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Scaglione M, Masala S, Tamburrini S, Lassandro G, Barbuto L, Romano L, Iacobellis F, Sica G, Crivelli P, Turilli D, Sandomenico F, Granata V, Patlas MN. Abdominal Emergencies in Cancer Patients. Can Assoc Radiol J 2024; 75:161-170. [PMID: 37192390 DOI: 10.1177/08465371231175521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.
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Affiliation(s)
| | | | | | | | - Luigi Barbuto
- Department of General and Emergency Radiology, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, Naples, Italy
| | | | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Naples, Italy
| | | | | | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Michael N Patlas
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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Lee Y, Yoon JH, Han S, Joo I, Lee JM. Contrast-enhanced ultrasonography-CT/MRI fusion guidance for percutaneous ablation of inconspicuous, small liver tumors: improving feasibility and therapeutic outcome. Cancer Imaging 2024; 24:4. [PMID: 38172949 PMCID: PMC10762814 DOI: 10.1186/s40644-023-00650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is pivotal for treating small malignant liver tumors, but tumors often remain inconspicuous on B-mode ultrasound (US). This study evaluates the potential of CEUS-CT/MRI fusion imaging (FI) to improve tumor visibility and the associated RFA outcomes for small (≤ 3 cm) malignant liver tumors that were inconspicuous on US. METHODS Between January 2019 and April 2021, a prospective study enrolled 248 patients with liver malignancies (≤ 3 cm) that were poorly visible on B-mode US. Tumor visibility and ablation feasibility were assessed using B-mode US, US-CT/MRI FI, and CEUS-CT/MRI FI, and graded on a 4-point scale. CEUS was employed post-registration of US and CT/MRI images, utilizing either SonoVue or Sonazoid. Comparisons between US-based and CEUS-based fusion visibility and feasibility scores were undertaken using the Friedman test. Moreover, rates of technical success, technique efficacy, local tumor progression (LTP), and major complications were assessed. RESULTS The cohort included 223 hepatocellular carcinomas (HCCs) (89.9%) and 23 metastases (9.3%), with an average tumor size of 1.6 cm. CEUS-CT/MRI FI demonstrated a significant advantage in tumor visibility (3.4 ± 0.7 vs. 1.9 ± 0.6, P < 0.001) and technical feasibility (3.6 ± 0.6 vs. 2.9 ± 0.8, P < 0.001) compared to US-FI. In 85.5% of patients, CEUS addition to US-FI ameliorated tumor visibility. Technical success was achieved in 99.6% of cases. No severe complications were reported. One and two-year post CEUS-CT/MRI FI-guided RFA estimates for LTP were 9.3% and 10.9%, respectively. CONCLUSIONS CEUS-CT/MRI FI significantly improves the visualization of tumors not discernible on B-mode US, thus augmenting percutaneous RFA success and delivering improved therapeutic outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT05445973. Registered 17 June 2022 - Retrospectively registered, http://clinicaltrials.gov/study/NCT05445973?id=NCT05445973&rank=1 .
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Affiliation(s)
- Yuna Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seungchul Han
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Spiliopoulos S, Moschovaki-Zeiger O, Sethi A, Festas G, Reppas L, Filippiadis D, Kelekis N. An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease. Expert Rev Med Devices 2023; 20:293-302. [PMID: 36825337 DOI: 10.1080/17434440.2023.2185137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. AREAS COVERED This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years. EXPERT OPINION Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Akshay Sethi
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, NHS Grampian, Aberdeen, UK
| | - George Festas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Li L, Yao J, Yan X, Qi X, Liang P, Han Z, Liu F, Cheng Z, Luo Y, Zheng R, Cheng W, Wei Q, Yu S, Yu J, Yu X. Long-term efficacy and safety of microwave ablation for hepatocellular carcinoma adjacent to the gallbladder with a diameter ≤ 5 cm: a multicenter, propensity score matching study. Int J Hyperthermia 2023; 40:2248425. [PMID: 37607775 DOI: 10.1080/02656736.2023.2248425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To compare the long-term efficacy and safety of microwave ablation (MWA) as first-line therapy for hepatocellular carcinoma (HCC) adjacent versus nonadjacent to the gallbladder. MATERIALS AND METHODS From 2006 to 2018, 657 patients with ≤5 cm HCC who underwent percutaneous ultrasound-guided MWA as first-line therapy from 5 hospitals were enrolled in this retrospective study. Patients were grouped into the adjacent group (n = 49) and the nonadjacent group (n = 608) according to whether the tumor was adjacent to the gallbladder. Propensity score matching (PSM) was used to balance baseline variables between the two groups. RESULTS Forty-eight patient pairs were matched after PSM. For the PSM cohort, during a median follow-up time of 60 months, there were no differences in PFS (hazard ratio [HR], 1.011; 95% confidence interval [CI], 0.647-1.578; p = 0.963) or OS (HR 0.925; 95% CI 0.522-1.639; p = 0.789) between the adjacent and nonadjacent groups. Univariate and multivariate analyses revealed that the tumor adjacent to the gallbladder was not an independent risk factor for PFS or OS (all p > 0.05). Subgroup analysis showed comparable PFS and OS between the two groups in the <3 cm subgroup and the 3-5 cm subgroups (all p > 0.05). In addition to more use of assistive technology (p < 0.05), the adjacent group shared comparable local tumor progression, complications, technical success rate, and hospital stay (all p > 0.05) to the nonadjacent group. CONCLUSION There were comparable long-term efficacy and complications between patients with HCC adjacent and nonadjacent to the gallbladder treated with MWA.
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Affiliation(s)
- Lijuan Li
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jundong Yao
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xizi Yan
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xiaoguang Qi
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanchun Luo
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of Science and Technology, Tianyou Hospital, Wuhan, China
| | - Jie Yu
- Department of Ultrasound, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing, China
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Solbiati LA, Arai Y. Interventional oncology of liver tumors: how it all started and where are we now. Br J Radiol 2022; 95:20220434. [PMID: 35776630 PMCID: PMC9815741 DOI: 10.1259/bjr.20220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023] Open
Abstract
Liver was the very first organ for which interventional procedures were applied for the local treatment of primary and secondary malignancies. In this paper, the history of Interventional Oncology of liver, from the very beginning to the current situation, is summarized, including both percutaneous and intravascular procedures, and together with the evolution of the techniques for image guidance. The main ongoing developments, such as new techniques, combined interventional treatments and association of local interventions with new drugs are briefly described, too.
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Affiliation(s)
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan
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Francica G. Pyogenic liver abscess: contrast-enhanced ultrasound allows morpho-evolutive classification and guides personalized management. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: The aim of this study is to propose a contrast-enhanced ultrasound (CEUS)-based morphologic classification of pyogenic liver abscess (PLA) reflecting different evolutive stages and to assess the added value of CEUS in the management of PLA.
Methods: Forty-four PLAs of different etiologies in 44 patients (male/female = 24/20; mean age 66 ± 14.7 years) were evaluated with ultrasound (US) B-mode and CEUS (using SonoVue). PLAs were mainly located in the right lobe (n = 28, 63.6%) with a mean diameter of 6.8 cm [standard deviation (SD) ± 3.2, range 1.7–15 cm]. Conventional US findings were categorized as the presence and extension of liquified areas, echogenicity and echostructure of the index lesion. Peripheral hyperenhancing rim, transient segmental enhancement, hyperenhancing septa and “honeycomb” aspect were considered PLA hallmarks in the arterial phase after contrast agent injection. CEUS results were judged as clinically relevant if they modified the approach to percutaneous treatment in comparison with pre-operative US B-mode findings.
Results: CEUS was superior to US B-mode as to depiction of PLA internal echostructure and enabled identification of 4 evolutive stages of PLA: type I (tumor-like), type II (“honeycomb”), type III (multiloculated with incomplete septa), and type IV (cystic-like). In 22 cases (67.4%) out of 34 who underwent percutaneous treatment, the operator tailored percutaneous approach according to PLA internal echostructure observed during CEUS exam.
Conclusions: CEUS depicts the internal structure of PLA so allowing a morpho-evolutive classification of PLA and provides invaluable information for immediately tailoring the management to the single case. By showing the structure of PLA more precisely, CEUS allows a morpho-evolutive PLA classification and guides tailored management in the single case.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castel Volturno (CE), Italy
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Fite BZ, Wang J, Ghanouni P, Ferrara KW. A Review of Imaging Methods to Assess Ultrasound-Mediated Ablation. BME FRONTIERS 2022; 2022:9758652. [PMID: 35957844 PMCID: PMC9364780 DOI: 10.34133/2022/9758652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 12/18/2022] Open
Abstract
Ultrasound ablation techniques are minimally invasive alternatives to surgical resection and have rapidly increased in use. The response of tissue to HIFU ablation differs based on the relative contributions of thermal and mechanical effects, which can be varied to achieve optimal ablation parameters for a given tissue type and location. In tumor ablation, similar to surgical resection, it is desirable to include a safety margin of ablated tissue around the entirety of the tumor. A factor in optimizing ablative techniques is minimizing the recurrence rate, which can be due to incomplete ablation of the target tissue. Further, combining focal ablation with immunotherapy is likely to be key for effective treatment of metastatic cancer, and therefore characterizing the impact of ablation on the tumor microenvironment will be important. Thus, visualization and quantification of the extent of ablation is an integral component of ablative procedures. The aim of this review article is to describe the radiological findings after ultrasound ablation across multiple imaging modalities. This review presents readers with a general overview of the current and emerging imaging methods to assess the efficacy of ultrasound ablative treatments.
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Affiliation(s)
- Brett Z. Fite
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - James Wang
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA
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Lin YM, Bale R, Brock KK, Odisio BC. Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment. Int J Hyperthermia 2022; 39:649-663. [DOI: 10.1080/02656736.2021.1970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sparchez Z, Mocan T, Craciun R, Sparchez M, Nolsøe C. Contrast enhancement for ultrasound-guided interventions: when to use it and what to expect? Ultrasonography 2022; 41:263-278. [PMID: 35073625 PMCID: PMC8942733 DOI: 10.14366/usg.21207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/09/2021] [Indexed: 02/01/2023] Open
Abstract
The use of contrast-enhanced ultrasonography (CEUS) has recently become synonymous with high-standard ultrasonography (US). From expanding the reach of US diagnostics to improving the precision of various invasive procedures, CEUS is rapidly becoming a standard in numerous niches. However, proficiency in CEUS comes with a cost, both from a learning curve and material standpoint, and as every growing field, lacks firm evidence and standardization. Therefore, in the current paper, we aim to provide an evidence-based review of available methods and to discuss the advantages and pitfalls of CEUS in interventional procedures, trying to provide strong evidence whenever available, or at least an educated expert opinion if data are lacking.
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Affiliation(s)
- Zeno Sparchez
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Prof. Dr. O. Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Tudor Mocan
- "Prof. Dr. O. Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Rares Craciun
- 3rd Medical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Prof. Dr. O. Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mihaela Sparchez
- Department of Pediatrics, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian Nolsøe
- Center for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen and the Capital Region of Denmark, Copenhagen E, Denmark
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Fei X, Han P, Jiang B, Zhu L, Tian W, Sang M, Zhang X, Zhu Y, Luo Y. High Frame Rate Contrast-enhanced Ultrasound Helps Differentiate Malignant and Benign Focal Liver Lesions. J Clin Transl Hepatol 2022; 10:26-33. [PMID: 35233370 PMCID: PMC8845153 DOI: 10.14218/jcth.2020.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/24/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS This study aimed to evaluate the diagnostic performance of high frame rate contrast-enhanced ultrasound (H-CEUS) of focal liver lesions (FLLs). METHODS From July 2017 to June 2019, conventional contrast-enhanced ultrasound (C-CEUS) and H-CEUS were performed in 78 patients with 78 nodules. The characteristics of C-CEUS and H-CEUS in malignant and benign groups and the differences between different lesion sizes (1-3 cm, 3-5 cm, or >5 cm) of C-CEUS and H-CEUS were examined. The diagnostic performance of C-CEUS and H-CEUS was analyzed. The chi-square test or Fisher's exact test was used to assess inter-group differences. The receiver operating characteristic curve was plotted to determine the diagnostic performance of C-CEUS and H-CEUS. RESULTS There were significant differences in the enhancement area, fill-in direction and vascular architecture between C-CEUS and H-CEUS for both benign and malignant lesions (all p=0.000-0.008), but there were no significant differences in washout results (p=0.566 and p=0.684, respectively). For lesions 1-3 cm in size, the enhancement area, fill-in direction, and vascular architecture on C-CEUS and H-CEUS were significantly different (all p=0.000), unlike for lesions 3-5 cm or >5 cm in size. For differentiation of malignant from benign FLLs in the 1-3 cm group, H-CEUS showed sensitivity, specificity, accuracy, and positive and negative predictive values of 92.86%, 95.0%, 96.3%, 90.48% and 93.75%, respectively, which were higher than those for C-CEUS (75.0%, 70.0%, 77.78%, 66.67% and 72.91%, respectively). CONCLUSIONS H-CEUS provided more vascular information which could help differentiate malignant from benign FLLs, especially for lesions 1-3 cm in size.
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Affiliation(s)
- Xiang Fei
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Peng Han
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wenshuo Tian
- Clinical Research Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Maodong Sang
- R&D Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Xirui Zhang
- R&D Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Correspondence to: Yukun Luo, Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, NO. 28 Fu Xing Road, Beijing 100853, China. Tel: +86-10-66936848, E-mail:
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Hsu KF, Hsieh CB, Shih YL, Tseng YC, Chou YC, Hsieh CC, Hsieh TY, Chen TW. Impact of resection versus radiofrequency ablation on medium-sized hepatocellular carcinomas: Long-term outcome and prognostic factors. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_366_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Conci S, D'Onofrio M, Bianco A, Campagnaro T, Martone E, De Bellis M, Longo C, Dedoni S, Vittoria D'Addetta M, Ciangherotti A, Pedrazzani C, Dalbeni A, Campagnola P, Mansueto G, Guglielmi A, Ruzzenente A. Ablation Difficulty Score: Proposal of a new tool to predict success rate of percutaneous ablation for hepatocarcinoma. Eur J Radiol 2021; 146:110097. [PMID: 34896959 DOI: 10.1016/j.ejrad.2021.110097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Identify the factors related to failure ablation after percutaneous ultrasound guided single electrode radiofrequency ablation (RFA) for hepatocarcinoma (HCC) and propose a score for improving patient selection and treatment allocation. METHODS From 2010 to 2020 585 HCC nodules treated with RFA were prospectively collected. Ablation Difficulty Score (ADS) was built-up according to clinical and radiological factors related to failure ablation identified by Cox-logistic regression analysis. The study population was stratified in low risk (ADS 0), intermediate risk (ADS 1), and high risk (ADS ≥ 2) of failure ablation. RESULTS Overall ablation success rate was 85.5%. Morbidity and mortality rates were 3.5% and 0.0%. According to per nodule analysis the following factors resulted related to failure ablation: size > 20 mm (p = 0.002), sub-capsular location (p = 0.008), perivascular location (p = 0.024), isoechoic appearance (p = 0.008), and non-cirrhotic liver (p = 0.009). The ablation success rate was 93.5% in ADS 0, 85.8% in ADS 1 and 71.3% in ADS ≥ 2 (p < 0.001). The 1-year local tumor progression (LTP) free survival was 90.2% in ADS 0, 80.6% in ADS 1, and 72.3% in ADS ≥ 2 (p = 0.009). Nodule's size > 20 mm (p = 0.014), isoechoic appearance (p = 0.012), perivascular location (p = 0.012) resulted related to lower LTP free survival. CONCLUSION Ablation Difficulty Score could be a simple and useful tool for guiding the treatment decision making of HCC. RFA in high risk nodules (ADS ≥ 2) should be carefully evaluated and reserved for patients not suitable for surgery or liver transplantation.
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Affiliation(s)
- Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy.
| | - Mirko D'Onofrio
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Bianco
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Tommaso Campagnaro
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Enrico Martone
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Mario De Bellis
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Chiara Longo
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Sara Dedoni
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Maria Vittoria D'Addetta
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Ciangherotti
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Dalbeni
- Division of General Medicine and Hypertension, Department of Medicine, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Pietro Campagnola
- Gastroenterology Unit, Department of Medicine, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Giancarlo Mansueto
- Department of Radiology, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Ginecology and Pediatrics, University of Verona, University Hospital G.B. Rossi, 37134 Verona, Italy
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13
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Francica G, Meloni MF, Riccardi L. Ultrasound Tools for Detection of Vascular Complications After Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2781. [PMID: 33570177 DOI: 10.1002/jum.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Giampiero Francica
- Unità di Ecografia Interventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Maria Franca Meloni
- Servizio di Radiologia, Casa di Cura Igea, Milano, Italy and Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura Riccardi
- Medicina e Interna e Gastroenterologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
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14
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Chammas MC, Bordini AL. Contrast-enhanced ultrasonography for the evaluation of malignant focal liver lesions. Ultrasonography 2021; 41:4-24. [PMID: 34724777 PMCID: PMC8696138 DOI: 10.14366/usg.21001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
In this review, the authors address the analysis of different types of malignant focal liver lesions (FLLs) using contrast-enhanced ultrasonography (CEUS). The specific enhancing patterns of hepatocellular carcinoma, cholangiocarcinoma, and metastases are discussed and exemplified with images. In addition, the use of CEUS in malignant portal vein thrombosis is discussed. The advantages and limitations of CEUS for the analysis of malignant FLLs are also discussed.
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Affiliation(s)
- Maria Cristina Chammas
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - André Leopoldino Bordini
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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15
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Tinguely P, Paolucci I, Ruiter SJS, Weber S, de Jong KP, Candinas D, Freedman J, Engstrand J. Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:713685. [PMID: 34631539 PMCID: PMC8495244 DOI: 10.3389/fonc.2021.713685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023] Open
Abstract
Background Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors. Methods A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed. Results Thirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies). Conclusions Advances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.
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Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.,Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
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16
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Lin YM, Paolucci I, Brock KK, Odisio BC. Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward. Cancers (Basel) 2021; 13:3926. [PMID: 34439081 PMCID: PMC8394430 DOI: 10.3390/cancers13163926] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Kristy K. Brock
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
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17
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Francica G, Meloni MF, Riccardi L, Giangregorio F, Caturelli E, Terracciano F, de Sio I. Role of Contrast-Enhanced Ultrasound in the Detection of Complications After Ultrasound-Guided Liver Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1665-1673. [PMID: 33085814 DOI: 10.1002/jum.15540] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
The role of contrast-enhanced ultrasound (CEUS) in interventional ultrasound-guided procedures in the liver has been increasingly recognized. However, little is known about the capability of CEUS for diagnosing complications after liver biopsy and ablation with special regard to postprocedural hemorrhage. The aim of this Pictorial Essay is to present the CEUS features of a wide spectrum of vascular complications (with or without bleeding) and injuries of the surrounding abdominal and chest wall occurring after liver interventional procedures.
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Affiliation(s)
- Giampiero Francica
- Unità di Ecografia Interventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Maria Franca Meloni
- Servizio di Radiologia, Casa di Cura Igea, Milan, Italy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Laura Riccardi
- Medicina e Interna e Gastroenterologia, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | | | | | - Fulvia Terracciano
- Gastroenterologia, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
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18
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Eisenbrey JR, Gabriel H, Savsani E, Lyshchik A. Contrast-enhanced ultrasound (CEUS) in HCC diagnosis and assessment of tumor response to locoregional therapies. Abdom Radiol (NY) 2021; 46:3579-3595. [PMID: 33825927 DOI: 10.1007/s00261-021-03059-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) is a global problem constituting the second leading cause of cancer deaths worldwide, thereby necessitating an accurate and cost-effective solution for managing care. Ultrasound is well poised to address this need due to its low cost, portability, safety, and excellent temporal resolution. The role of ultrasound for HCC screening has been well established and supported by multiple international guidelines. Similarly, contrast-enhanced ultrasound (CEUS) can be used for the characterization of focal liver lesions in high-risk populations, and standardized criteria for CEUS have been established by the American College of Radiology Liver Imaging Reporting & Data System (LI-RADS). Following HCC identification, CEUS can also be highly beneficial in treatment planning, delivery, and monitoring HCC response to locoregional therapies. Specific advantages of CEUS include providing real-time treatment guidance and improved diagnostic performance for the detection of residual tumor viability or recurrence, thereby identifying patients in need of retreatment substantially earlier than contrast-enhanced CT and MRI. This review provides a primer on ultrasound and CEUS for the screening and characterization of HCC, with an emphasis on assessing tumor response to locoregional therapies.
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Affiliation(s)
- John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, 132 South 10th St, 796E Main Building, Philadelphia, PA, 19107, USA.
| | - Helena Gabriel
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Esika Savsani
- Department of Radiology, Thomas Jefferson University, 132 South 10th St, 796E Main Building, Philadelphia, PA, 19107, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, 132 South 10th St, 796E Main Building, Philadelphia, PA, 19107, USA
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19
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Solbiati L, Ierace T, Gennaro N, Muglia R, Cosman ER, Goldberg SN. Percutaneous radiofrequency ablation of HCC: reduced ablation duration and increased ablation size using single, internally cooled electrodes with an optimized pulsing algorithm. Int J Hyperthermia 2021; 37:861-867. [PMID: 32669003 DOI: 10.1080/02656736.2020.1790678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the use of optimized radiofrequency (RF) to achieve larger, spherical ablation volumes with short application duration for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty-two patients (M:F = 17:5, median age 69.6 year, range 63-88) with 28 HCCs due to HCV + liver cirrhosis underwent RFA. 20/28 (71.4%) were tumors ≤3cm diameter, and 8/28 (28.6%) ranged from 3.2 to 4.2 cm. RF was applied using up to 2500mA via an optimized pulsing algorithm with real-time ultrasound monitoring to detect hyperechogenic changes. Single insertions of an internally cooled electrode were performed using exposed tips of 2 or 3 cm for 13 HCCs and 4 cm for 15 HCCs. All patients were followed-up for a minimum of 5 years with contrast-enhanced computed tomography (CECT). RESULTS Technical success was achieved without adverse events in all cases. The mean ablation time was 8.5 ± 2.6 min. In 21/28 (75%), ablation duration ranged from 3 to 9 min, with 12 min duration applied in only 7/28 (25%). Mean coagulation diameters were 2.4 ± 0.14, 3.3 ± 0.62, and 4.4 ± 1.0, for 2, 3 and 4 cm electrodes, respectively (p < 0.01). The sphericity index was 74.9 ± 12.8 for 4 cm electrodes and 81.9 ± 8.0 for shorter electrodes (p = 0.091). At 5-year follow-up, no tumor ≤3 cm had recurrence and only 2/8 (25%) >3 cm tumors developed local progression. One patient had multifocal disease with no local progression. CONCLUSION Efficient delivery of RF energy can considerably decrease the ablation time in many instances while achieving larger, relatively spherical, and reproducible areas of ablation with extremely low rates of local tumor progression and adverse events.
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Affiliation(s)
- Luigi Solbiati
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan Italy
| | - Tiziana Ierace
- Department of Radiology, Humanitas Clinical and Research Hospital, Rozzano, Milan Italy
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University, Milan, Italy
| | - Riccardo Muglia
- Training School in Radiology, Humanitas University, Milan, Italy
| | | | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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20
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Zhou Y, Wang Y, Wang F, Zhang X, Ding J, Zhou H, Jing X. Additional Diagnostic Value of Fusion Imaging of CEUS and First CEUS of Invisible Hepatic Lesions ≤2 cm. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1173-1181. [PMID: 32941666 DOI: 10.1002/jum.15498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the clinical value of image fusion of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography (CECT) in the diagnosis of invisible lesions with a size ≤2 cm on conventional ultrasound imaging, and compare it with the clinical value of "first CEUS" . METHODS A total of 132 patients with 147 lesions with abnormal blood supply with a size ≤2 cm on CECT were included in this study. "first CEUS" was performed for these lesions. Then "fusion CEUS," that is, CEUS administered after fusion of US and CECT images, was carried out. The detection rates of the "first CEUS" and "fusion CEUS" were compared. How "fusion CEUS" corrects the misdiagnosis of liver lesions on CECT was analyzed. RESULTS One hundred nine lesions considered as HCC and 38 lesions considered as benign lesions on CECT were included. The detection rates for the lesions of "first CEUS" and "fusion CEUS" were 71.4% and 96.6%, respectively (P < 0.001). Among the 147 lesions, 68 were with a diameter ≤ 1 cm. The detection rate of "first CEUS" and "fusion CEUS" were 55.9% and 95.6%, respectively (P < 0.001) for the lesions with a size ≤1 cm. "Fusion CEUS" and "first CEUS" corrected the misdiagnosis in 2 lesions on CECT. CONCLUSION The "first CEUS" and "fusion CEUS" can improve the lesion conspicuity. Compared with "first CEUS," "fusion CEUS" has a higher diagnostic ability and hence can detect most of the invisible lesions on the former.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Fengmei Wang
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, 300192, China
| | - Xiang Zhang
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
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21
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Cunha GM, Fowler KJ, Abushamat F, Sirlin CB, Kono Y. Imaging Diagnosis of Hepatocellular Carcinoma: The Liver Imaging Reporting and Data System, Why and How? Clin Liver Dis 2020; 24:623-636. [PMID: 33012449 DOI: 10.1016/j.cld.2020.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) provides standardized lexicon, technique, interpretation, and reporting of liver imaging in patients at risk for hepatocellular carcinoma (HCC). When applied to at-risk populations, LI-RADS achieves higher than 95% positive predictive value for the noninvasive diagnosis of HCC on computed tomography (CT), MRI and contrast-enhanced ultrasound (CEUS). This article focuses on similarities and differences between the CT/MRI diagnostic algorithm (CT/MRI LI-RADS) and the CEUS diagnostic algorithm (CEUS LI-RADS) to inform health care professionals for efficient and appropriate clinical decisions through the management of patients at risk.
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Affiliation(s)
- Guilherme Moura Cunha
- Liver Imaging Group, Department of Radiology, University of California, 9500 Gilman Drive, San Diego, CA 92093, USA.
| | - Kathryn J Fowler
- Liver Imaging Group, Department of Radiology, University of California, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Farid Abushamat
- Division of Gastroenterology & Hepatology, University of California, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, 9500 Gilman Drive, San Diego, CA 92093, USA
| | - Yuko Kono
- Division of Gastroenterology & Hepatology, University of California, 9500 Gilman Drive, San Diego, CA 92093, USA.
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22
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Yang Y, Liu F, Yu J, Cheng Z, Han Z, Dou J, Hu J, Wang Z, Gao H, Yang Q, Tian J, Xu Y, Bai X, Lu L, Liang P. Risk Factor Analysis of Acute Kidney Injury After Microwave Ablation of Hepatocellular Carcinoma: A Retrospective Study. Front Oncol 2020; 10:1408. [PMID: 33014779 PMCID: PMC7498714 DOI: 10.3389/fonc.2020.01408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/03/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives: Acute kidney injury (AKI) is a recently observed side effect in patients after microwave ablation (MWA) of hepatocellular carcinoma (HCC) and is associated with negative outcomes. The aim of this study is to explore the risk factors of affecting the occurrence of AKI (stages 1b, 2, and 3), because they have a higher mortality rate than patients with AKI (stage 1a) and without AKI. Materials and methods: In this retrospective study, a total of 1,214 patients with HCC who were treated with MWA under ultrasound (US) guidance in our department between January 2005 and November 2017 were enrolled. We evaluated the influence of 20 risk factors. Univariate and multivariate analysis were used for statistical analysis. The possible risk factors of AKI after MWA for HCC were summarized. Results: AKI, AKI (stage 1a), and AKI (stages 1b, 2, and 3) after MWA were found in 34, 15, and 19 patients (2.80, 1.24, and 1.57%), respectively. Among 34 patients with AKI, 10 cases with AKI (stage 1a) and 6 cases with AKI (stages 1b, 2, and 3) recovered before their discharge without any treatment for AKI and 9 cases with AKI (stages 1b, 2, and 3) with further treatment. Four cases who had chronic renal failure before MWA of liver accepted renal dialysis. By univariate analysis, the number of antenna insertions (P = 0.027, OR = 3.3), MWA time ≥20 min (P = 0.029, OR = 4.3), creatinine (Cr)-pre above the upper limit of the reference value (P < 0.001, OR = 35.5), albumin (Alb)-pre (P = 0.030, OR = 0.9), and red blood cell (RBC)-pre (P < 0.001, OR = 0.3) were significant risk factors. By multivariate analysis, Cr-pre ≥ 110 μmol/L (P < 0.001, OR = 31.4) and MWA time ≥20 min (P = 0.043 OR = 9.9) were the independent risk factors. Conclusion: AKI (stages 1b, 2, and 3) is a relatively serious complication after MWA for HCC, which is related to MWA time and Cr-pre. It requires attention by clinicians. So it is of great necessity to assess the Cr-pre level and reduce the MWA time to <20 min to minimize the risk of AKI after MWA for HCC.
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Affiliation(s)
- Yongfeng Yang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Hu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ze Wang
- Special Clinic Department, The 985th Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Taiyuan, China
| | - Haigang Gao
- Ultrasonic Diagnosis Department, The 991st Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Xiangyang, China
| | - Qiao Yang
- Ultrasound Department, Zunhua People's Hospital, Zunhua, China
| | - Jing Tian
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yongjie Xu
- Department of Diagnostic Ultrasound, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xiaoli Bai
- Ultrasound Department, Hohhot Mongolian Hospital of Traditional Chinese Medicine, Hohhot, China
| | - Liping Lu
- Department of Ultrasonography, Nanhai Hospital of Southern Medical University, Foshan, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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23
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Computed Tomography Thermography for Ablation Zone Prediction in Microwave Ablation and Cryoablation: Advantages and Challenges in an Ex Vivo Porcine Liver Model. J Comput Assist Tomogr 2020; 44:744-749. [PMID: 32842063 DOI: 10.1097/rct.0000000000001081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model. METHODS Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation. RESULTS With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = -0.79 [confidence interval (CI), -0.85 to -0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of -2.00 HU/°C (95% CI, -1.58 to -2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below -20°C were distinguished with 65.3% accuracy. CONCLUSIONS Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.
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Safety and efficacy of ultrasound-guided percutaneous coaxial core biopsy of pancreatic lesions: a retrospective study. J Ultrasound 2020; 24:269-277. [PMID: 32705502 DOI: 10.1007/s40477-020-00487-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pancreatic cancer tumors are difficult to access for biopsy. The use of coaxial needles during ultrasound (US)-guided coarse needle biopsy (CNB) may help to improve specimen collection yields and avoid tissue damage. In this retrospective study, the safety, efficacy, and clinical benefits of US-guided percutaneous coaxial CNB of pancreatic masses were evaluated and compared to those of non-coaxial CNB. METHODS A total sample of 220 biopsies performed from August 2015 to August 2019 were analyzed, including 114 performed with a coaxial needle (17-gauge coaxial coarse needle combined with an 18-gauge coarse biopsy needle) and 106 performed with a non-coaxial needle (18-gauge coarse biopsy needle without a coaxial sheath). The coaxial CNB group was stratified by lesion location to further evaluate the applicability of coaxial core needles. The satisfactory specimen rate, diagnostic efficiency, operating time, and complication rate were compared statistically between groups and subgroups. RESULTS Compared to the non-coaxial CNB group, the coaxial CNB group had a greater satisfactory specimen rate (98.3% vs. 92.3%; p = 0.048), a lesser mean operating time (8.9 ± 3.27 min vs. 16.8 ± 5.77 min; p < 0.001), and a lower complication rate (2.6% vs. 9.6%, p =0 .04). A better diagnostic efficiency was obtained for coaxial CNBs in the head of pancreas (98.7%) than in the body or tail of the pancreas (90%, p = 0.047). CONCLUSION For pancreatic masses, coaxial CNB can yield a higher satisfactory sample rate, lower complication rate, and shorter operating time than non-coaxial biopsy. US-guided percutaneous coaxial CNB is a safe and efficient puncture technique for pancreatic lesion diagnosis.
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Zhuang Z, Fan G, Yuan Y, Joseph Raj AN, Qiu S. A fuzzy clustering based color-coded diagram for effective illustration of blood perfusion parameters in contrast-enhanced ultrasound videos. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 190:105233. [PMID: 31796224 DOI: 10.1016/j.cmpb.2019.105233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Early identification and diagnosis of tumors are of great significance to improve the survival rate of patients. Amongst other techniques, contrast-enhanced ultrasound is an important means to help doctors diagnose tumors. Due to the advantages of high efficiency, accuracy and objectivity, more and more computer-aided methods are used in medical diagnosis. Here we propose, a color-coded diagram based on quantitative blood perfusion parameters for contrast-enhanced ultrasound video. The method realizes the static description of the dynamic blood perfusion process in contrast-enhanced ultrasound videos and reveal the blood perfusion characteristics of all regions of the tissue providing assistance to the doctors in their clinical diagnosis. METHODS For effective illustration of the blood perfusion through tissues, we propose (a) an improved block matching algorithm to eliminate the image distortions caused by breathing; (b) compute the time-grayscale intensity curve for each pixel to obtain four different quantitative blood perfusion parameters; and finally (c) employ the fuzzy C-means clustering algorithm to cluster the blood perfusion parameters, where each parameter is associated with a particular color. Thus based on the correspondence between the pixel and the blood perfusion parameters, all the pixels are color-coded to obtain the color-coded diagram. RESULTS To the best of our knowledge, the proposed technique is one-of-its-kind to color code the contrast-enhanced ultrasound videos using blood perfusion parameters in order to understand the hemodynamic characteristics of the benign and malignant lesion. In our experiments, various contrast-enhanced ultrasound videos corresponding to several real-world cases were color-coded and the results of the experiments illustrated that the proposed color-coded diagrams are consistent with the diagnosis presented by the physicians. CONCLUSIONS The experimental results suggested that the proposed method can comprehensively describe the blood perfusion characteristics of tissues during the angiography process thereby effectively assisting the doctors in diagnosis.
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Affiliation(s)
- Zhemin Zhuang
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China
| | - Guangwen Fan
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China
| | - Ye Yuan
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China
| | - Alex Noel Joseph Raj
- Department of Electronic Engineering, Shantou University, Shantou, Guangdong, China; Guangdong Provincial Key Laboratory of Digital Signal and Image Processing, Shantou University, Shantou, Guangdong, China.
| | - Shunmin Qiu
- Imaging Department, First Hospital of Medical College of Shantou University, Shantou, Guangdong, China
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Qiao W, Yu Y, Huang Y, Gao W, Liu Z. Impact of focused ultrasound on the ethanol ablation of VX2 liver tumours in rabbits. Eur Radiol 2020; 30:5862-5870. [PMID: 32533238 DOI: 10.1007/s00330-020-06941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In this study, a treatment combining ethanol ablation (EA) and focused ultrasound (FUS) was performed to investigate its synergistic ablation effect on normal liver and VX2 liver tumours in rabbits. METHODS A total of 59 healthy New Zealand white rabbits were included. For normal liver ablation, 39 animals were treated with FUS alone (n = 12), EA alone (n = 12), EA+FUS combination treatment (n = 12), or the control treatment (n = 3). The other 20 rabbits with implanted VX2 liver tumours were treated with EA alone (n = 10) or EA+FUS (n = 10). For FUS, the liver was exposed to 1 MHz FUS with an intensity of 33.0 W/cm2 (ISPTA) for 20 s. The EA group received an injection of absolute ethanol in the liver or liver tumours. For EA+FUS combination therapy, FUS was focused at the EA injection site, and both methods were carried out at the same time. RESULTS In normal liver tissues, the ablated volume treated by FUS combined with EA (1.46 ± 0.30 cm3) was approximately 3 times larger than that of EA alone (0.51 ± 0.17 cm3); in VX2 liver tumours, the tumour necrosis rate of the combination therapy was 90.27%, which was much higher than that of EA treatment (63.55%). CONCLUSION The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis. KEY POINTS • This study demonstrated a novel method for enhancing ethanol ablation and elucidated its potential to enhance percutaneous ethanol ablation (PEA) in a simple non-invasive way. • Ethanol excited by focused ultrasound (FUS) exposure tended to accumulate at the injection site, which could prevent ethanol from being washed out by the bloodstream. • The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis.
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Affiliation(s)
- Wei Qiao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Yanlan Yu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Ye Huang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Wenhong Gao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zheng Liu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
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Intracavitary contrast-enhanced ultrasound in ultrasound-guided percutaneous management of abdominal fluid collections/abscesses by a single clinician: an example of point-of-care ultrasound. J Ultrasound 2020; 23:175-181. [PMID: 32361920 DOI: 10.1007/s40477-020-00467-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess the role of intracavitary contrast-enhanced ultrasound (IC-CEUS) as a focused ultrasound (US) examination aimed at supporting a single physician in the management of interventional procedures for abdominal fluid collections/abscesses. METHODS In 43 patients (27 M/16 F, median age 68 years, range 35-91), a single physician performed catheter drainage (42) or needle aspiration (3) for the following: 14 infected abdominal fluid collections, 11 non-infected abdominal fluid collections, 9 pyogenic liver abscesses, 8 gallbladder empyema, and 3 infected pancreatic fluid collections. IC-CEUS (0.1-0.2 mL of SonoVue in 20 mL of saline) was carried out during catheter/needle placement and during the follow-up for catheters left in place. RESULTS Immediate IC-CEUS allowed to verify the (1) correct positioning of the needle/catheter inside the target in all cases and (2) communication with adjacent structures so as to choose a proper treatment in 21% of the cases. Follow-up IC-CEUS aided in the management of 40 catheters left in place. Appropriate treatment was implemented in 19.3% of the cases because of the presence of biliary fistulas and gallbladder perforation. IC-CEUS helped the physician with the appropriate timing of catheter removal by providing information on catheter malfunction (due to obstruction/dislodgement) and the size of residual undrained cavities. No side effects were registered following IC-CEUS. CONCLUSION Even if not strictly performed at bedside, IC-CEUS may represent an example of point-of-care ultrasound since it allows an interventional clinician to assess needle/catheter placement success, make treatment decisions, and choose the optimal timing for catheter removal with low costs and without side effects.
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Giorgio A, Gatti P, De Luca M, Matteucci P, Giorgio V. Editorial on "Role of thermal ablation in the management of colorectal liver metastasis". Hepatobiliary Surg Nutr 2020; 9:62-64. [PMID: 32142060 PMCID: PMC7026782 DOI: 10.21037/hbsn.2019.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/21/2019] [Indexed: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy
| | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | | | - Valentina Giorgio
- Fondazione Policlinico A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Roma, Italy
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Ballestri S, Nascimbeni F, Lugari S, Lonardo A, Francica G. A critical appraisal of the use of ultrasound in hepatic steatosis. Expert Rev Gastroenterol Hepatol 2019; 13:667-681. [PMID: 31104523 DOI: 10.1080/17474124.2019.1621164] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Nonalcoholic fatty liver disease (NAFLD) spans steatosis through nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). NAFLD carries an increased risk of cardio-metabolic and liver-related events accounting for a substantial economic burden. Given that the natural history of NAFLD is critically dependent on the stage of fibrosis, non-invasively identifying the subgroup of patients at a higher risk of progressive disease is key. Areas covered: This review highlights the recent developments in the use of ultrasound-based techniques in NAFLD and their performance in predicting metabolic derangements, cardiovascular risk, and progression of liver disease, notably including diagnosis of fibrosing NASH, identification, and treatment of HCC. Expert opinion: Our ability to identify NAFLD patients and to estimate steatofibrosis with various ultrasound-based techniques has undergone tremendous progress over the last few years. However, it is more difficult to capture the inflammatory component of NASH with such ultrasound-assisted techniques. Moreover, semi-quantitative, quantitative, elastographic, and contrast-enhanced ultrasound techniques are increasingly being appreciated and made available but not all such techniques will gain success in the clinical and research area. Therefore, further research will precisely define the role of the most innovative ultrasonographic techniques, while reducing costs and increasing feasibility.
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Affiliation(s)
- Stefano Ballestri
- a Internal Medicine Unit , Azienda USL of Modena, Pavullo Hospital , Modena , Italy
| | - Fabio Nascimbeni
- b Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero Universitaria of Modena , Modena , Italy
| | - Simonetta Lugari
- c Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero-Universitaria of Modena and University of Modena and Reggio Emilia , Modena , Italy
| | - Amedeo Lonardo
- b Ospedale Civile di Baggiovara, Metabolic Medicine Unit , Azienda Ospedaliero Universitaria of Modena , Modena , Italy
| | - Giampiero Francica
- d Interventional Ultrasound Unit , Pineta Grande Hospital , Castel Volturno , Italy
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Jiang AN, Wang S, Yang W, Zhao K, Bai XM, Zhang ZY, Wu W, Chen MH, Yan K. The Role of a Curved Electrode with Controllable Direction in the Radiofrequency Ablation of Liver Tumors Behind Large Vessels. Cardiovasc Intervent Radiol 2019; 42:893-904. [PMID: 30761411 DOI: 10.1007/s00270-019-02182-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/05/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the role of a novel curved radiofrequency ablation (RFA) electrode with controllable direction in the ablation of tumors behind large hepatic vessels in ex vivo bovine and in vivo canine liver experiments. MATERIALS AND METHODS Approval from the institutional animal care and use committee was obtained. In ex vivo experiments, conventional multi-tines expandable electrodes, conventional monopolar straight electrodes and novel curved electrodes were used in the ablation of the bovine liver (n = 90). The ablated area, parallel axis, vertical axis and shape of different electrodes were compared. Then, 24 beagle dogs (10 months old, female) were used for in vivo experiments. Visual tumor targets deeply located in the portal vein were established, and ultrasound-guided liver ablation was performed with different electrodes. The ablation range, target coverage rate, percentage of normal tissue injury and damage to adjacent vessels were evaluated. The Kruskal-Wallis test and the Chi-squared test were used for statistical analysis. RESULTS For the ex vivo study with a 3-cm electrode, the ablation area of the multi-tines expandable electrode group (7.14 ± 0.16 cm2) was significantly larger than that of the novel curved electrode group (5.01 ± 0.30 cm2, P < 0.001) and the monopolar straight electrode group (5.43 ± 0.15 cm2, P < 0.001). The results obtained with the 4-cm electrode in the three groups were in accordance with those of the 3-cm electrode. In vivo, the normal tissue damage area of the novel curved electrode group was smaller than that of the multi-tines expandable electrode group (1.10 ± 0.18 cm2 vs. 4.00 ± 0.18 cm2, P < 0.001). The target coverage rate of the novel curved electrode group was better than that of the monopolar straight electrode group (100% vs. 80.86 ± 1.68%, P < 0.001). The hematoxylin and eosin (H&E) and TUNEL staining results showed that the ablation necrosis area was adjacent to large vessels, but the vascular wall was not significantly damaged in the novel curved electrode group. CONCLUSION Our preliminary results showed that the novel curved RFA electrode with controllable direction could achieve accurate ablation for tumors behind large hepatic vessels, with a better target coverage rate and less damage to normal tissue, than conventional multi-tines expandable electrodes and monopolar straight electrodes.
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Affiliation(s)
- An-Na Jiang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Kun Zhao
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiu-Mei Bai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhong-Yi Zhang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Min-Hua Chen
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
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