Imaging Comparison of Lipiodol Retention after Transarterial Lipiodol Chemoembolization for Hepatocellular Carcinoma

經動脈化學栓塞治療肝癌後滯留碘油之影像學比較

10.6200/TCMJ.2006.3.7.05

杜錫杰(Shyi-Jye Duh)；陳潤秋(Ran-Chou Chen)；杜興洋(Hsing-Yang Tu)；李俊銘(Jiunn-Ming Lii)；陳韻正(Tom Yun-Cheng Chen)；王鍾貴(Chung-Kwe Wang)；陳慰宗(Wei-Tsung Chen)；姜良忠(Liang-Chung Chiang)

Lipiodol電腦斷層 ； 超音波 ； 肝細胞癌 ； lipiodol ； Computed Tomography ； Ultrasonography ； Hepatocellular Carcinoma

北市醫學雜誌

3卷7期（2006 / 07 / 01）

683 - 692

英文

目的：探討經血管化學栓塞術治療後肝癌因碘油的存留對超音波影像的影響。方法：過去四年間，共有55位治療後肝癌的病患（共86個腫瘤），其中42個腫瘤接受經血管化學栓塞術(TACE)的治療，另44個腫瘤則是以經血管化學栓塞術與經皮穿肝酒精注射術(TACE+PEI)合併治療，將其電腦斷層與超音波之影像加以比較。結果：這86個腫瘤中,有82個在治療後的超音波影像與治療前不相同，在TACE這一組，其在電腦斷層上有碘油存留的部分：有40.5%在超音波呈現高回音影像，9.5%為同回音影像，14.3%為低回音，35.7%為雜回音；在電腦斷層上無碘油存留部分則30%為高回音，10%為同回音，50%為低回音，10%為雜回音；在TACE與PEI這一組，其在電腦斷層上有碘油存留部分：有40.5%為高回音，16.7%為同回音，11.9%為低回音，30.9%為雜回音；在非碘油存留部分則32.3%為高回音，19.4%為同回音，25.8%為低回音，22.5%為雜回音。結論：在TACE組，碘油存在與否與超音波影像是有相關的，主要呈現高回音或雜回音影像，而在TACE與PEI組，兩者則沒有此種相關性。治療後之肝癌在超音波上變化頗大，很難以回音之高低來預測治療的結果。

Background and Purpose: The purpose of this study is to evaluate the change in echogeneity of hepatocelluar carcinomas (HCC) treated with transarteriallipiodol chemoembolization. Methods: Fifty-five cases with 86 HCCs were analyzed retrospectively. Forty-two tumors received transcatheter arterial chemoembolization (TACE), while the other 44 tumors received combination therapy of TACE and percutaneous ethanol injection (PEI) treatment. Results: All 86 tumors except 4 displayed changes in their sonographic echogeneity after the treatments. In the TACE-only group, post-treatment echogeneity of the lipiodol-retaining tumoral components were as follows: 40.5% hyperechoic, 9.5% isoechoic, 14.3% hypoechoic, and 35.7% mixed-echoic. In contrast, the echogeneity of non-lipiodol retaining parts were: 30% hyperechoic, 10% isoechoic, 50% hypoechoic, and 10% mixed-echoic. As for the combination therapy group, the echogeneity of its lipiodol-retaining parts were: 40.5% hyperechoic, 16.7% isoechoic, 11.9 hypoechoic, and 30.9% mixed-echoic. The non-lipiodol retaining parts' echogeneity were as follows: 32.3% hyperechoic, 19.4% isoechoic, 25.8% hypoechoic, and 22.5% mixed-echoic. Conclusion: There was significant difference in echogeneity between the lipiodol retaining and the non-lipiodol retaining components of the HCCs after treatment, in the TACE-only group. The majority of lipiodol-retaining tumor components were hyperechoic or mixed echoic, however the echogeneity of the lipiodol-retaining components from the combination therapy group was variable. Therefore the treatment efficacy of TACE, especially when used in conjunction with PEI, cannot be reliably assessed by ultrasonography alone.