目的:观察分析肺部恶性肿瘤射频消融治疗后CT影像学改变.方法:搜集因肺部恶性肿瘤行CT引导下射频消融治疗的患者226例(共计消融灶233个),分析评价治疗后病灶CT影像学改变.患者中原发性肺癌201例,肺转移癌25例.接受射频消融的病灶直径1.00～10.60 cm,平均(4.36±2.45)cm.平均随访时间13.61个月(1～30个月).结果:215例患者(95.13％)治疗后立即出现消融灶周围肺组织内毛玻璃样改变,多在1个月内吸收；191患者(84.51％)治疗后肿瘤立即出现增大,127例患者(56.19％)出现消融灶内多发小空泡形成.术后51例患者(22.57％)出现空洞,恶性胸水多发生在治疗3个月以后.121例患者(65.05％)在术后第一个月随访时胸部CT提示病灶有增大,46.15％和50.89％的患者在3个月及6个月复查时病灶缩小,之后这一比例开始降低,至12个月时,只有33.64％的患者病灶较上一次评估时缩小,到24个月时这一比例降低到4.35％.结论:病变周围的毛玻璃样改变、空洞形成、多发小空泡形成和胸膜改变是射频消融后最常见的CT改变.体积较大的病灶更可能出现空洞改变,射频消融术后1个月内病灶多出现增大表现,治疗后6个月是病灶缩小最明显的时期,6个月后出现的病灶较上一评估周期增大提示患者肿瘤进展.CT是射频术后疗效评估的有效手段之一.%Objective:The purpose of this study is to describe and analyze the CT appearance of malignant pulmonary neoplasms after radiofrequency ablation (RFA). Methods: 226 patients with malignant pulmonary neoplasms (233 lesions) underwent CT guided RFA. The CT appearances after RFA were evaluated and analyzed. Altogether there were primary lung cancer (201 patients) and pulmonary metastases (25 patients). The mean diameter of pretreatment neoplasm was (4. 36 + 2. 45)cm,ranged from 1.0～10. 60cm. The mean follow-up period was 13. 61 months (ranged from l~30 months). Results:The most common finding immediately after treatment was peri-tumoral ground glass opacity,found in 215 patients (95. 13%),and mostly resolved within the first month; immediate enlargement of the tumor after treatment was found in 191 tumors (84. 51%) ; bubble-like lucencies within the ablation area were seen in 127 tumors (56. 19%). Cavity formation was seen in 51 tumors (22. 57%) on follow-up CT. Malignant pleural effusions was usually seen after 3 months. Enlargement of the tumor (121 tumors,65. 05%) was found on follow-up imaging at 1 month after RFA,and 46. 15% and 50. 89% showed tumors decreased in size at 3 and 6 months follow-up respectively. Then the percentage declined,at 12 months only 33. 64% of the tumor were smaller than that at the previous examination and which were only 4. 25% at 24 months follow-up. Conclusion: Peri-tumoral ground-glass opacity, cavitation, multiple small bubble-like lucencies and plural effusion were common findings on follow-up CT after RFA. Cavitation was commonly found in bigger neoplasms. Many treated neoplasms increased in size within 1 month. The most obvious shrinkage of tumor size was showed at 6 months follow-up. Enlargement of a treated tumor after 6 months suggested tumor progression. CT scanning is one of the effective methods to evaluate the lung neoplasm after RFA.
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