| research objective1.Comparing with traditional two-dimensional imaging,the advantages of CT three-dimensional fusion technology in displaying hepatocellular carcinoma before operation and choosing radiofrequency ablation pathway were discussed.2.To compare the prognostic differences of three groups of patients with hepatocellular carcinoma after radiofrequency ablation: 5 mm≤ AM < 8mm,8 mm≤ AM < 10 mm,and AM ≥ 10 mm,and to explore the optimal value of AM,so as to minimize the liver damage caused by radiofrequency ablation.Materials and Methods1.Clinical data: From January 2013 to September 2017,31 patients with primary liver cancer were diagnosed in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine.There were 42 lesions.The maximum diameter of the axes of the lesions ranged from 8.2 mm to44.4 mm.Among them,there were 19 males and 12 females.The patients ranged in age from 34 to 76 years,with an average age of 51(±12.3).According to Child-Pugh classification of liver function,there were 20 grade A and 11 grade B.90.3%(28/31)of patients with history of hepatitis and 70.0%(22/31)of patients with history of cirrhosis.It was clinically proved to be primary liver cancer.2.Experimental instrument(1)64-slice spiral CT produced by GE Company(Radiology Department,First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Model: Optima TMCT670);(2)64-slice spiral produced by Siemens Company(Radiology Department,First Affiliated Hospital of HenanUniversity of Traditional Chinese Medicine,Model: Emotion 60320);(3)16-slice spiral CT produced by Siemens(Model: Somatom Scope Emotion16);(4)Medical image analysis system brought by GE64-slice CT workstation(Model: AW4.7).3.research method(1)The selected patients underwent CT plain scan plus three-phase contrast-enhanced examination 1 month,3 months,6 months and 12 months after operation,and then were re-examined every six months.For relapsed patients,CT is reviewed every three months.Siemens 64-slice spiral CT was used.Scanning parameters were as follows: the thickness of CT scanning layer was 5.0 mm,the spacing was 5 mm,the pitch was 1,the tube voltage was 120 k V,and the tube current was 250 m A.The patient took the appropriate position and underwent upper abdominal scan.Closed venous indwelling needle was buried in median elbow vein.Suspension double-barrel high-pressure syringe was used to inject 60-100 ml of Onepek350 as contrast agent.The flow rate was 4.0-4.5 ml/s(selected according to the patient’s arterial condition).Contrast agent tracking scanning technology was used to start the scanning when the monitoring point reached the predetermined CT threshold(120HU).(2)Axis images of tumors and ablation focus were drawn out before and after treatment,and data were measured under the guidance of two experienced doctors.Firstly,the maximum axial cross section of the lesion or ablation focus was found,and the data were recorded after measuring the maximum cross section.Selection of reference objects(the reference objects should be the same before and after ablation)and measurement of the distance between the reference objects and the boundary of the lesion and ablation focus were made on the maximum cross section.Then,up and down layers(the interval depends on the size of the lesion)were selected respectively and the reference objects were measured to the lesion.Or the distance of ablation focus.The data measured before radiofrequency ablation were subtracted from the data on the side after radiofrequency ablation.The average of three planes was the size of ablation boundary(AM value).Radiofrequency ablation was performed thoroughly in three groups according to the size of the boundary.5mm ≤ AM < 8mm in group A,8mm ≤ AM < 10 mm in group Band AM ≥ 10 mm in group C.(3)After scanning,reconstruction was performed.The reconstruction thickness was 1 mm and the interval was 1mm.The reconstructed image is imported into the three-dimensional fusion software.The three-dimensional images of tumor focus,hepatic artery,portal vein and hepatic vein were reconstructed and preserved by reconstruction software.All the saved images were transferred to different display screens,and VR mode was selected.The images were superimposed by clicking on the image.Then the hepatic artery,portal vein and hepatic vein were dragged into the display screen where the tumor was located to complete the three-dimensional fusion reconstruction of the tumor and the intrahepatic vessels.ResultTo evaluate the recurrence rate of different AM groups after operation,this study compared the recurrence rates among groups A,B and C.The overall recurrence rate was 43.75% in group A,and 6.25%,12.5%,25%,37.5% and 43.75% in 6,12,18,24 and 30 months after operation,respectively.The overall recurrence rate in group B was 6.25%,and the recurrence rates at 6,12,18,24 and 30 months after operation were 0,6.25%,6.25%,6.25% and 6.25%,respectively.The overall recurrence rate was 10% in group C.The recurrence rates at 6,12,18,24 and 30 months after operation were 0,0,10%,10% respectively.In order to compare the recurrence rates of different AM after RFA,two comparisons were made between group A and group B,group B and group C.It was found that the recurrence rate of group A was higher than that of group B(P=0.041);there was no significant difference in the recurrence rate between group B and group C(P=1.000).conclusion1.CT three-dimensional fusion technology can display the anatomical structure of tumors and blood vessels and their three-dimensional spatial relationship before operation.It can select the best radiofrequency ablation path.Compared with traditional two-dimensional imaging,it achieves the precise treatment of RFA.2.The 8-10 mm ablation boundary explored in this study has achieved good results,which can guide the clinical ablation of AM greater than 8mm,so as to reduce the damage to normal liver tissue. |
PDF Full Text Request