本文選題：磁共振成像 + 血管�。� 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:研究MRI引導(dǎo)下射頻消融治療較大血管旁(直徑3mm)兔肝VX2腫瘤可行性及療效,評(píng)價(jià)消融灶MRI表現(xiàn)及病理特征。方法:在2只新西蘭雄性大白兔雙側(cè)后腿內(nèi)側(cè)肌肉組織接種VX2腫瘤,使之成瘤,作為建立兔肝大血管旁VX2腫瘤模型的細(xì)胞株。將11只新西蘭雄性大白兔腿部肌肉注射氯胺酮1ml/kg和氯丙嗪0.5ml/kg,全麻后固定于MRI掃描床上,采用特定肝臟掃描序列,確定穿刺路徑、方向及深度,在無菌條件下,用14G磁共振兼容穿刺針在MRI引導(dǎo)下逐步到達(dá)兔肝臟大血管(直徑大于3mm)旁種植VX2腫瘤。2周后行MRI掃描,隨機(jī)處死1只實(shí)驗(yàn)兔,行病理證實(shí)。剩余10只腫瘤兔在全麻及無菌條件下行1.5T MRI引導(dǎo)下病灶射頻消融。維生素E丸定位,確定穿刺點(diǎn)及進(jìn)針角度,用14G磁共振兼容穿刺針沿設(shè)定的進(jìn)針角度穿刺,術(shù)中多次行T1WI-VIBE掃描以確定穿刺針進(jìn)針方向,然后將RITA射頻針沿著穿刺針針鞘進(jìn)針,逐步進(jìn)針穿透腫瘤。將掃描床退至原始位置,將射頻針及皮膚電極導(dǎo)線與延長(zhǎng)電纜連接,設(shè)定功率35W,靶溫103 oC,消融時(shí)間12min。完成消融后行MRI掃描評(píng)估消融療效,消融灶完全覆蓋原病灶、范圍超出病灶邊緣0.5~1.0cm為消融完全,高信號(hào)環(huán)未完全包繞低信號(hào)瘤灶,則提示消融腫瘤殘留,可予補(bǔ)充消融。MRI掃描后即刻將10只實(shí)驗(yàn)兔處死,行組織病理學(xué)檢查,判斷有無腫瘤殘留。結(jié)果:1.11只實(shí)驗(yàn)兔肝臟VX2腫瘤均種植成功,共有12個(gè)瘤灶,11個(gè)瘤灶位于血管旁,未侵犯血管,1個(gè)瘤灶位于穿刺路徑上,每個(gè)瘤灶直徑為1.0~1.5cm(平均1.35cm)。瘤灶MRI表現(xiàn):腫瘤灶在3D-VIBE上呈稍低信號(hào),部分瘤灶中心液化壞死,呈更低信號(hào);T2WI上呈稍高信號(hào),部分瘤灶中央呈更高信號(hào),鄰近血管呈流空信號(hào)影。組織病理學(xué)檢查證實(shí)為VX2腫瘤組織。2.對(duì)10只腫瘤兔均成功行RFA,11個(gè)瘤灶共消融20次,平均2次/個(gè),其中4個(gè)瘤灶消融1次,5個(gè)瘤灶消融2次,2個(gè)瘤灶消融3次。瘤灶完全消融MRI表現(xiàn):消融灶在T2WI上呈等低信號(hào);3D-VIBE上呈同心圓狀改變,中央?yún)^(qū)原病灶仍呈低信號(hào),周邊呈明顯環(huán)狀高信號(hào),邊界清晰,行病理檢查,未發(fā)現(xiàn)腫瘤細(xì)胞。瘤灶不完全消融MRI表現(xiàn):3D-VIBE上消融灶高信號(hào)環(huán)未完全包繞低信號(hào)瘤灶,組織病理檢查證實(shí)為VX2腫瘤組織。結(jié)論:1.磁共振引導(dǎo)下兔肝大血管旁腫瘤種植是一種微創(chuàng)、有效的造模方法。2.MRI平掃可準(zhǔn)確顯示消融灶范圍,是評(píng)價(jià)小肝癌射頻消融療效的有效手段。3.MRI引導(dǎo)下RFA治療兔肝大血管旁VX2腫瘤是一種有效、可行的手術(shù)方法。
[Abstract]:Objective: to study the feasibility and efficacy of radiofrequency catheter ablation (RFCA) guided by MRI in the treatment of large paravascular (3 mm) rabbit liver VX2 tumors, and to evaluate the MRI findings and pathological features of ablation focus. Methods: two New Zealand male rabbits were inoculated with VX2 tumor in bilateral medial hind leg muscle tissue to establish VX2 tumor model. Ketamine 1ml/kg and chlorpromazine 0.5 ml / kg were injected intramuscularly into the legs of 11 New Zealand male white rabbits. After general anesthesia, the rabbits were fixed on the MRI scanning bed. The specific liver scanning sequence was used to determine the route, direction and depth of the puncture under aseptic conditions. Under the guidance of MRI, a 14G MRC-compatible puncture needle was used to gradually reach the hepatic large vessels (diameter > 3 mm) and implanted with VX2 tumor for 2 weeks, then MRI scan was performed. One experimental rabbit was killed at random and confirmed by pathology. The remaining 10 rabbits underwent 1.5 T MRI guided radiofrequency ablation under general anesthesia and aseptic conditions. Vitamin E pills were located, puncture point and angle were determined, 14G magnetic resonance compatible puncture needle was punctured along the set needle angle, T1WI-VIBE scan was performed many times during the operation to determine the direction of the needle, and then the RITA radio frequency needle was inserted along the sheath of the needle, and the needle was inserted along the sheath of the needle. Step by step the needle penetrates the tumor. The scanning bed was retreated to the original position, the radiofrequency needle and the skin electrode wire were connected with the extended cable, the power was set at 35 W, the target temperature was 103 OC, and the ablation time was 12 min. After ablation, MRI scan was performed to evaluate the effect of ablation. The ablation focus completely covered the original lesion, the range beyond the margin of the lesion was complete 0.5~1.0cm, and the hyperintense loop was not completely wrapped around the hyposignal tumor, which indicated that the ablation was residual. Ten experimental rabbits could be killed immediately after ablation. MRI scanning. Histopathological examination was performed to determine whether there were tumor residues. Results VX2 tumors were successfully implanted in the liver of 1. 11 rabbits. There were 12 tumor foci, 11 lesions were located beside the blood vessels, and 1 tumor focus was located on the puncture path. The diameter of each tumor was 1. 0 ~ 1. 5 cm (mean, 1. 35 cm). The MRI findings of tumor focus were as follows: low signal intensity on 3D-VIBE, liquefaction and necrosis in the center of some tumor foci, slightly high signal intensity on T _ 2WI with lower signal intensity, higher signal intensity in the center of some lesions, and flow empty signal in adjacent vessels. Histopathological examination confirmed VX2 tumor tissue. 2. RFA was successfully performed in 10 tumor rabbits. The 11 lesions were ablated 20 times (mean 2 times per tumor), of which 4 lesions were ablated once, 5 tumors were ablated twice, and 2 lesions were ablated 3 times. MRI findings of complete ablation: the lesion showed concentric circular changes on T2WI with isohypointential signal intensity 3D-VIBE, low signal intensity in the central area, obvious annular hyperintensity around the lesion, clear boundary, pathological examination, and no tumor cells were found. MRI findings of incomplete ablation of tumor foci showed that the hyperintense loop of the ablation focus on 3 D-VIBE was not completely wrapped around the low signal signal tumor. Histopathological examination confirmed that the tumor tissue was VX2. Conclusion 1. MR-guided implantation of paravascular tumor in rabbit liver is a minimally invasive method. 2. Plain MRI scan can accurately show the extent of ablation focus. It is an effective method to evaluate the curative effect of radiofrequency ablation of small hepatocellular carcinoma. 3. MRI-guided RFA is an effective and feasible surgical method for the treatment of rabbit paravascular VX2 tumor.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.7;R445.2

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