IVR TAE CT. Real-time Vertial Sonography(RVS) CT-MPR Realtime

Transcription

1 IVR TAE CT Real-time Vertial Sonography(RVS)CT-MPRRealtime In the treatment of hepatocellular carcinoma, which often recurrents at the high rate, interventional radiology (IVR), a minimally invasive technique, seems to be most promising. Transcatheter arterial embolization (TAE) is useful for nonresectable advanced hepatocellular carcinomas. But for small hepatocellular carcinomas, percutaneous local ablation is the main therapy. Although percutaneous ethanol injection, microwave coagulation, etc. have been developed, percutaneous radio-frequency ablation (PRFA) has now become the core therapy. PRFA is usually carried out as an ultrasound-guided procedure. Therefore, it is difficult to treat lesions that cannot be identified by ultrasonography, even if they are detected by CT. The recently developed technique of Real-time Virtual Sonography (RVS) provides a real-time display of the reconstructed CT image corresponding to the ultrasound cross-sectional image, on the same monitor screen. This makes it possible to treat lesions that were difficult to define by ultrasonography alone. This has not only made the identification of candidate lesions easier but also made it possible to obtain information of adjacent organs around the treatment area. Therefore, RVS has the potential to play a significant role in more accurate and safer execution of PRFA, which is now covered by health insurance and would come into wider use. Key Words: Interventional Radiology, Real-time Vertial Sonography, Percutaneous Radiofrequency Ablation, Hepatocellular Carcinoma MEDIX VOL.42 15

2 IVR IVR ( ) Interventional Radiology CT (US)MRI IVR (TAETranscatheter arterial embolization)1983yamada TAE 1) TAE ) TAE USCT TAE ) (PEIPercutaneous Ethanol Injection)1990 heterogeneous 4) (PMCTPercutaneous Microwave Coagulation) 1 5) 6) (PRFA Percutaneous Radioferequency Ablation) )8) TAE(TAI) 1990PEIPCA(Percutaneous Chemical Ablation) 1994(PTA Percutaneou Thermal Ablation) 1999 PRFA 2000 PRFA 9) PRFA kHz2450MHz PRFA 2 S81.8cmPRFA CT 8 PRFA 16 MEDIX VOL.42

3 RITA 1 RTCCool- Tip 2 3RITAAVS 2004 RITA150070(2 7)90(5cm2 9)RF 50W150W RTCBoston Scientific W RF3000 generator LeVeen 3 Needle Electrode Cool-Tip Cool- Tip ) PRFAUS US US PRFA PRFA US PRFA PRFA MEDIX VOL.42 17

4 10) US B US US 11) US CTUS MPR US MPRUS 2RVS 2S7PRFA (4ab) RVSUS RVS(4cd) Real-time Virtual Sonography(RVS) CTraw dataus MPR 12) CT US 13)14) RVSPRFA CTCT 4 CT CTACTAP CTGELight- Speed 5 Ultra(16 MDCT) GE Light- Speed Plus(4 MDCT) 3.75mm1.8mm DICOMRVS 1RVS 3S31.5cm CT US CT 18 MEDIX VOL.42

5 PRFA(4ef) 3RVS 3S5TAE DCT (5ab) BUS US RVS(5cd) PRFACT A5RVS (6de)PRFA (6c) 5 PRFA S6 (7d)US(7b)CT PRFA RVS (5ef) 4BUSRVS PRFA 4CTS5BUS RVSCTA MEDIX VOL.42 19

6 (7a) PRFA(7c)(7e) RVS2004 RVSPRFA17240 USRVS RVS 2 3PRFA US RVS 13 PRFA 15) 204US RVS US 16) RVS PRFACT US RVSCT-MPRUS RVS (1) PRFARVS (2) USPRFA PRFA (3) CTUSRVS PRFA (4) 1 RITARITA 2 Cool-TipSHERWOOD SERVICES AG 3 LeVeen 4 5 LightSpeed 2) : TAE ,,,, ) Ebara M, et al : Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma. Study of 95 patients. J Gastroentel Hepatol 5 : 616, ) Seki T, et al : Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer, 74 : 817, ), :. J.Microwave Surg, 16 : 27-32, ) Rossi S, et al : Percutaneous ultrasound-guided radiofrequency electrocautery for the treatment of small hepatocellular carcinoma. J Intervent Radiology, 8 : 97, ), : Cool-tip., 41 : 24, ), : (RFA)., 42 : 22, ) : IVR(TAE PRFA) ), : CLIP score, JIS score., 38(5) : , ) Minami Y, et al : Treatment of Hepatocellular Carcinoma with Percutaneous Radiofrequency Ablation : Usefulness of Contrast Harmonic Sonography for Lesions Poorly Defined with B-Mode Sonography. Am. J. Roentgenol ; 183 : ), : Real-time Virtual Sonography. Medix, 40 : 31-35, ), : Realtime Virtual Sonography. Medix, 40 : 4-9, ), : Real-time Virtual Sonography RFA., 45 : , ) Suginoshita Y, et al : Real-time Virtual Sonography is useful for identification of local recurrences and incompletely ablated lesions in radio-frequency ablation for hepatocellular carcinomas. In submission. 16), : Real-time Virtual Sonography. 1) Yamada R, et al : Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology, 148 : 397, MEDIX VOL.42