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Möller K, Stock B, Ignee A, Zadeh ES, De Molo C, Serra C, Jenssen C, Lim A, Görg C, Dong Y, Klinger C, Tana C, Meloni MF, Sparchez Z, Francica G, Dirks K, Hollerweger A, Kinkel H, Weskott HP, Montagut NE, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - non-infectious, non-neoplastic. Med Ultrason 2023; 25:435-444. [PMID: 37369029 DOI: 10.11152/mu-4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of non-infectious and non-neoplastic focal liver lesions (FLL) are discussed. Improved detection and characterization of common FLL are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper is on non-infectious and non-neoplastic FLL and their appearance on B-mode, Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany.
| | - Bahar Stock
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - André Ignee
- Medical Clinic, Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Ehsan Safai Zadeh
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Christian Görg
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Claudio Tana
- Geriatrics Clinic, University Hospital of Chieti, Chieti, Italy
| | - Maria Franca Meloni
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA, Department of Interventional Ultrasound Casa di Cura Igea, Milano, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pinetagrande, Hospital Castelvolturno (CE), Italy
| | | | - Alois Hollerweger
- 5Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Horst Kinkel
- 6Medical Care Center RUR, Gastroenterology, Düren, Germany
| | | | | | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence; Inselspital Bern, Hospital of the University of Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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Cafarchio A, Iasiello M, Brunese MC, Francica G, Rocca A, Andreozzi A. Emprint Microwave Thermoablation System: Bridging Thermal Ablation Efficacy between Human Patients and Porcine Models through Mathematical Correlation. Bioengineering (Basel) 2023; 10:1057. [PMID: 37760159 PMCID: PMC10525213 DOI: 10.3390/bioengineering10091057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
To investigate the in vivo ablation characteristics of a microwave ablation antenna in the livers of humans with tumors, a retrospective analysis of the ablation zones was conducted after applying Emprint microwave ablation systems for treatment. Percutaneous microwave ablations performed between January 2022 and September 2022 were included in this study. Subsequently, immediate post-ablation echography images were subjected to retrospective evaluation to state the long ablated diameter, short ablated diameter, and volume. The calculated ablation lengths and volume indices were then compared between in vivo and ex vivo results obtained from laboratory experiments conducted on porcine liver. The ex vivo data showed a good correlation between energy delivered and both increasing ablated dimensions (both p < 0.001) and volume (p < 0.001). The in vivo data showed a good correlation for dimensions (p = 0.037 and p = 0.019) and a worse correlation for volume (p = 0.142). When comparing ex vivo and in vivo data for higher energies, the ablated volumes grew much more rapidly in ex vivo cases compared to in vivo ones. Finally, a set of correlations to scale ex vivo results with in vivo ones is presented. This phenomenon was likely due to the absence of perfusion, which acts as a cooling system.
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Affiliation(s)
- Andrea Cafarchio
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Marcello Iasiello
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
| | - Maria Chiara Brunese
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy;
| | - Aldo Rocca
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Assunta Andreozzi
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
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Tortora R, Farella N, Morisco F, Coppola C, Izzo F, Salomone Megna A, Federico A, Messina V, Nardone G, Piai G, Ragone E, Adinolfi LE, D’Adamo G, Stanzione M, Francica G, Torre P, De Girolamo V, Coppola N, Guarino M, Dallio M, Rocco L, Di Costanzo GG. Development of a risk score to predict portal vein tumor thrombosis in patients with hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2023; 35:734-741. [PMID: 37115974 PMCID: PMC10234326 DOI: 10.1097/meg.0000000000002549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/29/2022] [Indexed: 04/30/2023]
Abstract
BACKGROUND Portal vein tumor thrombosis (PVTT) is a common complication of hepatocellular carcinoma and is one of the most negative prognostic factors. The management of patients with PVTT is challenging. The aim of the study was to develop a score predictive of tumor thrombosis. METHODS Data from a large cohort of 2243 hepatocellular carcinoma patients (all stages) recorded in the Progetto Epatocarcinoma Campania (January 2013-April 2021) database were analyzed. To construct the score, univariate generalized estimated equation models, the bootstrap approach for internal validation, and a regression coefficient-based scoring system were used. RESULTS PVTT (any location) was found in 14.4% of cases and was related to shorter survival. Males, younger patients, and symptomatic cases were more prevalent among the PVTT group. At multivariate analysis, size ≥5 cm, massive or infiltrative hepatocellular carcinoma growth, and alpha-fetoprotein ≥400 ng/mL were significantly associated with PVTT. A risk prediction score of PVTT based on eight variables was developed. Using a continuous score, the risk was associated with an odds ratio (OR) of 1.30 (1.27-1.34; P < 0.001). Considering a dichotomous score >8 versus a score ≤8 the OR for PVTT was 11.33 (8.55-15.00; P < 0.001). CONCLUSION The risk score for PVTT might be useful for clinicians to optimize hepatocellular carcinoma management by picking out patients with more aggressive cancers and higher mortality rates. Prospective validation of the score is needed before its application in daily clinical practice.
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Affiliation(s)
| | - Nunzia Farella
- UOC Malattie infettive ad indirizzo Ecointerventistico, A.O.R.N dei Colli P.O. D. Cotugno
| | - Filomena Morisco
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Carmine Coppola
- UO di Epatologia ed Ecografia Interventistica, OO.RR. Area Stabiese, Gragnano (NA)
| | - Francesco Izzo
- UOC Chirurgia Oncologica Addominale ad indirizzo Epatobiliare, Istituto Nazionale per lo studio e la cura dei Tumori, IRCCS Fondazione Pascale, Napoli
| | | | | | - Vincenzo Messina
- UOC Malattie Infettive, -AORN Sant’Anna e San Sebastiano, Caserta
| | - Gerardo Nardone
- UOC Gastroenterologia ed Epatologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli
| | - Guido Piai
- UOSD Fisiopatologia Epatica con Servizio di Assistenza ai Trapiantati e Trapiantandi Epatici, Dipartimento di Scienze Mediche, AORN Sant’Anna e San Sebastiano, Caserta
| | - Enrico Ragone
- UOC Medicina Infettivologica e dei trapianti UOS Ecointerventistica, Clinica AORN Dei Colli - Ospedale Monaldi
| | - Luigi Elio Adinolfi
- Dipartimento di Scienze Mediche e Chirugiche Avanzate; Università della Campania Luigi Vanvitelli, Napoli
| | | | - Maria Stanzione
- UOC Malattie Infettive, Universita’ della Campania Luigi Vanvitelli, Napoli
| | - Giampiero Francica
- Unita di Ecografia Interventistica, PO Pineta Grande, Castelvolturno (CE)
| | - Pietro Torre
- Divisione di Medicina Interna ed Epatologia, Dipartimento di Medicina, Università di Salerno, Salerno
| | | | - Nicola Coppola
- UOC Malattie tropicali, Universita’ della Campania Luigi Vanvitelli, Napoli, Italy
| | - Maria Guarino
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Marcello Dallio
- Dipartimento di Epatogastroenterologia - Università L Vanvitelli, Napoli
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Francica G, Meloni MF, Riccardi L, de Sio I, Caturelli E, Terracciano F, Giangregorio F, Chiang J, Danzi R, Marra A, Niosi M, Ranalli TV, Pompili M. Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver - a Multicenter Report. Ultraschall Med 2023; 44:81-88. [PMID: 34433216 DOI: 10.1055/a-1579-9457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy. MATERIALS AND METHODS 22 patients (M/F 13/9; mean age 59.4 years, SD ± 10.7, range 35-81) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules. RESULTS SNN was an incidental finding in healthy people in 10 cases (45.5 %), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases = 41 %) or chronic liver disease (3 cases = 13.5 %). SNNs had a mean size of 19.3 mm (SD ± 6.5, range 9-40). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7 %), "target-like" in 7 cases (29.2 %), and homogeneously hyperechoic in 1 case (4.1 %). On CEUS, all lesions appeared devoid of contrast enhancement ("punched out" aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6 %). Clinical and imaging follow-up (mean duration 42.2 months, SD ± 34.9, range 2-108) was available in 15 patients with 16 SNNs: no changes in size and echostructure were seen. CONCLUSION CEUS can contribute to the diagnosis of SNN when a "punched out" appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Srl, Castel Volturno, Italy
| | - Maria Franca Meloni
- Radiology, Casa di Cura Igea, Milano, Italy
- Radiology, University of Wisconsin-Madison, United States
| | - Laura Riccardi
- Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy
| | - Ilario de Sio
- Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | | | - Fulvia Terracciano
- Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Jason Chiang
- Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, United States
| | - Roberta Danzi
- Radiology, Pineta Grande Srl, Castel Volturno, Italy
| | - Antonella Marra
- Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Niosi
- Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy
| | | | - Maurizio Pompili
- Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Altiero M, Orabona GD, Laccetti E, Rengo A, Danzi R, Romano F, Di Serafino M, Iacobellis F, Francica G, Scaglione M, Romano L. The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum. Diagnostics (Basel) 2022; 12:diagnostics12020401. [PMID: 35204492 PMCID: PMC8871049 DOI: 10.3390/diagnostics12020401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/22/2022] [Accepted: 01/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Pneumoperitoneum is defined by the presence of free air in the abdominal cavity; gastrointestinal perforation is an important cause of this pathological condition. In emergency situations, radiology is considered vital in the early detection and identification of the site and cause of the perforation, which is critical for proper surgical planning. Aim: The aim of our study was to evaluate a new diagnostic US tool, based on the US contrast-specific software generally used during contrast-enhanced US examination (CEUS), without the administration of sonographic contrast media, and to describe the specific imaging features in the detection of free intra-peritoneal air. Subjects and Methods: One hundred and fifty-seven consecutive and hemodynamically stable patients, who arrived in our E.D. with an acute abdomen between April 2018 and October 2019, underwent US and CT examination, performed by three radiologists (with 5, 5, and 25 years of experience). The US was performed first and divided into two steps, using B-mode US and both B-mode and contrast-specific software US, with no contrast media administration. All the patients underwent CT examination. Results: In 32 out of 157 patients, the surgery confirmed GI perforation. CT correctly detected 31 out of 32 patients; the contrast-specific software US identified 30 perforated patients. CT reached a sensitivity value of 97% and specificity value of 100%; contrast-specific software US demonstrated higher values than B-mode US in sensitivity (93% vs. 70%, respectively) and specificity (98% vs. 88%, respectively). Conclusion: the use of contrast-specific software in emergencies improves image quality, and reaches higher levels of sensitivity and specificity with no time delay compared to standard US examination, helping radiologists expedite diagnoses.
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Affiliation(s)
- Michele Altiero
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
- Correspondence:
| | - Ettore Laccetti
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Alessandro Rengo
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Roberta Danzi
- Department of Radiology, S. Maria delle Grazie Hospital, 80078 Pozzuoli, Italy;
| | - Federica Romano
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
| | - Giampiero Francica
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, 81030 Castel Volturno, Italy; (M.A.); (E.L.); (A.R.); (G.F.); (M.S.)
- Department of Radiology, University of Sassari, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, A. Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (F.I.); (L.R.)
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Francica G, Meloni MF, Riccardi L. Ultrasound Tools for Detection of Vascular Complications After Interventional Procedures. J Ultrasound Med 2021; 40:2781. [PMID: 33570177 DOI: 10.1002/jum.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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. J Ultrasound Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Meloni MF, Francica G, Chiang J, Coltorti A, Danzi R, Laeseke PF. Use of Contrast-Enhanced Ultrasound in Ablation Therapy of HCC: Planning, Guiding, and Assessing Treatment Response. J Ultrasound Med 2021; 40:879-894. [PMID: 32936485 DOI: 10.1002/jum.15471] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
Contrast-enhanced ultrasonography (CEUS) plays an important role in the management of patients treated with ablation therapies, in the diagnostic, therapeutic and monitoring phases. Compared to contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging, CEUS presents several advantages in imaging HCC, including real time imaging capability, high sensitivity for tumor vascularity, absence of renal toxicity, no ionizing radiation, repeatability of injections, good compliance by the patient and low cost. The purpose of this review is to evaluate the role of CEUS in the management of the patients with HCC treated with ablation therapies and describe how in our protocol CEUS is integrated with the other imaging modalities such as contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging.
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Affiliation(s)
- Maria Franca Meloni
- Radiology Department, University of Pavia, Italy and Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Jason Chiang
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Andrea Coltorti
- Department of Radiology, Federico II University, Naples, Italy
| | - Roberta Danzi
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
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Francica G, Binder FC, Guarnieri G, Mitchison MT, Goold J, Plastina F. Quantum Coherence and Ergotropy. Phys Rev Lett 2020; 125:180603. [PMID: 33196219 DOI: 10.1103/physrevlett.125.180603] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/13/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Constraints on work extraction are fundamental to our operational understanding of the thermodynamics of both classical and quantum systems. In the quantum setting, finite-time control operations typically generate coherence in the instantaneous energy eigenbasis of the dynamical system. Thermodynamic cycles can, in principle, be designed to extract work from this nonequilibrium resource. Here, we isolate and study the quantum coherent component to the work yield in such protocols. Specifically, we identify a coherent contribution to the ergotropy (the maximum amount of unitarily extractable work via cyclical variation of Hamiltonian parameters). We show this by dividing the optimal transformation into an incoherent operation and a coherence extraction cycle. We obtain bounds for both the coherent and incoherent parts of the extractable work and discuss their saturation in specific settings. Our results are illustrated with several examples, including finite-dimensional systems and bosonic Gaussian states that describe recent experiments on quantum heat engines with a quantized load.
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Affiliation(s)
- G Francica
- CNR-SPIN, I-84084 Fisciano (Salerno), Italy
| | - F C Binder
- Institute for Quantum Optics and Quantum Information-IQOQI Vienna, Austrian Academy of Sciences, Boltzmanngasse 3, 1090 Vienna, Austria
| | - G Guarnieri
- School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - M T Mitchison
- School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - J Goold
- School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - F Plastina
- Dipartimento di Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy
- INFN-Gruppo Collegato di Cosenza
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11
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Francica G, Borzio M. Status of, and strategies for improving, adherence to HCC screening and surveillance. J Hepatocell Carcinoma 2019; 6:131-141. [PMID: 31440486 PMCID: PMC6664854 DOI: 10.2147/jhc.s159269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) represents the second leading cause of cancer deaths worldwide and the main cause of death in patients with cirrhosis. Secondary prevention of HCC can be accomplished through the serial application of screening tests (ultrasound with or without alpha-fetoprotein) to detect the presence of subclinical lesions amenable to potentially curative treatment, such as surgery and ablation. The efficacy of HCC screening is accepted by hepatologists in terms of decline in cancer-specific mortality, but its translation into clinical practice is less than ideal. The effectiveness of HCC screening is hampered by several factors: failure to identify at-risk patients, failure to access care and failure to detect HCC. For each of these steps, possible improvements are discussed in order to face the changing etiology of cirrhosis and expand the screening of at-risk populations by including selected nonalcoholic fatty liver disease patients.
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Affiliation(s)
- Giampiero Francica
- Unità Operativa Ecografia ed Ecointerventistica, Pineta Grande Hospital, Castel Volturno, Italy
| | - Mauro Borzio
- Unità Operativa Complessa Gastroenterologia ed Endoscopia Digestiva, Azienda Socio Sanitaria Territoriale Melegnano e della Martesana, Milano, Italy
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12
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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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13
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Abstract
Exploiting the relative entropy of coherence, we isolate the coherent contribution in the energetics of a driven nonequilibrium quantum system. We prove that a division of the irreversible work can be made into a coherent and incoherent part. This provides an operational criterion for quantifying the coherent contribution in a generic nonequilibrium transformation on a closed quantum system. We then study such a contribution in two physical models of a driven qubit and kicked rotor. In addition, we also show that coherence generation is connected to the nonadiabaticity of a processes, for which it gives the dominant contribution for slow-enough transformations. The amount of generated coherence in the energy eigenbasis is equivalent to the change in diagonal entropy, and here we show that it fulfills a fluctuation theorem.
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Affiliation(s)
- G Francica
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy
- INFN-Gruppo Collegato di Cosenza, 87036, Cosenza, Italy
| | - J Goold
- School of Physics, Trinity College Dublin, Dublin 2, D02 PN40, Ireland
| | - F Plastina
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy
- INFN-Gruppo Collegato di Cosenza, 87036, Cosenza, Italy
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14
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Francica G, Altiero M, Laccetti E, Pezzullo F, Tanga M, Avitabile G, Elameer M, Scaglione M. Long-term follow-up of unresectable medium-large hepatocellular carcinoma nodules treated with radiofrequency ablation using a multiple-electrode switching system. Br J Radiol 2018; 92:20180625. [PMID: 30272482 DOI: 10.1259/bjr.20180625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat unresectable medium-large (3.1-6.0 cm) HCC nodules. METHODS RFA using a multiple-electrode switching system was performed for HCC nodules with size > 3.0 < 6.0 cm in nonsurgical candidates. Two electrodes were consecutively placed for 3.1-4.0 cm tumours, and three electrodes for 4.1-5.9 cm tumours, with a 2.0-2.5 cm spacing. The power was switched from one electrode to the next automatically when the impedance reached 30 Ω above the baseline level. 25 patients (M/F = 9/16; median age 76 years, range 61-84) with liver cirrhosis (20 HCV-positive) in Child's Class A (22 cases) and B (3 cases) and 26 HCC nodules (median diameter 4.0 cm; range 3.2-5.5 cm) underwent treatment in 25 sessions from 2013 and 2018. Therapeutic effectiveness was assessed through CT or MRI exam at 30-40 days post-ablation. RESULTS No procedure-related death or major complications occurred. Complete ablation was obtained in all nodules (100%). At a median follow up of 30 months, local tumor progression occurred in five out of 26 nodules (19.2%). Overall survival at 4 years was 49%. CONCLUSION RFA with a multiple-electrode switching system may be a safe, quick and effective therapeutic option for treatment of 3.1-6.0 cm unresectable HCC tumours. ADVANCES IN KNOWLEDGE RFA with multiple electrodes provides favourable clinical results in patients with medium-large HCC nodules who are not suitable for surgery.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Altiero
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Ettore Laccetti
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Filomena Pezzullo
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michela Tanga
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Mathew Elameer
- Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy.,Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
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15
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Garcovich M, Faccia M, Meloni F, Bertolini E, de Sio I, Calabria G, Francica G, Vidili G, Riccardi L, Zocco MA, Ainora ME, Ponziani FR, De Gaetano AM, Gasbarrini A, Rapaccini GL, Pompili M. Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience. J Ultrasound 2018; 22:157-165. [PMID: 30306412 DOI: 10.1007/s40477-018-0322-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/14/2018] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities. METHODS We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units. RESULTS The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively. CONCLUSIONS This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.
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Affiliation(s)
- Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Mariella Faccia
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Franca Meloni
- Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy.,Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Emanuela Bertolini
- Department of Internal Medicine, Hepatology and Gastroenterology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Ilario de Sio
- Hepatogastroenterology Unit, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Giosuele Calabria
- IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Gianpaolo Vidili
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Laura Riccardi
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Elena Ainora
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Romana Ponziani
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Anna Maria De Gaetano
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
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16
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Francica G, Meloni MF, Riccardi L, de Sio I, Terracciano F, Caturelli E, Iadevaia MD, Amoruso A, Roselli P, Chiang J, Scaglione M, Pompili M. Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study. Eur J Radiol 2018; 105:96-101. [DOI: 10.1016/j.ejrad.2018.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
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17
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Francica G, de Sio I, Meloni MF, Terracciano F, Caturelli E, Riccardi L, Iadevaia MD, Roselli P, Giovanni L, Scaglione M, Chiang J, Pompili M. Biopsy of Liver Target Lesions under Contrast-Enhanced Ultrasound Guidance - A Multi-Center Study. Ultraschall Med 2018; 39:448-453. [PMID: 29232723 PMCID: PMC6405338 DOI: 10.1055/s-0043-122496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS) as a guidance technique for the biopsy of liver target lesions (LTLs) at six interventional ultrasound centers. MATERIALS AND METHODS The six participating centers retrospectively selected all patients in whom biopsy needles were positioned in LTLs during CEUS. The prevalence of CEUS-guided biopsies at each center between 2005 and 2016, contrast agent consumption, procedure indications, diagnostic yield and complications were assessed. Informed consent was obtained for all patients. RESULTS CEUS-guided biopsy of LTLs was carried out in 103 patients (68 M/35 F, median age: 69 yrs) with 103 liver target lesions (median size: 20 mm) using cutting needles (18 - 20 g) in 94 cases (91.2 %). CEUS-guided biopsy represented 2.6 % (range: 0.8 - 7.7 %) of 3818 biopsies on LTLs carried out at the participating centers. Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (27.2 %), improvement of conspicuity of the target (33 %), choice of non-necrotic area inside the target (39.8 %). 26 patients (25.2 %) had a previously non-diagnostic cyto-histological exam. The diagnostic accuracy of the technique was 99 %. No major complications followed infusion of contrast agent or biopsy performance. CONCLUSION The indications for CEUS-guided biopsy for LTLs are limited, but CEUS can be useful in challenging clinical scenarios, e. g. poorly visualized or invisible lesions or sampling of non-necrotic areas in the target lesions. There is also a potential advantage in using CEUS to guide repeat biopsies after unsuccessful sampling performed using the standard ultrasound technique.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno (CE), Italy
| | - Ilario de Sio
- Department of Hepatogastroenterology, Second Univeristy of Naples, Naples, Italy
| | - Maria Franca Meloni
- Department of Interventional Ultrasound, Institute of Care Igea, Milano, Italy and Department of Radiology, University of Wisconsin, Madison (WI), USA
| | - Fulvia Terracciano
- Department of Gastroenterology, IRCSS Casa Sollievo della Sofferenza, S. Giovanni Rotondo (FG)
| | | | - Laura Riccardi
- Department of Internal Medicine and Gastroenterology, Catholic University of Sacred Heart, Rome, Italy
| | | | - Paola Roselli
- Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy
| | - Lenna Giovanni
- Department of Surgery, Institute of Care Igea, Milano, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging Pineta Grande Hospital, Castel Volturno (CE), Italy and Radiology Department, Royal Stoke University Hospital, University Hospital of North Midlands, NHS Trust, UK
| | - Jason Chiang
- Department of Radiology, University of Wisconsin, Madison (WI), USA
| | - Maurizio Pompili
- Department of Internal Medicine and Gastroenterology, Catholic University of Sacred Heart, Rome, Italy
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18
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Borzio M, Dionigi E, Rossini A, Marignani M, Sacco R, De Sio I, Bertolini E, Francica G, Giacomin A, Parisi G, Vicari S, Toldi A, Salmi A, Boccia S, Mitra M, Fornari F. External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: A multicenter cohort study. Hepatology 2018; 67:2215-2225. [PMID: 29165831 DOI: 10.1002/hep.29662] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/12/2017] [Accepted: 11/14/2017] [Indexed: 12/20/2022]
Abstract
UNLABELLED Several staging systems for hepatocellular carcinoma (HCC) have been developed. The Barcelona Clinic Liver Cancer staging system is considered the best in predicting survival, although limitations have emerged. Recently, the Italian Liver Cancer (ITA.LI.CA) prognostic system, integrating ITA.LI.CA tumor staging (stages 0, A, B1-3, C) with the Child-Turcotte-Pugh score, Eastern Cooperative Oncology Group performance status, and alpha-fetoprotein with a strong ability to predict survival, was proposed. The aim of our study was to provide an external validation of the ITA.LI.CA system in an independent real-life occidental cohort of HCCs. From September 2008 to April 2016, 1,508 patients with cirrhosis and incident HCC were consecutively enrolled in 27 Italian institutions. Clinical, tumor, and treatment-related variables were collected, and patients were stratified according to scores of the Barcelona Clinic Liver Cancer system, ITA.LI.CA prognostic system, Hong Kong Liver Cancer system, Cancer of the Liver Italian Program, Japanese Integrated System, and model to estimate survival in ambulatory patients with hepatocellular carcinoma. Harrell's C-index, Akaike information criterion, and likelihood-ratio test were used to compare the predictive ability of the different systems. A subgroup analysis for treatment category (curative versus palliative) was performed. Median follow-up was 44 months (interquartile range, 23-63 months), and median overall survival was 34 months (interquartile range, 13-82 months). Median age was 71 years, and patients were mainly male individuals and hepatitis C virus carriers. According to ITA.LI.CA tumor staging, 246 patients were in stage 0, 472 were in stage A, 657 were in stages B1/3, and 133 were in stage C. The ITA.LI.CA prognostic system showed the best discriminatory ability (C-index = 0.77) and monotonicity of gradients compared to other systems, and its superiority was also confirmed after stratification for treatment strategy. CONCLUSION This is the first study that independently validated the ITA.LI.CA prognostic system in a large cohort of Western patients with incident HCCs. The ITA.LI.CA system performed better than other multidimensional prognostic systems, even after stratification by curative or palliative treatment. This new system appears to be particularly useful for predicting individual HCC prognosis in clinical practice. (Hepatology 2018;67:2215-2225).
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Affiliation(s)
- Mauro Borzio
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Milano, Italy
| | - Elena Dionigi
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Milano, Italy
| | - Angelo Rossini
- Dipartimento di Medicina, SSVD di Epatologia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimo Marignani
- UOS Malattie delle vie Biliari e del Fegato, UOC malattie dell'Apparato Digerente e del Fegato, AO S. Andrea, Università Sapienza Roma, Roma, Italy
| | - Rodolfo Sacco
- UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy
| | - Ilario De Sio
- Unità di Gastroenterologia, Ospedale Policlinico, Napoli, Italy
| | - Emanuela Bertolini
- UO Medicina VI Epatologia e Gastroenterologia, Ospedale San Paolo, Università degli Studi di Milano, Milan, Italy
| | - Giampiero Francica
- Presidio Ospedaliero Pineta Grande, Unità di Ecointerventistica, Castel Volturno, Italy
| | - Anna Giacomin
- Dipartimento di Scienze Chirurgiche e Gastroenterologiche Ospedale Policlinico Padova, Padova, Italy
| | - Giancarlo Parisi
- Dipartimento di Medicina, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Susanna Vicari
- UOS Gastroenterologia Ospedale di Bentivoglio, Bologna, Italy
| | - Anna Toldi
- UO Gastroenterologia Ospedale Valduce, Como, Italy
| | - Andrea Salmi
- Dipartimento Medicina, Università di Verona, Verona, Italy
| | - Sergio Boccia
- UOC Gastroenterologia, Ospedale S. Anna, Ferrara, Italy
| | - Mario Mitra
- UO Medicina Interna I, Ospedale Civico e Benfratelli, Palermo, Italy
| | - Fabio Fornari
- Unità di Gastroenterologia ed Epatologia, Ospedale G da Saliceto, Piacenza, Italy
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19
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Guarino M, Tortora R, de Stefano G, Coppola C, Morisco F, Salomone Megna A, Izzo F, Nardone G, Piai G, Adinolfi LE, D'Adamo G, Gaeta GB, Messina V, Francica G, De Girolamo V, Coppola N, Persico M, Di Costanzo GG. Adherence to Barcelona Clinic Liver Cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania. J Gastroenterol Hepatol 2018; 33:1123-1130. [PMID: 28994145 DOI: 10.1111/jgh.14013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/24/2017] [Accepted: 10/03/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM The Barcelona Clinic Liver Cancer (BCLC) algorithm is the standard system for clinical management of hepatocellular carcinoma (HCC). Data on adherence to this therapeutic paradigm are scarce. This field practice study aimed to provide a description of HCC cirrhotic patients in Southern Italy, to evaluate the adherence to BCLC guidelines and its impact on patients' survival. METHODS We analyzed the region-wide Italian database of Progetto Epatocarcinoma Campania, which includes data of HCC cirrhotic patients, prospectively collected from January 2013 to December 2015 in 16 regional centers. RESULTS Overall, 1008 HCC patients were enrolled: 70.6% patients received therapies recommended by BCLC algorithm, while 29.4% underwent different treatments. Among patients who were treated in adherence to guidelines, a higher rate of diagnosis on surveillance programs, better liver function, lower rate of alpha-fetoprotein > 200 ng/mL, more early-stage and monofocal HCC, lower frequency of nodules > 5 cm, portal vein thrombosis and metastases were observed. The overall survival was evaluated according to HCC stage and no differences between groups and patients managed differently were found. The multivariate analysis showed that non-adherence to treatment guidelines was independently associated to the BCLC stage B, Child-Pugh classes B and C, and the presence of neoplastic thrombosis and metastases. CONCLUSION Adherence to BCLC algorithm in field practice was high in early and end-stage HCC patients, but it was poor in intermediate and advanced patients.
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Affiliation(s)
- Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Giorgio de Stefano
- IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, P.O. Cotugno, Naples, Italy
| | | | - Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Izzo
- Department of Abdominal Surgical Oncology and Hepatobiliary Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy
| | - Gerardo Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Guido Piai
- Unit for Liver Transplant Management, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Luigi Elio Adinolfi
- Department of Medical, Surgical, Neurological, Geriatric and Metabolic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Persico
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Borzio M, Dionigi E, Vitale A, Rossini A, Marignani M, Fornari F, Vicari S, De Sio I, Farinati F, Bertolini E, Oliveri F, Leandro G, Francica G, Mitra M, Omazzi B, Boccia S, Salmi A, Toldi A, Sacco R. Management and prognosis of hepatocellular carcinoma in the elderly: Results of an in-field multicenter cohort study. Liver Int 2017; 37:1184-1192. [PMID: 28214386 DOI: 10.1111/liv.13392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/14/2017] [Indexed: 02/13/2023]
Abstract
AIMS This multicentre cohort study evaluated the role of ageing on clinical characteristics, treatment allocation and outcome of new hepatocellular carcinomas (HCCs), in clinical practice. MATERIAL & METHODS From September 2008, 541 patients >70 years old (elderly group), and 527 ≤70 years old (non-elderly group) with newly diagnosed HCC were consecutively enrolled in 30 Italian centres. Differences in clinical characteristics and treatment allocation between groups were described by a multivariable logistic regression model measuring the inverse probability weight to meet the elderly group. Survival differences were measured by unadjusted and adjusted (by inverse probability weight) survival analysis. RESULTS Elderly patients were mainly females, hepatitis C virus infected and with better conserved liver function (P<.001). At presentation, HCC median size was similar in both groups while, in youngers, HCC was more frequently multinodular (P=.001), and associated with neoplastic thrombosis (P=.009). Adjusted survival analysis showed that age did not predict short-mid-term survival (within 24 months), while it was a significant independent predictor of long-term survival. Moreover, age had a significant long-term survival impact mainly on early HCC stages (Barcelona Clinic for Liver Cancer [BCLC] 0-A), its impact on BCLC B stage was lower, while it was negligible for advanced-terminal stages. CONCLUSIONS Age per se does not impact on short-mid-term prognosis (≤24 months) of HCC patients, and should not represent a limitation to its management.
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Affiliation(s)
- Mauro Borzio
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Cernusco sul Naviglio, Italy
| | - Elena Dionigi
- UOC Gastroenterologia ed Endoscopia Digestiva, ASST Melegnano e della Martesana, Cernusco sul Naviglio, Italy
| | - Alessandro Vitale
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche Azienda Università di Padova, Padova, Italy
| | - Angelo Rossini
- Dipartimento di Medicina, SSVD di Epatologia, ASST Spedali Civili di Brescia, Cernusco sul Naviglio, Italy
| | - Massimo Marignani
- UOS Malattie delle vie Biliari e del Fegato, UOC malattie dell'Apparato Digerente e del Fegato, AO S.Andrea, Università "Sapienza" Roma, Rome, Italy
| | - Fabio Fornari
- Unità di Gastroenterologia ed Epatologia, Ospedale G da Saliceto, Piacenza, Italy
| | - Susanna Vicari
- UOS Gastroenterologia Ospedale di Bentivoglio, Bologna, Italy
| | - Ilario De Sio
- Unità di Gastroenterologia, Ospedale Policlinico, Napoli, Italy
| | - Fabio Farinati
- Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche Azienda Università di Padova, Padova, Italy
| | - Emanuela Bertolini
- U.O. Medicina VI Epatologia e Gastroenterologia, Ospedale San Paolo, Università degli Studi di Milano, Milano, Italy
| | - Filippo Oliveri
- U.O. Epatologia, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy
| | | | - Giampiero Francica
- Unità di Ecointerventistica, Presidio Ospedaliero Pineta Grande, Castelvolturno, Italy
| | - Mario Mitra
- UO Medicina Interna I, Ospedale "Civico e Benfratelli", Palermo, Italy
| | - Barbara Omazzi
- UOC Gastroenterologia, Ospedale G Salvini, Rho, Milano, Italy
| | - Sergio Boccia
- UOC Gastroenterologia, Ospedale S.Anna, Ferrara, Italy
| | - Andrea Salmi
- Dipartimento Medicina, Università di Verona, Verona, Italy
| | - Anna Toldi
- UO Gastroenterologia Ospedale Valduce, Como, Italy
| | - Rodolfo Sacco
- UO Gastroenterologia e Malattie del Ricambio, Azienda Ospedaliero Universitaria Pisana, Ospedale Cisanello, Pisa, Italy
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Abstract
Neoplastic seeding may arise after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). A low risk of seeding after RFA (0–1.1%) has been reported, which may rise up to 2.5% if ablation followed diagnostic biopsy. Needle track seeding presents with one or multiple rounded nodules along the needle track located within the peritoneum, along the abdominal muscles, which were penetrated by the needle, pleural surface, or in the subcutaneous and cutaneous tissues. The most widely used method for the assessment of seeding nodules is ultrasound (US), which usually displays hypoechoic nodules with intralesional vascularization. Fine needle aspiration biopsy of the nodule suspicious for malignant implant is mandatory to confirm the diagnosis and plan therapy. Wide surgical excision is the treatment of choice for neoplastic seeding. Thanks to early diagnosis and prompt treatment, development of needle track seeding is not likely to affect the long-term survival of patients.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
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Pompili M, Francica G. Role of ablation: should it be used as primary therapy for early-stage hepatocellular carcinoma? Hepat Oncol 2015; 2:339-342. [PMID: 30191015 DOI: 10.2217/hep.15.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maurizio Pompili
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampiero Francica
- Diagnostic & Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy.,Diagnostic & Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
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Ballestri S, Romagnoli D, Nascimbeni F, Francica G, Lonardo A. Role of ultrasound in the diagnosis and treatment of nonalcoholic fatty liver disease and its complications. Expert Rev Gastroenterol Hepatol 2015; 9:603-27. [PMID: 25694178 DOI: 10.1586/17474124.2015.1007955] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We review the role of liver ultrasonography (US) and related techniques as non-invasive tools in predicting metabolic derangements, liver histology, portal hypertension and cardiovascular risk as well as allowing early diagnosis and management of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. In this setting, US detects fatty changes as low as ≥20% and hepatic steatosis identified ultrasonographically, in its turn, closely mirrors coronary and carotid atherosclerosis burden. Semi-quantitative US indices (to exclude nonalcoholic steatohepatitis) and sonoelastography (to quantify fibrosis) help in predicting liver histology and selecting patients to submit to liver biopsy. Surveillance for hepatocellular carcinoma conducted through biannual US is mandatory and US has a role in guiding locoregional treatment and in evaluating the efficacy of treatment. High-intensity focused ultrasound can be delivered with precision resulting in coagulative necrosis of hepatocellular carcinoma without puncturing the liver. Costs and inconveniences have so far hampered its diffusion.
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Affiliation(s)
- Stefano Ballestri
- Division of Internal Medicine, Hospital of Pavullo - Department of Internal Medicine, Azienda USL, Pavullo, Modena 41126, Italy
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Maurizio Pacella C, Francica G, Di Costanzo GG. Laser ablation: an alternative to radiofrequency ablation for hepatocellular carcinoma in cirrhotic patients? Hepat Oncol 2015; 2:111-115. [DOI: 10.2217/hep.15.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging & Interventional Radiology, Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castelvolturno, Italy
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Pompili M, De Matthaeis N, Saviano A, De Sio I, Francica G, Brunello F, Cantamessa A, Giorgio A, Scognamiglio U, Fornari F, Giangregorio F, Piscaglia F, Gualandi S, Caturelli E, Roselli P, Riccardi L, Rapaccini GL. Single hepatocellular carcinoma smaller than 2 cm: are ethanol injection and radiofrequency ablation equally effective? Anticancer Res 2015; 35:325-332. [PMID: 25550567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The impact of radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) on survival in patients with small hepatocellular carcinoma (HCC) is unclear. We compared their efficacy in cirrhotics with single HCC ≤2 cm. PATIENTS AND METHODS Two hundred forty-four cirrhotics with single HCC ≤2 cm treated with PEI (108 cases) or RFA (136 cases) were enrolled in the study. Eighty-one patients in each group were selected for propensity score matching analysis. RESULTS The five-year survival was not significantly different (64.7% in PEI and 72.9% in RFA group) but the 5-year recurrence (73.3% in PEI and 49% in RFA group, p=0.023) and local tumor progression (49% in PEI and 30.1% in RFA group, p=0.018) were higher in the PEI group. CONCLUSION PEI and RFA are equally effective in treating HCCs smaller than 2 cm in terms of 5-year survival, despite higher cumulative and local recurrence rates, in patients treated with PEI.
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Affiliation(s)
- Maurizio Pompili
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Antonio Saviano
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilario De Sio
- Internal Medicine and Gastroenterology, University of Naples, Naples, Italy
| | - Giampiero Francica
- Diagnostic and Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Franco Brunello
- Department of Hepatology and Gastroenterology, San Giovanni Battista Hospital, Turin, Italy
| | - Alessandro Cantamessa
- Department of Hepatology and Gastroenterology, San Giovanni Battista Hospital, Turin, Italy
| | - Antonio Giorgio
- IX Infectious Disease and Interventional Ultrasound Unit, D Cotugno Hospital, Naples, Italy
| | - Umberto Scognamiglio
- IX Infectious Disease and Interventional Ultrasound Unit, D Cotugno Hospital, Naples, Italy
| | - Fabio Fornari
- Gastroenterology, G. da Saliceto Hospital, Piacenza, Italy
| | | | - Fabio Piscaglia
- Internal Medicine, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Silvia Gualandi
- Internal Medicine, S. Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Laura Riccardi
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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Plastina F, Alecce A, Apollaro TJG, Falcone G, Francica G, Galve F, Lo Gullo N, Zambrini R. Irreversible work and inner friction in quantum thermodynamic processes. Phys Rev Lett 2014; 113:260601. [PMID: 25615295 DOI: 10.1103/physrevlett.113.260601] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Indexed: 06/04/2023]
Abstract
We discuss the thermodynamics of closed quantum systems driven out of equilibrium by a change in a control parameter and undergoing a unitary process. We compare the work actually done on the system with the one that would be performed along ideal adiabatic and isothermal transformations. The comparison with the latter leads to the introduction of irreversible work, while that with the former leads to the introduction of inner friction. We show that these two quantities can be treated on an equal footing, as both can be linked with the heat exchanged in thermalization processes and both can be expressed as relative entropies. Furthermore, we show that a specific fluctuation relation for the entropy production associated with the inner friction exists, which allows the inner friction to be written in terms of its cumulants.
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Affiliation(s)
- F Plastina
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy and INFN-Gruppo collegato di Cosenza, Cosenza, Italy
| | - A Alecce
- Dipartimento di Fisica e Astronomia "G. Galilei", Università degli Studi di Padova, via Marzolo 8, 35131 Padova (Italy)
| | - T J G Apollaro
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy and INFN-Gruppo collegato di Cosenza, Cosenza, Italy and Centre for Theoretical Atomic, Molecular and Optical Physics, School of Mathematics and Physics, Queen's University, Belfast BT7 1NN, United Kingdom
| | - G Falcone
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy and INFN-Gruppo collegato di Cosenza, Cosenza, Italy
| | - G Francica
- Dip. Fisica, Università della Calabria, 87036 Arcavacata di Rende (CS), Italy and INFN-Gruppo collegato di Cosenza, Cosenza, Italy
| | - F Galve
- IFISC (UIB-CSIC), Instituto de Física Interdisciplinar y Sistemas Complejos, UIB Campus, E-07122 Palma de Mallorca, Spain
| | - N Lo Gullo
- Dipartimento di Fisica e Astronomia "G. Galilei", Università degli Studi di Padova, via Marzolo 8, 35131 Padova (Italy) and CNISM, Sezione di Padova, Italy
| | - R Zambrini
- IFISC (UIB-CSIC), Instituto de Física Interdisciplinar y Sistemas Complejos, UIB Campus, E-07122 Palma de Mallorca, Spain
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Costanzo GGD, Francica G, Pacella CM. Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives. World J Hepatol 2014; 6:704-715. [PMID: 25349642 PMCID: PMC4209416 DOI: 10.4254/wjh.v6.i10.704] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 06/17/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.
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Pompili M, Francica G, Ponziani FR, Iezzi R, Avolio AW. Bridging and downstaging treatments for hepatocellular carcinoma in patients on the waiting list for liver transplantation. World J Gastroenterol 2013; 19:7515-7530. [PMID: 24282343 PMCID: PMC3837250 DOI: 10.3748/wjg.v19.i43.7515] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/30/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Several therapeutic procedures have been proposed as bridging treatments for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT). The most used treatments include transarterial chemoembolization and radiofrequency ablation. Surgical resection has also been successfully used as a bridging procedure, and LT should be considered a rescue treatment in patients with previous HCC resection who experience tumor recurrence or post-treatment severe decompensation of liver function. The aims of bridging treatments include decreasing the waiting list dropout rate before transplantation, reducing HCC recurrence after transplantation, and improving post-transplant overall survival. To date, no data from prospective randomized studies are available; however, for HCC patients listed for LT within the Milan criteria, prolonging the waiting time over 6-12 mo is a risk factor for tumor spread. Bridging treatments are useful in containing tumor progression and decreasing dropout. Furthermore, the response to pre-LT treatments may represent a surrogate marker of tumor biological aggressiveness and could therefore be evaluated to prioritize HCC candidates for LT. Lastly, although a definitive conclusion can not be reached, the experiences reported to date suggest a positive impact of these treatments on both tumor recurrence and post-transplant patient survival. Advanced HCC may be downstaged to achieve and maintain the current conventional criteria for inclusion in the waiting list for LT. Recent studies have demonstrated that successfully downstaged patients can achieve a 5-year survival rate comparable to that of patients meeting the conventional criteria without requiring downstaging.
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Di Costanzo GG, D'Adamo G, Tortora R, Zanfardino F, Mattera S, Francica G, Pacella CM. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54:876-81. [PMID: 23761559 DOI: 10.1177/0284185113489825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have shown that laser ablation with the multifiber technique is effective in the treatment of liver tumors. However, the correct positioning of multiple needles may be challenging. PURPOSE To investigate the use of a novel needle guide system that was developed to perform percutaneous laser ablation of liver tumors with the multifiber technique under ultrasonographic guidance. MATERIAL AND METHODS Between February 2009 and June 2011, 116 patients (104 hepatocellular carcinomas and 12 metastases) with 127 liver nodules (median diameter, 3.0 cm; range, 1.5-6.0) were treated. Nineteen nodules were in high-risk locations. A needle guide with separate channels to insert two needles in a parallel position and at a prefixed distance was used. RESULTS Needles were positioned inside the target nodule easily and quickly, and correct spacing (1.5-1.8 cm) between light sources was immediately achieved. Complete tumor ablation was achieved in a single session in 112 (88.2%) lesions. In nodules ≤3.0 cm and >3.0 cm in size, ablation was complete in 93.6% and 79.6% of cases, respectively. Of note, complete ablation was achieved in 91.7% of nodules up to 5.0 cm. CONCLUSION With the new guidance system, needles could be inserted in parallel fashion, which facilitated positioning the needles in geometrical configurations to maximize the ablative effect. Worthy of note, the complete ablation rate in nodules >3.0 cm using the new guide system was higher than what has been reported in the literature so far.
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Affiliation(s)
| | | | | | | | | | - Giampiero Francica
- Diagnostic and Interventional Ultrasound Unit, Camilliani Hospital, Naples
| | - Claudio Maurizio Pacella
- Regina Apostolorum Hospital, Diagnostic Imaging and Interventional Radiology, Albano Laziale, Italy
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de Sio I, Funaro A, Vitale LM, Niosi M, Francica G, Federico A, Sgambato D, Loguercio C, Romano M. Ultrasound-guided percutaneous biopsy for diagnosis of gastrointestinal lesions. Dig Liver Dis 2013; 45:816-9. [PMID: 23707404 DOI: 10.1016/j.dld.2013.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 02/19/2013] [Accepted: 04/07/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Endoscopical examination is not always sufficient for the diagnosis of gastrointestinal masses. This study assessed the diagnostic accuracy and safety of ultrasound-guided percutaneous biopsy of gastrointestinal lesions. METHODS This retrospective study evaluated 114 patients who underwent ultrasound-guided biopsy of gastrointestinal masses with a 18G needle. Thirty-two of these patients underwent a 22G fine-needle biopsy for cytology. Histology was compared with a composite standard of reference for diagnosis (i.e. post-surgery histological evaluation in 73 cases and computed tomography or magnetic resonance scan findings, together with a compatible clinical follow-up for at least 24 months, in the remaining 41 cases). Safety was assessed by recording side effects for up to 4h after the procedure. RESULTS Of the 114 lesions evaluated, 112 were malignant (98.2%) and 2 benign (1.8%). Specimens were adequate for histology in all but one case. Specimens were obtained from the stomach (n=38; 33.3%), small bowel (n=36; 31.6%) and colon (n=40; 35.1%). Diagnosis was correct in 113/114 cases (99.1%). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were 99.1%, 100%, 100%, 66%, and 99%, respectively. One of the 114 patients (0.9%) bled from a gastric GIST. CONCLUSIONS Ultrasound-guided percutaneous biopsy of gastrointestinal lesions is a valid alternative when diagnosis of a gastrointestinal mass cannot be obtained with an endoscopical procedure.
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Affiliation(s)
- Ilario de Sio
- Department of Clinical and Experimental Medicine "Magrassi-Lanzara", Gastroenterology Unit, Second University of Naples, Naples, Italy.
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Francica G, Petrolati A, Di Stasio E, Pacella S, Stasi R, Pacella CM. Influence of ablative margin on local tumor progression and survival in patients with HCC ≤4 cm after laser ablation. Acta Radiol 2012; 53:394-400. [PMID: 22393158 DOI: 10.1258/ar.2012.110471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ablation of the normal hepatic parenchyma surrounding the tumor (ablative margin [AM]) is necessary to prevent local tumor progression. PURPOSE To assess the prognostic value of the ablative margin in patients with HCC ≤4 cm treated with US-guided laser ablation. MATERIAL AND METHODS A cohort of 116 patients (53 women and 63 men, age range 42-82 years) with 132 HCC nodules ≤4 cm completely ablated by US-guided laser ablation was retrospectively analyzed. Rates of local tumor progression were compared using different ablative margin cut-offs (≥2.5, 5.0, 7.5, and 10.0 mm). Survival probability curves were obtained with the Kaplan-Meier method. RESULTS The mean period of follow-up was 42 months (range 3-114 months). Local tumor progression was identified in 24 out of 132 lesions (18%), with an average time to progression of 24 months (range 6-36 months). A significant difference in local tumor progression was observed only if the ablative margin was ≥7.5 mm (7% vs. 23%, P = 0.020). Survival curves of patients with or without an ablative margin ≥7.5 mm were not different (P = 0.665; mean survival time 43.8 ± 3.1 and 46.8 ± 6.1 for an AM < or ≥7.5 mm, respectively). CONCLUSION An ablative margin ≥7.5 mm turned out to be useful in preventing local tumor progression but did not affect long-term survival in patients with HCC ≤4 cm treated with laser ablation.
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Affiliation(s)
- Giampiero Francica
- Gastroenterology Department, Diagnostic and Interventional Ultrasound Unit, S Maria della Pietà Hospital, Casoria, Italy
| | - Alesssandra Petrolati
- Department of Endocrine, Metabolic and Digestive Diseases, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Roberto Stasi
- Department of Haematology, St George's Hospital, London, UK
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Francica G. Reliable clinical and sonographic findings in the diagnosis of abdominal wall endometriosis near cesarean section scar. World J Radiol 2012; 4:135-40. [PMID: 22590667 PMCID: PMC3351681 DOI: 10.4329/wjr.v4.i4.135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 03/23/2012] [Accepted: 03/30/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To highlight sonographic and clinical characteristics of scar endometrioma with special emphasis on size-related features.
METHODS: Thirty women (mean age 30.6 years, range 20-42 years) with 33 scar endometriomas (mean diameter 27.1 mm, range 7-60 mm) were consecutively studied by Sonography and Color Doppler examination prior to surgery. Pathological examination was available in all cases.
RESULTS: The most frequent (24 of 33 nodules, 74%) sonographic B-mode aspect of endometrioma was that of an inhomogenously hypoechoic roundish nodule with fibrotic changes (in the form of hyperechoic spots or strands), a peripheral inflammatory hyperechoic ring, spiculated margins and a single vascular pedicle entering the mass at the periphery. On average, 1.6 cesarean sections were recorded per patient (range 1-3). The median interval between the last cesarean section and admission to hospital was 36 mo (range 12-120 mo) and the median duration of symptoms before admission was 25.7 mo (range 0.5-80 mo). 13 patients had 13 large endometriomas (≥ 30 mm) with a mean lesion diameter of 41.3 ± 9.02 mm (range 30-60 mm). Seventeen women had 20 small endometriomas with a mean lesion size of 18.2 ± 5.17 mm (range 7-26 mm). The mean interval between the last cesarean section and admission to hospital (66.0 mo vs 39.6 mo, P < 0.01) and the mean duration of symptoms before admission (43.0 mo vs 17.4 mo, P < 0.01) were significantly longer in patients with large endometriomas; in addition, a statistically significant higher percentage of patients with large implants had undergone previous inconclusive diagnostic examinations, including either computed tomography/magnetic resonance imaging/fine needle biopsy/laparoscopy (38.4% vs 0%, P < 0.05). On sonography, large endometriomas showed frequent cystic portions and fistulous tracts (P < 0.02), loss of round/oval shape (P < 0.04) along with increased vascularity (P < 0.04).
CONCLUSION: Endometrioma near cesarean section scar is an often neglected disease, but knowledge of its clinical and sonographic findings may prevent a delay in diagnosis that typically occurs in patients with larger (≥ 3 cm) endometriomas.
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Francica G, Scarano F, Bellini S, Miragliuolo A. Prospective evaluation of interobserver diagnostic agreement for focal urinary bladder wall abnormalities detected by ultrasound. J Ultrasound 2011; 14:1-6. [DOI: 10.1016/j.jus.2010.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Maconi G, Terracciano F, de Sio I, Rigazio C, Roselli P, Radice E, Castellano L, Farci F, Francica G, Giannetti A, Marcucci F, Dalaiti A, Badini M, Fraquelli M, Massironi S. Referrals for bowel ultrasound in clinical practice: a survey in 12 nationwide centres in Italy. Dig Liver Dis 2011; 43:165-8. [PMID: 20615765 DOI: 10.1016/j.dld.2010.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 04/06/2010] [Accepted: 05/26/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND The value of ultrasound (US) in assessing gastrointestinal diseases is well documented, but its demand in clinical practice is unknown. This survey evaluated the demand for bowel US in Italy. METHODS Twelve sonographers of the Gastroenterology Section of the Italian Society of Ultrasound participated in a 1-month survey; they compiled a questionnaire assessing total number of patients referred for abdominal US and for gastrointestinal tract US, type of referring physician, indications and results of examinations. RESULTS The survey included 2424 examinations, 586 of which (24%) investigated the gastrointestinal tract: 280 for signs or symptoms and 268 for follow-up of pre-existing gastrointestinal diseases. Referring physicians were mainly gastroenterologists (78%) and general practitioners (13%). Organic lesions were found or suspected in 292 examinations. CONCLUSIONS Bowel US is used in Italy in routine practice, mainly by gastroenterologists and general practitioners, both for follow-up of pre-existing diseases and for gastrointestinal complaints.
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Affiliation(s)
- Giovanni Maconi
- Department of Clinical Sciences, L Sacco University Hospital, Milan, Italy.
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Francica G, Scarano F. Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars. J Ultrasound 2009; 12:101-6. [PMID: 23396117 DOI: 10.1016/j.jus.2009.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of the present study was to highlight the sonographic and clinical characteristics of large (≥30 mm in diameter) scar endometriomas near Pfannenstiel incisions, assuming that large size is a marker of delayed diagnosis. METHODS We compared clinical, ultrasound (US) and color Doppler findings in 13 patients (mean age 31.3 years) with 13 large scar endometriomas (L-SEs) (mean lesion diameter 41.8 mm; range 30-60 mm) and 17 women (mean age 30.7 years) with 19 small scar endometriomas (S-SEs) (mean lesion size 18.3 mm; range 7-26 mm). RESULTS Compared with the S-SE group, the L-SE group had a significantly longer mean interval between the last cesarean section and hospital admission (5.5 vs. 3.3 years; p < 0.01) and longer mean duration of symptoms before admission (43 vs. 17.4 months; p < 0.01). The L-SE group also had a significantly higher percentage of patients who had undergone at least one inconclusive diagnostic examination (Computed Tomography, Magnetic Resonance Imaging, fine needle biopsy, or laparoscopy) (39% vs. 0%; p < 0.05). As for US findings, L-SEs more frequently displayed cystic regions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05). CONCLUSIONS Delayed diagnosis of scar endometrioma reflected by a longer and more complex medical history results in larger than usual endometriomas with peculiar US findings, which are even more likely to be misinterpreted by physicians and radiologists.
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Affiliation(s)
- G Francica
- Diagnostic and Interventional Sonography Unit, Santa Maria della Pietà Hospital, Casoria (NA), Italy
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Francica G, Scarano F, Scotti L, Angelone G, Giardiello C. Endometriomas in the region of a scar from Cesarean section: sonographic appearance and clinical presentation vary with the size of the lesion. J Clin Ultrasound 2009; 37:215-220. [PMID: 19253349 DOI: 10.1002/jcu.20569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE To describe the sonographic (US) appearances of endometriomas developed in the vicinity of a scar from Cesarean section and compare sonographic and clinical characteristics of large (> or =3 cm) scar endometriomas (LSEs) with small scar endometriomas (SSEs). METHOD Twenty-eight consecutive women (mean age, 31 years; range, 20-42) with 31 scar endometriomas (mean diameter, 2.7 cm; range, 0.7-6 cm) were examined by US, including color Doppler imaging prior to surgery. Clinical and US findings in women with LSE were compared with those of women with SSE. RESULTS Twelve patients had 12 LSEs with a mean longest diameter of 4.1 cm (range, 3-6 cm); in 1 case, a large nodule was associated with a small lesion. Sixteen women had 18 SSEs with a mean lesion size of 1.8 cm (range, 0.7-2.6 cm).The mean time interval between the last Cesarean section and hospital admission was longer in patients with LSE (66 versus 40 months; p < 0.01) as was the mean duration of symptoms before admission (43 versus 17 months; p < 0.01); in addition, 41.6% of patients with LSE had undergone previous inconclusive diagnostic examinations (CT, MRI, fine needle aspiration, or laparoscopy) compared with 0% in patients with SSE (p < 0.05). LSEs more frequently showed cystic portions and fistulous tracts (p < 0.05), loss of round/oval shape (p < 0.05), and increased vascularity (p < 0.05) than SSEs did. CONCLUSION LSEs were associated with a delay in diagnosis and some US findings that could result in further diagnostic difficulties.
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Affiliation(s)
- Giampiero Francica
- Unità Operativa di Ecografia Diagnostica e Interventistica, Presidio Ospedaliero Camilliani S Maria della Pietà, Casoria (NA), Italy
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Pacella CM, Francica G, Di Lascio FML, Arienti V, Antico E, Caspani B, Magnolfi F, Megna AS, Pretolani S, Regine R, Sponza M, Stasi R. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 2009; 27:2615-21. [PMID: 19332729 DOI: 10.1200/jco.2008.19.0082] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Percutaneous laser ablation (PLA) has been proposed as an active treatment in patients with hepatocellular carcinoma (HCC). However, large multicenter studies using this technique have not been reported. PATIENTS AND METHODS We retrospectively analyzed treatment and survival parameters of 432 cirrhotic patients with nonsurgical early HCC (single nodule < or = 4 cm or three nodules < or = 3 cm each) who had received PLA in nine Italian centers. RESULTS Single tumors were seen in 344 (80%) of 432 patients, and two to three nodules were seen in 88 patients (20%), for a total of 548 tumors. An initial complete response after PLA was observed in 338 patients (78%). Median overall survival time was 47 months (95% CI, 41 to 53 months). The 3- and 5-year cumulative survival rates were 61% and 34%, respectively. In multivariate analysis, independent predictors of survival were serum albumin levels more than 3.5 g/dL (P = .002; risk ratio [RR] = 0.580; 95% CI, 0.409 to 0.821), the achievement of a complete tumor ablation (P = .001; RR = 0.517; 95% CI, 0.346 to 0.771), and age less than 73 years (P < .001; RR = 0.466; 95% CI, 0.320 to 0.681). Child-Turcotte-Pugh class A patients had a 5-year cumulative survival rate of 41%; this figure increased up to 60% with a median survival time of 63 months (95% CI, 48 to 78 months) in patients with tumors < or = 2.0 cm. CONCLUSION This analysis confirms that a complete tumor ablation results in improved survival in patients with nonsurgical HCC. Ideal candidates for PLA are younger patients with normal serum albumin levels and tumor size < or = 2 cm.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
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Francica G, Bellini SA, Scarano F, Miragliuolo A, De Marino FA, Maniscalco M. Correlation of transabdominal sonographic and cystoscopic findings in the diagnosis of focal abnormalities of the urinary bladder wall: a prospective study. J Ultrasound Med 2008; 27:887-894. [PMID: 18499848 DOI: 10.7863/jum.2008.27.6.887] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to prospectively assess the diagnostic capabilities of transabdominal sonography performed with newer sonography machines for showing focal bladder wall abnormalities (FBWAs) detected on cystoscopy. METHODS One hundred twelve consecutive patients (97 male and 15 female; mean age, 68 years) underwent cystoscopy. Reasons for referral were macroscopic hematuria (44 cases [39%]), surveillance after transurethral resection (56 cases [49.5%]), and incidental sonographic findings (12 cases [11.5%]). One to 2 days before cystoscopy, sonography was carried out by a single operator who was blinded to clinical and recent sonographic findings. The presence, size, number, and location of FBWAs (eg, polypoid vegetations and asymmetric bladder wall thickening) were recorded and compared with cystoscopic and histologic findings. RESULTS One hundred ten patients with a histologic diagnosis were available for the study. Benign conditions, nontransitional tumors, and transitional tumors were found in 26.3%, 3.7% and 70% of the patients, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of sonography of cystoscopic lesions were 91.4%, 79.3%, 91.4%, 79.3%, and 88.2%. Cancers of 15 mm or smaller and flat tumors were often missed by sonography, whereas chronic cystitis accounted for most of the false-positive sonographic findings; however, sonography had poor capability of characterizing FBWAs, with specificity of 62%. In this respect, color Doppler findings proved of little aid as well. CONCLUSIONS In patients selected for cystoscopy, transabdominal sonography with newer sonography machines showed good diagnostic accuracy for focal alterations of the bladder wall found on cystoscopy.
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Affiliation(s)
- Giampiero Francica
- Diagnostic and Interventional Ultrasound Service, Presidio Ospedaliero Camilliani Santa Maria Della Pietà, Casoria, Italy.
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Arienti V, Pretolani S, Pacella CM, Magnolfi F, Caspani B, Francica G, Megna AS, Regine R, Sponza M, Antico E, Di Lascio FML. Complications of Laser Ablation for Hepatocellular Carcinoma: A Multicenter Study. Radiology 2008; 246:947-55. [DOI: 10.1148/radiol.2463070390] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Francica G, Iodice G, Delle Cave M, Sarrantonio R, Lapiccirella G, Molese V, Smeraldo D, Scarano F, De Marino F. Factors predicting complete necrosis rate after ultrasound-guided percutaneous laser thermoablation of small hepatocellular carcinoma tumors in cirrhotic patients: a multivariate analysis. Acta Radiol 2007; 48:514-9. [PMID: 17520427 DOI: 10.1080/02841850701199942] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess factors affecting the effectiveness of percutaneous laser ablation (PLA) under ultrasound (US) guidance in terms of complete ablation achievement. MATERIAL AND METHODS The clinical records of 86 hepatocellular carcinoma (HCC) tumors (mean diameter 23.7 mm) in 60 cirrhotic patients (mean age 68.3 years; 36 males; 57 HCV+; 53 Child's class A, seven Child's class B) treated by means of PLA were reviewed. PLA was performed with a continuous-wave Nd:YAG laser by a single operator who positioned two to four 300-microm optic fibers advanced in 21-gauge needles into target lesions under US guidance. Triphasic computed tomography (CT) studies were used to verify treatment effectiveness 1 month after PLA completion. The association between characteristics of the lesion and outcome (complete or incomplete ablation) was evaluated by logistic regression, taking into account the following predictive factors: tumor size, pattern of growth (infiltrating or not) at imaging, location, first diagnosis of HCC (naïve tumors vs. non-naïve tumors), number of sessions (1/ > 1), total delivered energy, and years of treatment in 2001-2002 (first period) vs. 2003-2004 (second period). RESULTS Complete ablation was obtained in 62 nodules (72%). Statistically significant predictors of incomplete ablation after the first PLA course at both univariate and multivariate analysis included: infiltrating growth pattern (odds ratio (OR) 12.3, P<0.002), non-naïve tumors (OR 8.7, P<0.001), and first period of treatment (OR 10.3, P<0.002). CONCLUSION The effectiveness of US-guided PLA for HCC tumors < or =4 cm turned out to be negatively affected by both operator-related (the beginning of the operator's experience with the technique) and tumor-related factors (non-naïve, infiltrating HCC tumors).
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Affiliation(s)
- G Francica
- Unità Operativa di Ecografia ed Ecointerventistica, Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, and Dipartimento di Diagnostica per Immagini, Presidio Ospedaliero Camilliani S. Maria della Pietà, Casoria, Italy.
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Tarantino L, Francica G, Sordelli I, Esposito F, Giorgio A, Sorrentino P, de Stefano G, Di Sarno A, Ferraioli G, Sperlongano P. Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. ACTA ACUST UNITED AC 2007; 31:537-44. [PMID: 16865315 DOI: 10.1007/s00261-005-0150-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC). METHODS Fifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up. RESULTS Follow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. However, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein. CONCLUSION CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.
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Affiliation(s)
- L Tarantino
- Hepatology and Interventional Ultrasound Unit, S. Giovanni di Dio Hospital, ASL NA3, Frattaminore, Naples, Italy.
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Pacella CM, Bizzarri G, Francica G, Forlini G, Petrolati A, Valle D, Anelli V, Bianchini A, Nuntis SD, Pacella S, Rossi Z, Osborn J, Stasi R. Analysis of factors predicting survival in patients with hepatocellular carcinoma treated with percutaneous laser ablation. J Hepatol 2006; 44:902-9. [PMID: 16545480 DOI: 10.1016/j.jhep.2006.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 01/15/2006] [Accepted: 01/22/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS The factors which predict the long-term outcome in patients with hepatocellular carcinoma who are treated with percutaneous laser ablation (PLA) are not well established. METHODS We prospectively analyzed treatment and survival parameters of 148 cirrhotic patients with nonsurgical hepatocellular carcinoma who had undergone PLA at a single institution during an 11-year period. RESULTS Single tumors were seen in 129 of 148 (87%) patients, and 2-3 nodules were seen in 19 (13%) patients, for a total of 169 tumors. The median overall time survival was 39 months (95% confidence interval [CI], 30-47 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 89, 75, 52, 43, and 27%, respectively. From multiple regression analysis, the independent predictors of survival were found to be tumor grading (P=0.002; risk ratio [RR] 0.37, 95% CI 0.20-0.70), bilirubin levels < or =2.5mg/dl (P=0.014; RR 1.58, 95% CI 1.09-2.28), and the achievement of complete tumor ablation (P=0.020; RR 0.53, 95% CI 0.31-0.90). An initial complete tumor ablation was the only factor associated with longer survival in patients with Child-Turcotte-Pugh class A cirrhosis (P=0.012; hazard ratio [HR] 0.48, 95% CI 0.23-1.03). CONCLUSIONS A complete tumor ablation results in improved survival in all patients with nonsurgical hepatocellular carcinoma. Ideal candidates for PLA are those with a well-differentiated histology, and normal bilirubin levels.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via San Francesco, 50-00041, Albano Laziale, Rome, Italy.
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Francica G, Lapiccirella G, Giardiello C, Scarano F, Angelone G, De Marino F, Molese V. Giant mucocele of the appendix: clinical and imaging findings in 3 cases. J Ultrasound Med 2006; 25:643-8. [PMID: 16632789 DOI: 10.7863/jum.2006.25.5.643] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Clinical and imaging (sonographic and computed tomographic [CT]) findings in 3 cases of giant mucocele of the appendix are described. METHODS Clinical records of 3 cases of giant mucocele of the appendix were reviewed. All patients had a basal B-mode sonographic examination and a contrast-enhanced sonographic examination using a second-generation low-mechanical index contrast medium. In all cases, a dual-phase spiral CT examination was carried out. RESULTS In 2 cases, the abdominal masses were discovered in asymptomatic patients; 1 patient had vague abdominal discomfort. A pathologic diagnosis of benign cystoadenoma was found at pathologic examination in all cases, and malignant pseudomyxoma peritonei was disclosed in 1 patient 1 year later. Common sonographic findings were as follows: (1) a huge abdominal mass with a maximum diameter ranging between 20 and 25 cm; (2) a thin hyperechoic border without either solid vegetations or signs of infiltration of surrounding tissues; (3) a complex internal echo structure with anechoic lacunae interspersed between curvilinear, wavy bands of echogenic material (the so-called sonographic onion skin sign); and (4) avascularity of the masses shown on contrast-enhanced sonography with a low-mechanical index medium. At CT, a well-circumscribed cysticlike mass of low attenuation was displayed in all cases. There was lack of enhancement during a dual-phase examination in 2 cases; in the other, a small peripheral area of faint enhancement was appreciated. Only in the latter case could CT reliably assess the origin of the mass. CONCLUSIONS It is suggested that a combination of sonographic (namely the onion skin sign) and CT findings may aid in the correct preoperative diagnosis of giant mucocele of the appendix.
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Affiliation(s)
- Giampiero Francica
- Unità Operativa di Ecografia ed Ecointerventistica, Presidio Ospedaliero Camilliani S. Maria Della Pietà, Casoria, Italy.
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Pacella CM, Bizzarri G, Francica G, Bianchini A, De Nuntis S, Pacella S, Crescenzi A, Taccogna S, Forlini G, Rossi Z, Osborn J, Stasi R. Percutaneous laser ablation in the treatment of hepatocellular carcinoma with small tumors: analysis of factors affecting the achievement of tumor necrosis. J Vasc Interv Radiol 2006; 16:1447-57. [PMID: 16319150 DOI: 10.1097/01.rvi.90000172121.82299.38] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To identify the factors that affect the achievement of tumor necrosis with percutaneous laser ablation (PLA) in patients with hepatocellular carcinoma (HCC) and tumor size no larger than 4.0 cm. MATERIALS AND METHODS Ultrasound-guided biopsy results were retrospectively studied in 99 lesions (range, 0.5-4.0 cm; mean, 2.7 cm) from 82 patients (44 men, 38 women; age range, 50-80 years; median, 68 y) who had undergone PLA. RESULTS Complete tumor ablation was obtained in 90 lesions (90.9%). Of the nine cases in which complete tumor necrosis was not achieved, six had tumors located in sites that did not allow the optimal placement of fibers, and five of these had a tumor diameter greater than 3 cm. Early discontinuation of PLA as a result of decompensation of liver cirrhosis was the reason for not achieving a complete tumor ablation in three other cases. There was a clear relationship between the energy delivered and the volume of necrosis achieved (r = 0.56; P < .001) regardless of the initial size of HCC tumors. The number of illuminations required, and consequently the amount of energy delivered, was also affected by tumor location. In fact, lesions adjacent to large vessels (> or = 3 mm) required a greater number of illuminations than the other lesions to achieve complete ablation (2.9 +/- 1.4 vs 2.3 +/- 0.9; P = .043). The eight cases with undifferentiated histology required more illuminations than the cases with other histologic types (3.4 +/- 0.9 vs 2.2 +/- 0.9; P < .001). However, these cases were located in sites that did not allow the optimal placement of fibers, therefore requiring multiple treatments. CONCLUSION PLA is a highly effective treatment in HCC with a tumor size of 4.0 cm or smaller. In this setting, two variables, tumor size and tumor location, affect the achievement of complete tumor ablation and the number of treatments required to obtain tumor necrosis.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Rome, Italy.
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Tarantino L, Francica G, Esposito F, Pisaniello D, Parmeggiani D, Marzullo G, Sordelli IMF, Sperlongano P. Seeding from hepatocellular carcinoma after percutaneous ablation: color Doppler ultrasound findings. ACTA ACUST UNITED AC 2005; 31:69-77. [PMID: 16333710 DOI: 10.1007/s00261-004-0064-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 03/16/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND We describe the clinical and color Doppler ultrasound findings in a series of cases of seeding from hepatocellular carcinoma (HCC) observed in patients treated with percutaneous ablation therapy (PAT) over a 15-year period. METHODS We reviewed the clinical and imaging records of 12 patients with cirrhosis (nine men and three women, age range 51-82 years, mean age 63 years) that showed neoplastic seeding from HCC occurring after one or more PAT procedures. Five of 12 cases of seeding were observed as a complication of 1080 PAT procedures (0.46%) performed in 545 patients (0.96%) by two of the authors (L.T., G.F.) over a long period (15 years) at different institutions. The other seven patients had been treated with PAT procedures at other institutions and had come to our attention during post-treatment follow-up. RESULTS The 12 patients who had seeding nodules had undergone the following PAT procedures: multisession conventional percutaneous ethanol injection (PEI) without anesthesia (four patients), single-session PEI with general anesthesia (three patients), single-session PEI with general anesthesia plus multisession conventional PEI (four patients), and single-session PEI plus radiofrequency ablation (one patient). Seeding nodules ranged from 0.9 to 6.0 cm (mean 1.7 cm). Eleven of 12 seeding nodules appeared as hypervascular hypoechoic nodules with smooth and regular margins and multiple intralesional vascular signals. CONCLUSIONS Clinical and imaging findings of seeding from HCC should be recognized by physicians who perform follow-up ultrasound examinations of patients who are treated with PAT. Early diagnosis of seeding can be reliably made by scanning the abdominal wall with small probes in the area where the previous PAT has been performed. Hypoechoic hypervascular pattern of the seeding nodule allows definitive diagnosis.
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Affiliation(s)
- L Tarantino
- Interventional Ultrasound Unit, Department Of Medicine, S. Giovanni Di Dio Hospital Aslna 3, Via Mario Vergara Padre, 187, 80027 Frattamaggiore, Naples, Italy.
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Francica G, Giardiello C, Iodice G, Cristiano S, Scarano F, Delle Cave M, Sarrantonio G, Troiano E, Cerbone MR. Ultrasound as the imaging method of choice for monitoring the intragastric balloon in obese patients: normal findings, pitfalls and diagnosis of complications. Obes Surg 2004; 14:833-7. [PMID: 15318991 DOI: 10.1381/0960892041590791] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors studied ultrasound (U/S) monitoring of the BioEnterics intragastric balloon (BIB) for treatment of moderate obesity by describing normal U/S aspects, diagnostic pitfalls and assessment of complications. METHODS Over the last 3 years, 151 BIB systems have been endoscopically placed and filled with 500-700 ml of saline plus 10 ml of methylene blue in 131 patients (mean age 38.4 years, range 18-72); males/females 46/85; mean BMI 43.8 kg/m(2)). In all patients abdominal U/S was carried out before and 12 days after endoscopy and thereafter at scheduled follow-up examinations, and/or whenever the subject complained of epigastric burning/ache, vomiting, and lack of sensation of a BIB with or without staining of urine and/or feces. RESULTS The BIB appeared as a round anechoic structure, with a thick hyperechoic wall and a hyperechoic band-like valve inside. Complications occurred in 18 patients: in 8, staining of urine and/or feces prompted immediate endoscopic removal. In 10 patients, U/S findings were: 1) decreased volume, loss of the spherical shape with the valve still visible (5 cases); 2) multiple hyperechoic streaks regularly spaced due to a completely collapsed BIB, not modified by decubitus changes (3 cases); 3) migration through the intestine (2 cases): in one patient the BIB was passed in the stools after 4 days, whereas in the other case large bowel obstruction required laparoscopic surgery. CONCLUSION U/S affords a quick, safe and accurate method for assessing both BIB status after endoscopic deployment and the most frequently-occurring complications (partial/complete deflation, migration through the pylorus with intestinal obstruction) in obese patients.
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Affiliation(s)
- Giampiero Francica
- Unità Operativa di Ecografia ed Econterventistica, Presidio Ospedaliero S. Maria della Pietà Camilliani, Via S. Rocco 9, 80026 Casoria, Italy.
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Francica G, Giardiello C, Scarano F, Cristiano S, Iodice G, Delle Cave M. Ultrasound diagnosis of intragastric balloon complications in obese patients. Radiol Med 2004; 108:380-4. [PMID: 15525891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
PURPOSE Our study describes ultrasonography (US) aspects of complications related to the use of the Bioenterics intragastric balloon (BIB) system for the treatment of moderate obesity. MATERIALS AND METHODS Over the last three years 151 BIBs were endoscopically placed and inflated with 500-600 ml of saline plus 10 ml of methylene blue in 131 patients (mean age 38.4 years, range 18-72; 46 males, 85 females, mean body mass index 43.8 kg/m(2)). In all cases abdominal US was carried out before and 1-2 days after endoscopy and thereafter at scheduled follow-up visits and/or whenever the patient complained of heartburn, vomiting, a sensation of ''absence of the BIB'' with or without staining of urine and/or faeces. RESULTS The BIB appeared as a round anechoic structure, with a thick hyperechoic wall and a hyperechoic band-like valve inside. In 8 cases staining of urine and/or faeces prompted immediate endoscopic removal. In 10 patients US findings of BIB-related complications were: 1) decreased volume with a visible valve (5 cases; in two of these staining of urine was reported); 2) multiple hyperechoic streaks regularly spaced due to a completely collapsed BIB, not modified by decubitus changes (3 cases; one patient reported staining of urine); 3) migration through the bowel (2 cases): in one patient the BIB was passed after 4 days, whereas in the other case bowel obstruction required laparoscopic surgery. CONCLUSIONS In conclusion, US provides a quick and accurate method for the assessment of BIB-related complications in obese patients.
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Affiliation(s)
- Giampiero Francica
- Unità Operativa di Ecografia ed Ecointerventistica, Presidio Ospedaliero S. Maria della Pietà Camilliani, Casoria (Napoli), Italy.
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