microscopically on the ablated tumor. The ablated tumor showed iso-or hyperintensity on T1WI and hypointensity on T2WI, while the periphery of ablated lesions was hypointensity on T1WI and hyperintensity on T2WI. There was prominent rim enhancement along the ablated margin. In the chronic phase, peripheral fibrous rim became obvious, more regular and thicker than at subacute phase as hypointensity on T1WI and T2WI, and unenhancement was observed. Residual or recurrence of tumor was found in 17 rabbits as hypointensity on T1WI and hyperintensity on T2WI, and irregular, thicker rim or nodular enhancing abnormalities. Conclusion MRI can effectively show the histopathological tissue changes of rabbit VX2 carcinoma after ablation and demonstrate the residual or recurrence of tumor.