MDCT Versus MRI Assessment of Tumor Response After Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma
MDCT Versus MRI Assessment of Tumor Response After Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma
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DOI：
10.1007/s00270-009-9728-y
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发表时间：
2010-06-01
影响因子：
2.9
通讯作者：
Pitton, Michael B.
中科院分区：
文献类型：
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作者：
Kloeckner, Roman;Otto, Gerd;Pitton, Michael B.
本研究旨在比较多层螺旋CT（MDCT）和磁共振成像（MRI）评价经动脉化疗栓塞（TACE）后治疗结果的能力，特别关注碘油对根据EASL标准计算肿瘤坏死的影响。20例经活检证实的肝细胞癌患者（17例男性，3例女性; 69.5 +/- A 9.35岁）共115个结节接受了TACE治疗。使用多柔比星-碘油乳剂（组I）或负载多柔比星的DC微珠（组II）进行栓塞。随访包括三相对比增强64排MDCT（准直，0.625 mm;层厚，3 mm;对比剂团注，120 ml碘美普尔;通过团注触发延迟）和对比增强MRI（T1原生，T2原生; 5个动态对比增强相; 0.1 mmol/kg体重钆-DTPA;层厚，4 mm）。根据EASL评估肿瘤残留和肿瘤坏死程度。肿瘤病灶内的造影剂增强被怀疑代表活体肿瘤。在基于碘油的TACE方案中，由于碘油伪影，MDCT与MRI相比低估了残留存活肿瘤（第一次TACE后23.2% vs 47.7%，第二次TACE后11.9% vs 31.2%，第三次TACE后11.4% vs 23.7%;分别为p = 0.0014，p < 0.001和p < 0.001）。与MDCT相比，MRI完全没有碘油引起的任何伪影。在基于DC微珠的无碘油TACE方案中，MRI和CT显示了相似的残留肿瘤和治疗结果评级（46.4% vs 41.2%、31.9 vs 26.8%和26.0% vs 25.6%; n.s.）。总之，在检测基于碘油的TACE后的存活肿瘤残留方面，MRI优于MDCT上级。由于在MDCT中，碘油伪影叠加了存活的肿瘤组织，因此在基于碘油的TACE方案后的随访期间，MRI是强制性的可靠决策。
The purpose of this study was to compare the ability of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) to evaluate treatment results after transarterial chemoembolization (TACE), with a special focus on the influence of Lipiodol on calculation of tumor necrosis according to EASL criteria. A total of 115 nodules in 20 patients (17 males, 3 females; 69.5 +/- A 9.35 years) with biopsy-proven hepatocellular carcinoma were treated with TACE. Embolization was performed using a doxorubicin-Lipiodol emulsion (group I) or DC Beads loaded with doxorubicin (group II). Follow-up included triphasic contrast-enhanced 64-row MDCT (collimation, 0.625 mm; slice, 3 mm; contrast bolus, 120 ml iomeprol; delay by bolus trigger) and contrast-enhanced MRI (T1 native, T2 native; five dynamic contrast-enhanced phases; 0.1 mmol/kg body weight gadolinium-DTPA; slice thickness, 4 mm). Residual tumor and the extent of tumor necrosis were evaluated according to EASL. Contrast enhancement within tumor lesions was suspected to represent vital tumor. In the Lipiodol-based TACE protocol, MDCT underestimated residual viable tumor compared to MRI, due to Lipiodol artifacts (23.2% vs 47.7% after first, 11.9% vs 31.2% after second, and 11.4% vs 23.7% after third TACE; p = 0.0014, p < 0.001, and p < 0.001, respectively). In contrast to MDCT, MRI was completely free of any artifacts caused by Lipiodol. In the DC Bead-based Lipiodol-free TACE protocol, MRI and CT showed similar residual tumor and rating of treatment results (46.4% vs 41.2%, 31.9 vs 26.8%, and 26.0% vs 25.6%; n.s.). In conclusion, MRI is superior to MDCT for detection of viable tumor residuals after Lipiodol-based TACE. Since viable tumor tissue is superimposed by Lipiodol artifacts in MDCT, MRI is mandatory for reliable decision-making during follow-up after Lipiodol-based TACE protocols.