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Objective To investigate the value of real-time virtual navigation system (RVS) combined with CEUS in guiding radiofrequency ablation (RFA) therapy of neonatal or recurrent lesions of hepatocellular carcinoma (HCC).Methods Totally 111 patients with neonatal or recurrent lesions of HCC after RFA therapy were enrolled.Seventy-eight patients with 86 lesions (77 neonatal lesions and 9 recurrent lesions) underwent RFA guided by RVS combined with CEUS (RVS combined with CEUS group),and 33 patients with 38 lesions (26 neonatal lesions and 12 recurrent lesions) underwent RFA guided by CEUS alone (control group).The precise localization,inactivation rate and local recurrence rate between the two groups were compared.Results Eighty-four lesions (84/86,97.67％) in RVS combined with CEUS group and 25 lesions (25/38,65.79％) in control group were clearly showed and localized (P＜0.001).One month after RFA therapy,the tumor inactivation rate in RVS combined with CEUS group and control group was 95.35 ％ (82/86) and 76.31％ (29/38),respectively (P=0.003).The local recurrence rate in RVS combined with CEUS group was 8.14％ (7/86),while was 36.84％ (14/38) in control group (x2 =15.434,P＜0.001).Conclusion RVS combined with CEUS guidance can improve the accurate position rate and early inactivation rate of RFA therapy for neonatal or recurrent lesions of HCC.
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Objective To investigate the application value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treatment of liver metastases of malignant tumor.Methods Clinical and imaging data of 109 patients with liver metastases of malignant tumor who underwent ultrasound-guided percutaneous RFA during December 2009 to May 2015 were retrospectively analyzed.Results There were 31 patients (31/109,28.44％) with single liver metastases and 78 patients (78/109,71.56％) with multiple lesions.The primary tumors included colorectal,lung,breast,gastric,pancreatic,ovarian and prostate carcinomas.Among all 198 liver metastases,there were 151 (151/198,76.26％) with diameter ＜ 3 cm and 47 (47/198,23.74％) with diameter ≥3 cm.One month after RFA,187 lesions (187/198,94.44％) were completely inactivated,while the other 11 lesions (11/198,5.56％) still had residual activity.One month later,the tumor markers improved obviously compared with those before treatment (all P＜0.05).The incidence of intraoperative and postoperative complications was 6.42％ (7/109).Conclusion Ultrasound-guided percutaneous RFA is a safe and effective treatment for patients with non-surgical indications of malignant liver metastases,which can partially control the survival activity of liver metastases.
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<p><b>OBJECTIVE</b>To explore the value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in designing the indication, treatment protocol and operational skills for patients with primary hepatocellular carcinoma (HCC) near the liver surface.</p><p><b>METHODS</b>Sixty-one HCC patients with 69 lesions, confirmed by clinical examination and pathology, underwent percutaneous radiofrequency ablation. The study included 40 cases of liver function Child-Pugh grade A and 21 cases of grade B. The average size of tumors was (3.8 ± 1.2) cm, tumor diameter ≥ 4 cm accounted for 39.1% (27/69 lesions), and the average age was 58.2 years (range, 35-76 years). Taking comprehensive measures, such as intraperitoneal injection of saline adjacent to the tumor before RFA, increasing the puncture sites on the surface of tumor to avoid overlapping of the central portion of tumor, repeated ablation of the needle track to reduce needle tract metastasis, avoid vertical puncture, and other additional measures, to improve the inactivation of tumors adjacent to the liver surface. Enhanced CT/MRI was performed to evaluate the curative effect at 1, 3, 6 and 24 months after the treatment.</p><p><b>RESULTS</b>The inactivation rate of tumor was 98.6% (68/69 lesions) and local recurrence rate was 5.8%(4/69) after RFA. The tumor-related marker AFP was 1 000-1 500 ng/ml before and reduced to (98.5 ± 42.5) ng/ml after radiofrequency ablation, among them returned to normal in 13 cases (21.3%). Since the ablation area was rather small, the level of serum alanine aminotransferase was elevated only to (148.5 ± 38.5) U/ml at one week after RFA and returned to normal at (1.8 ± 0.6) week after RFA. No patient experienced severe liver dysfunction. The local HCC recurrent rate after RFA was 5.8%(4/69 lesions) and intrahepatic heterotopic recurrence rate was 24.6% (15/61). The 20-61 months follow-up showed that the 1-, 2- and 3-year survival rate was 83.6%, 57.3% and 44.2%, respectively.</p><p><b>CONCLUSIONS</b>Ultrasound-guided percutaneous radiofrequency ablation provides an effective minimally invasive treatment for primary HCC near the liver surface. Taking some additional measures such as intraperitoneal injection of saline, increase of percutaneous puncture sites, and avoiding vertical needle puncture, may reduce complications and improve the therapeutic outcome. RFA is one of effective and minimally invasive treatment and causing less liver damage for primary HCC near the liver surface.</p>
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Adult , Aged , Humans , Middle Aged , Biomarkers, Tumor , Blood , Carcinoma, Hepatocellular , Blood , Pathology , General Surgery , Catheter Ablation , Methods , Liver , Pathology , Liver Neoplasms , Blood , Pathology , General Surgery , Magnetic Resonance Imaging , Methods , Neoplasm Recurrence, Local , Survival Rate , Treatment Outcome , Tumor Burden , Ultrasonography, InterventionalABSTRACT
Objective To summarize the characteristics of low echo lesions by ultrasound findings in fat-ty liver,using real -time contrast -enhanced ultrasonography ( CEUS) for differential diagnosis .Methods The study was examed in 128 cases low echo lesions of fatty liver by using CEUS ,the malignant and the highly suspec-ted malignant and part of the benign lesions (in all the 52 cases)were punctured by ultrasound guided biopsy ,the rest of the 76 cases was confirmed benign by clinical comprehensive diagnosis ,were compared to the characteris-tics about ultrasound and contrast -enhanced ultrasound image and reviewed regular follow -up.We calculated the sensitivity,specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultrasound and apply for Kappa test for reliability analysis to contrast -enhanced ultrasonography and ultra-sound.Results There were 23 malignant lesions and 105 benign lesions in total of 128 patients.The sensitivity, specificity,youden index and the area under the ROC curve by contrast -enhanced ultrasonography and ultra-sound were 95.65%,98.10%,93.75% and 87.00%,91.43%,84.43%respectively.Compared contrast -en-hanced ultrasound examination diagnosis of low echo lesions in fatty liver with the clinical diagnosis performed good reliability(Kappa=0.922,P=0.045).Conclusion We should pay attention to low echo lesions in the fatty liver.contrast-enhanced ultrasound can effectively identify low echo lesions in the fatty liver ,and identify benign and malignant lesions in the liver ,and improve obviously the accuracy of diagnosis ,and reduce the misdi-agnosis rate.
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Objective To assess the value of contrast-enhanced ultrasonography (CEUS) before percutaneous radiofrequency ablation (RFA) in treating patients with liver metastases. Methods A total of 267 patients with 485 liver metastatic lesions were treated with percutaneous RFA in authors ’ department during the period from July 2001 to December 2012. Among them , 180 patients with 251 lesions received CEUS examination before RFA and based on CEUS findings the treatment scheme was made (CEUS group), and other 87 patients with 234 lesions without use of preoperative CEUS were used as control group. No significant differences in clinical data existed between the two groups (P0.05). The local recurrence rate of CEUS group was lower than that of the control group: 12.4% (46/234) vs. 19.7%(31/251) (P 0.05). Conclusion CEUS performed before RFA treatment for patients with liver metastases is very useful for accurately judging the size and number of the lesions, which is very helpful in making therapeutic scheme. Therefore, preoperative CEUS can significantly increase early tumor necrosis rate and decrease the local recurrence rate.
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Objective To evaluate the clinical value of contrast enhanced uhrasound(CEUS)for uhrasoundguided radiofrequency ablation(RFA)of liver metastasis.Methods One hundred and forty-one consecutive patients with liver metastasis asked for RFA treatment in our department.Of them,102 patients with received CEUS with SonoVue before RFA treatment.Eighty-six of the 102 patients were regarded as indications for RFA by CEUS(Group A).During the same period,another 39 patients who received conventional US without contrast before RFA were served as the control group(Group B).In Group A,the RFA protocol for each case was designed according to CEUS finding,which included perfusion feature,lesion number,size,shape,invasive range,location and relationship between tumor and surrounding structures.In Group B.the RFA protocol for each case was designed according to conventional ultrasound and CT/MRI result.Results In 102 patients who intended to receive RFA treatment,1 6 were excluded from RFA after CEUS examination.Of them,3 patients with 10 tumors received 6-10 sessions of chemotherapy and there were no enhancement within or around tumors.Another 13 cases were found that the invasive range being more than 8 cm in size,tumor number more than 7,and tumor location adhered to diaphragm and second hepatic helium by CEUS.In Grou0 A,CEUS detected additional 1-3 tumors in 36 patients(41.9%).The size range of the 58 new tumors was 8-15 mm.Of these,79.4%(46/58 tumors)were visualized in parenchymal phase.A total of 209 liver metastasis tumors were treated by RFA.CEUS before RFA demonstrated 49.7%(75/151 tumors)were 1arger in size compared with conventional US.Of these,69.3%(52/75 tumors)presented larger in arterial phase,the remaining 30.7%(23/75 tumors)presented larger in parenchymal phase,and the increased area was also ablated.On 1-3 months follow up with CT,the tumor necrosisrate in Group A was 94.7%(198/209 tumors),which was significantly higher than 87.6%(99/113 tumors)in Group B ( P=0.013). During follow-up period, local recurrence were found in 15 tumors (7.1 %) 2-17 months after REA and intrahepatic new tumors developed in 32 patients (37.2%) 2-17 months after RFA in group A,While local recurrence were found in 16 tumors (14.1%) and intrahepatic new tumors developed in 17 patients (43.5%) in group B ( P=0. 041, P ＞0.05, respectively). Conclusions CEUS provides important information for selecting candidation and designing optimal protocol for RFA in liver metastasis. The use of CEUS can increase tumor necrosis rate and decrease post-RFA tumor local recurrence,and then improve efficacy of RFA therapy.
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Objective To observe the degree of liver su rface abnormality using high frequency probes and additional methods and to investigate the diagnostic value of semi-quatitative grading in liver fibrosis and cirrhosis. Methods One hundred and twenty-seven cases of cirrhosis (including 83 cases of hepatocelular carcinoma) confirmed by operation and pathology were enrolled in the group while 56 cases of non-cirrhotic patients with no clinical signs and negative surgical gross findings (operation for other kinds of tumors) served as the control. Five additional methods such as high frequency probes, harmonic technique, local zooming out, regulating focus and decreasing gain were used to observe the configuration and thickness of liver surface. Five-grade classification of liver surface was adopted as follows: thin and regular-grade 0; slightly thickened with increased echogenicity-grade Ⅰ; thickened like fine ripples-grade Ⅱ; significantly thickened with segmental incontinuence-grade Ⅲ; significantly thickened like waves-grade Ⅳ. Observation on configuration of the round ligament: thin, regular with the thickness ≤2 mm was considered as normal whereas thickened, irregular with increased echogenicity as abnormal. Results Of the 127 cases in the study group, 11 cases were grade 0, and grade Ⅰ 21 cases, grade Ⅱ 27 cases, grade Ⅲ 32 cases, grade Ⅳ 36 cases. In the control group there were 48 cases of grade 0 and 8 cases of grade Ⅰ-Ⅱ. The sensitivity, specificity and accuracy of liver surface detection with this method were 91.3-%, 85.7-%, 89.6-%, respectively. 75% (9/12 cases) patients with liver fibrosis and 95.5%- patients ( 64/67- cases) with cirrhosis were found with abnormality of hepatic ligaments in the study group. While only 4 cases ( 8.9-%) with abnormality appeared in the control group.Conclusions Grading of changes in liver surface might sensitively reflect their pathological changes. In addition, it would be a reliable method in the diagnosis of liver fibrosis and early stage cirrhosis as well as a semi-quatitative diagnostic tool for advancement of diffuse liver diseases.
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ObjectiveTo evaluate the effect of ultrasound guided radiofrequency ablation (RFA) on malignant liver tumors.Methods82 patients of primary liver cancer and 49 patients of metastatic liver cancer with a total of 226 cancer foci underwent percutaneous ultrasound guided RFA.ResultsCT performed 1 day～1 month post treatment showed a complete ablation in 203(90%) nodules. One hundred and six patients were followed up for 3～26 months, the survival rate of 3, 6 months and 1 year was 98 1%(104/106), 85 7%(72/84) and 73 7%(42/57), respectively. The major post RFA complications occurred in 6 cases(4 6%) including hemorrhage, hepatic abscess, bile leak, and cholecystitis with no mortality.ConclusionUltrasound guided RFA for the treatment of malignant hepatic tumors has the advantage of good palliative results, easy compliance by the patients, and enabling repeated therapy.
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【Objective】To explore the therapeutic effect of TCM syndrome differentiation and treatment for immunoglobulin A(IgA) nephropathy.【Methods】The selected 123 patients with IgA nephropathy were divided into two groups(in the proportion of 3∶1) by number randomization.Group A(n=86) was given Tripterygium Glycosides tablets and differential treatment according to syndrome patterns,and Group B(n=37) was given routine western medicine including anti-inflammation drugs,drugs for controlling blood pressure and glucocorticoid hormone.The two groups received a 3-month treatment course and received one more course according to individual cases.The total therapeutic effect,effect for TCM syndrome patterns,and toxic and side effects were observed.The changes of TCM syndrome scoring were compared before and after treatment.【Results】In group A,symptoms were completely relieved in 29,markedly relieved in 30,relieved in 15 and un-relieved in 12 patients,the total effective rate being 86.05%,while respectively in 4,5,10 and 18 of patients in group B,the total effective rate being 51.35%.The total effect was better in group A than that in group B(P0.05).The improvement on TCM syndrome scoring in group A was superior to that in group B(P
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0.05).The Nestin and C-kit expressions can be detected in all cases of GISTs by RT-PCR and Western Blot.Conclusion In conjunction with C-kit,Nestin may be a useful marker for diagnosis of GISTs but it cannot be used as a tumor differentiation index.