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Objective To compare three-dimensional contrast-enhanced ultrasound ( 3DCEUS) fusion imaging and computed tomography ( CT ) fusion imaging in evaluating ablation margin ( AM ) after radiofrequency ablation ( RFA) for hepatocellular carcinoma ( HCC) . Methods The 3DCEUS images of 60 patients before and after RFA were collected . The AM was evaluated by the self-developed 3DCEUS fusion imaging technique . The consistency of AM evaluation was compared between 3DCEUS and CT fusion imaging . The risk factors of local tumor progression ( LTP) including AM were analyzed . Results The registration success rate of 3DCEUS fusion imaging was 96 .7％ ( 58/60) . Thirty-one cases were in the AM<5 mm group ,and 27 cases were in the AM ≥5 mm group . The consistency of AM evaluation between 3DCEUS and CT fusion imaging was good ( Kappa coefficient = 0 .895 , P < 0 .001) . During a follow-up period ranging 4 .2 to 18 months ,LTP was identified in 5 tumors (8 .6％ ,5/58) .The incidence of LTP with the AM<5 mm was higher than that with the AM ≥5 mm ( P =0 .033) . Conclusions 3DCEUS fusion imaging is feasible for AM evaluation immediately after RFA with high consistency with CT fusion imaging . AM<5 mm evaluated on 3DCEUS fusion immediately after RFA is a risk factor for LTP .
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Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.
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Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC).Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared.Results On CEUS,HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase.No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC.When the maximum diameter of tumor ≤3.0 cm,both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000).When the maximum diameter of tumor more than 3.0 cm,diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC,while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001).Conclusion The enhancement pattern of HBV-related CHC ＞3.0 cm has relative specific performance.
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Objective To evaluate the correlation between the imaging features on contrast-enhanced ultrasound (CEUS) and pathological characteristics of combined hepatocellular-cholangiocarcinoma (CHC).Methods Forty patients with pathologically proven hepatic CHC were evaluated,the CEUS imaging findings and pathological characteristics of CHC were retrospectively analyzed.Results On CEUS,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 13(32.5 ％),21 (52.5 ％) and 6(15.0％) lesions,respectively.Pathological findings showed that HCC-predominance,CC-predominant,and similar proportions of the two components were illustrated in 16 (40.0 ％),19 (47.5 ％) and 5 (12.5 ％) cases,respectively.The presence of necrosis were illustrated in 28 (70.0％) cases.On CEUS,when the enhancement pattern was peripheral irregular rim-like enhancement,CC-predominance and necrosis were presented in 11(84.6％) and 10(76.9％) cases,respectively.When the enhancement pattern was diffuse heterogeneous enhancement,CC-predominance and necrosis were presented in 11(52.4％) and 18(85.7％) cases,respectively.When the enhancement pattern was diffuse homogeneous enhancement,HCC-predominance and necrosis were presented in 4(66.6％) and 0 (0％) cases,respectively.There were significant differences in relative proportion of HCC,CC components and tumor necrosis among the three types of enhancement pattern on CEUS (P =0.009 and P ＜ 0.001).When CHCs were ≤ 5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 5,3 and 5 cases,respectively.When CHCs were ＞5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 8,18 and 1 cases,respectively.There were significant differences in the three types of enhancement pattern between lesion size of ≤5 cm and ＞5 cm on CEUS (P =0.006).Conclusions The imaging findings of CHC on CEUS depends on the relative proportions of HCC and CC component and on size-dependent patterns.
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Objective To evaluate the safety and effective of ultrasound-guide percutaneous radio frequency ablation (RFA).Methods Retrospectively analyze the incident,management and influence factors of complication of ultrasound-guide percutaneous RFA.Results From 2001 to 2011,536 patients with 762 lesions underwent RFA were enrolled in this study.Incident of RFA complication was 2.03％ (11/536),including 5 (0.92％) major complication.The complication covered fever (1 case),massive hydrothorax (2 cases),hydrothorax accompany with ascites (1 case),massive ascites (1 case),liver abscess (1 case),liver capsule hemorrhage (1 case) and hemothrorax (1 case).No RFA relate mortality was observed.According to logistics regression analysis,the liver function Child-Pugh grading was associated with the RFA complication (P =0.005).Conclusions Ultrasound-guide percutaneous RFA is a safe and effective local treatment approach for hepatocellular carcinoma.It's necessary to comprehensively think over the basic condition of patients and the characters of tumor such as tumor location,size and abutting organs.Nevertheless,an appropriate treatment plan and closely monitor during and after RFA are crucial.
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Objective To investigate the feasibility of our new found 3-dimensional contrast-enhanced ultrasound 3D-CEUS registration system as an early assessment of the therapeutic response to radio frequency ablation for liver cancer Methods Twenty-seven patients with 28 lesions accepted 3D-CEUS before and after radio frequency ablation RFA the therapeutic respond to which would be assessed with 3D-CEUS registration system recording the rate of successful registration The CT was considered as the reference standard Results Ten cases 35 7% were successful matched with auto-registration and 24 cases 85 7% were succesful matched with interactive-registration relatively All cases were considered as complete ablated which were confirmed by CECT with 100% accuracy There were two cases achieving ablation margins ≥5 mm without local tumor progression LTP and nineteen cases achieving 0 -4 mm ablation margin with 3 LTP 3-month 6-month and 1-year later Conclusions The 3D-CEUS interactive-registration system can easily assess the therapeutic response of RFA in liver cancer immediately with high accuracy.
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Objective To retrospectively analyze the ultrasonic imaging features and clinical out-comes of biliary complications after percutaneous ablation for hepatic malignant tumors .Methods The cli-nical data of patients with postablation biliary complications who underwent percutaneous ablation for hepatic malignant tumors in the past 7 years in our department were retrospectively analyzed .The ultrasonic imaging features and the clinical outcomes of biliary complications on follow-up of these patients were analyzed .Re-sults Postablation biliary complications occurred in 65 patients , including 34 patients with bile duct dilata-tion and 31 patients with biloma .In patients with bile duct dilatation , the dilated bile ducts were located dis-tal to the ablation lesions in all these patients .Among 30 patients with bile duct dilatation , the dilatation was progressive in 9 patients (9/30, 30.0%) and stable in 20 patients (20/30, 66.7%), while in one patient (1/30, 3.3%) it resolved on follow-up.The radiologic features of bilomas mainly manifested as four types:crescent , interspersed , circumferential and solitary nodular , and the number of patients with the four types were 13 (13/31, 41.9%), 13(13/31, 41.9%), 3(3/31, 9.7%) and 2(2/31, 6.5%), respectively. In 6 patients (6/31, 19.4%) the bilomas were subjected to interventional or surgical therapy while for the remaining 25 patients (6/31, 19.4%) they were treated conservatively .Three (3/25, 12.0%) of the lat-ter 25 patients had spontaneously disappearance of the biloma and 2 (2/25, 8.0%) of the remaining 22 pa-tients appeared to have progressive increase in size .In 17 (17/25, 68.0%) patients the biloma remained stable in size and in the remaining 3 patients (3/25, 12.0%) the bilomas resolved.Conclusions Postab-lation biliary complications of ultrasound-guided percutaneous ablation for hepatic malignant tumors mainly presented as biloma and bile duct dilatation .Dilated bile ducts were located in the distal side of the ablation zones.Crescent type and interspersed type were the most common morphological types of biloma .Although most patients with postablation biliary complications of ultrasound-guided percutaneous ablation remained sta-ble or resolved on follow-up, interventional or surgical therapy was necessary in the minority of patients .