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Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence in China and the whole world, and early diagnosis and treatment are the key to improving the prognosis of patients. To facilitate the communication and cooperation between doctors of different centers and specialties, American College of Radiology issued the first edition of contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) in 2016 to standardize the technical terms, techniques, interpretation, reporting, and data collection for liver imaging and perform HCC risk stratification for different focal liver lesions. This article reviews the development and clinical application of CEUS LI-RADS and believes that the application of CEUS LI-RADS has a great potential value in the clinical management of focal liver lesions in the population at a high risk of HCC, and the applicable population and indications for CEUS LI-RADS will continue to expand in the near future, so as to provide better service to clinical practice.
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Objective:To explore the inconsistent and consistent classifications for lesions ≤2 cm by contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System(LI-RADS) v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI) LI-RADS v2018.Methods:The focal liver lesions ≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018. Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa. Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results:A total of 145 lesions with a size of (1.65±0.33)cm in 145 patients were included. The numbers of lesions in LR-3, 4, 5 and M were 16, 23, 90 and 16 on CEUS LI-RADS, 25, 31, 87 and 2 on CECT/MRI, respectively. And 73.1% lesions were classified as LR-5 or M on CEUS, while 61.4% lesions were classified as LR-5 or M on CECT/MRI ( P=0.033). The incidences of HCC in LR-3, 4 and 5 were 37.5%, 52.2% and 97.8% on CEUS LI-RADS, 56.0%, 64.5% and 96.6% on CECT/MRI LI-RADS respectively. Among the 145 lesions, 56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS. Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1% of them were found to be HCC. Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7% of them were found to be HCC. Conclusions:The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC. However, the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor. The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M, while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.
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Objective:To investigate the feasibility and safety of ultrasound-guided percutaneous submandibular region puncture and drainage(PSPD) for treating parapharyngeal space abscess (PPSA).Methods:The clinical data of 26 patients with PPSA receiving PSPD from January 2015 to December 2019 in the Third Central Hospital of Tianjin were retrospectively analyzed.Results:All 26 patients successfully underwent puncture and catheterization with a primary success rate of 100%. After catherization, pain relieved within 12-24 hours, body temperature returned to normal within 24-48 hours, white blood cell(WBC) and C-reactive protein(CRP) returned to normal within 48-96 hours. The catheterization duration ranged from 5 to 14 days and the average time was 7 days. There were statistically significant differences in the body temperature, maximum abscess diameter, WBC and CRP between pre-operation and 7 days after operation(all P<0.001). None of the 26 patients experienced any serious complications such as major vessels, nerve or glands injury. Bacterial cultures were positive in 18 patients and the most common bacteria was hemolytic streptococcus. Conclusions:PSPD is an effective, safe and minimally invasive method for the treatment of PPSA as an alternative to operative incision and drainage.
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Objective:To investigate the diagnosis and treatment value of intraoperative ultrasound (IOUS) in video-assisted thoracic surgery (VATS) of small solitary pulmonary nodule (SSPN).Methods:Of the 35 SSPN patients who received VATS in Tianjin Third Central Hospital from January 2016 to January 2020, the visual and touch examination (VTE) and IOUS method were used to locate pulmonary nodules during the operation. The differences between the two methods in the locating success rate and locating time were compared. The imaging findings of SSPN were classified and the sonographic characteristics of SSPN were summarized by univariate analysis.Results:The success rate of IOUS locating was 91.43%(32/35), which was higher than that of VTE 48.57%(17/35), and the difference was statistically significant (χ 2=15.310, P<0.001). The time of IOUS locating (6.23±1.93)min was shorter than that of VTE(9.98±1.56)min, and the difference was statistically significant ( t=6.940, P<0.001). The sonograms of 32 SSPN(17 malignancy and 15 benign) patients were all hypoechoic, univariate analysis showed that heterogeneous echo (χ 2=10.615, P=0.01) and unclear borderline (χ 2=10.041, P<0.001) were helpful to judge the benign or malignant. Conclusions:In video-assisted thoracic surgery, using IOUS could quickly and accurately locate and diagnose SSPN, which can shorten the operation time, improve the resection efficiency and guide the operation.
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Objective:To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma (CHC) in CEUS and CECT/MRI and to explore the role of imaging, the discordance of imaging findings and tumor markers, differences in tumor markers in the diagnosis of CHC.Methods:Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed. The enhancement patterns of CHCs on CEUS and CECT/MRI were compared. A combination of the discordance of CEUS and CECT/MRI, the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results:About 62.9% and 37.1% lesions showed the HCC and ICC enhancement patterns on CEUS, while 48.6%, 31.4% and 20% lesions showed the HCC, ICC and CHC enhancement patterns, on CECT/MRI, respectively. For 12 lesions with a diameter≤3.0 cm, all of which presented HCC enhancement patterns on CEUS, and 91.7% lesions showed HCC enhancement pattern and 9.3% lesions showed ICC enhancement pattern on CECT/MRI, respectively. For 23 lesions with a size >3.0 cm, 43.5% and 56.5% of which showed the HCC and ICC enhancement patterns on CEUS, respectively. And 26.1%, 43.5% and 30.4% of the lesions showed the HCC, ICC and CHC enhancement patterns on CECT/MRI, respectively. If the discordance of CEUS and CECT/MRI, the discordance of image features and tumor markers, or simultaneous elevation of AFP and CA19-9, were used as diagnostic information, 78.6% of the lesions met at least one of the three criteria.Conclusions:CHCs show different enhancement patterns on CEUS and CECT/MRI. With the increase of size of tumors, the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like. Combination of the discordance of CEUS and CECT/MRI, the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.
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Objective:To explore the clinical value of Liver Imaging Reporting and Data System (LI-RADS) version 2017 with contrast-enhanced ultrasound (CEUS) for the risk prediction of hepatocellular carcinoma (HCC).Methods:Five hundred and seventy-one patients with HCC risk factors had received CEUS examination in Tianjin Third Central Hospital, 270 patients with 295 nodules were enrolled in this study according to the inclusion criteria. The final diagnostic reference standard was decided by surgical pathology or ultrasound-guided biopsy pathology. Each nodule was classified according to CEUS LI-RADS v2017. The diagnostic accuracy of CEUS LI-RADS v2017 for the prediction of HCC was analyzed retrospectively.Results:Of all 295 nodules, 95 nodules were diagnosed by surgical pathology and 200 nodules by ultrasoud-guided biopsy pathology, among which with 245 HCC, 13 intrahepatic cholangiocarcinoma (ICC), 8 combined hepatocellular cholangiocarcinoma(CHC), 2 metastatic neoplasm of other cellular origin and 27 benign nodules.The numbers of LR-3, LR-4, LR-5 and LR-M categories were 16(5.4%), 28(9.5%), 183(62.0%), 68(23.1%) and the positive predictive value (PPV) of LR-3, LR-4 and LR-5 were 43.8%, 60.7%, 98.4% for HCC, respectively. The sensitivity, specificity and positive predictive value of LR-5 category for HCC were 73.5%, 94.0%, 98.4%, respectively. 60.3%(41/68) LR-M category nodules were pathologically confirmed to be HCC.Conclusions:CEUS LI-RADS v2017 classification standard has reliable risk prediction value for patients with high risk factors of HCC, of which the LR-5 category has higher PPV for HCC. However, the differential diagnosis between HCC and other non-HCC malignancies still remains to be further studied for LR-M observations.
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Objective@#To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis, and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).@*Methods@#One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study. The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed. The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months. The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared. A new diagnostic strategy, which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.@*Results@#The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814(P>0.05), the sensitivity were 79.1%, 81.4%, specificity were 92.6%, 81.5% and diagnostic accuracy were 82.3% and 81.4%, respectively. By combination of CEUS and EOB-MRI, the area under the ROC curve was 0.831, without difference from CEUS, EOB-MRI (0.831 vs 0.858, 0.814; all P>0.05); its sensitivity was 66.3%, specificity was 100% and diagnostic accuracy was 74.3%. The area under the ROC curve of the new diagnostic strategy, combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934, which was larger than that of CEUS, EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858, 0.814, 0.831; all P<0.05). The sensitivity, specificity and diagnostic accuracy of new strategy were 94.2%, 92.6% and 93.8%, respectively.@*Conclusions@#The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions, which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective@#To explore the value of superb micro-vascular imaging(SMI) combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.@*Methods@#The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively. According to the pathological results, the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound, SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation, and the basal width, continuity of cystic wall and internal blood flow morphology of polyps were evaluated. The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps, the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold. Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.@*Results@#Of the 67 patients, 22 cases were neoplastic polyps, and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound (0-9 points) and the ROC curve was plotted with, area under curve 0.893(95% CI 0.792-0.994). The sensitivity, specificity and accuracy of diagnosing neoplastic polyps with score (≥4.5) were 77.3%, 93.3% and 88.1%, respectively. Compared with the score of CEUS for microblood flow display (0-4 points), the Kappa values of CDFI, SMI was 0.186, 0.688. SMI and CEUS have good consistency.@*Conclusions@#SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder, with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow. It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.
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Objective To explore the value of superb micro-vascular imaging(SMI)combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.Methods The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively.According to the pathological results,the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound,SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation,and the basal width,continuity of cystic wall and internal blood flow morphology of polyps were evaluated.The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps,the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold.Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.Results Of the 67 patients,22 cases were neoplastic polyps,and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound(0-9 points) and the ROC curve was plotted with,area under curve 0.893 (95％ CI 0.792-0.994).The sensitivity,specificity and accuracy of diagnosing neoplastic polyps with score(≥4.5) were 77.3％,93.3％ and 88.1％,respectively.Compared with the score of CEUS for microblood flow display(0-4 points),the Kappa values of CDFI,SMI was 0.186,0.688.SMI and CEUS have good consistency.Conclusions SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder,with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow.It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.
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Objective To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis,and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).Methods One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study.The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed.The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months.The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared.A new diagnostic strategy,which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.Results The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814 (P ＞ 0.05),the sensitivity were 79.1％,81.4％,specificity were 92.6 ％,81.5 ％ and diagnostic accuracy were 82.3 ％ and 81.4 ％,respectively.By combination of CEUS and EOB-MRI,the area under the ROC curve was 0.831,without difference from CEUS,EOB-MRI (0.831 vs 0.858,0.814;all P ＞0.05);its sensitivity was 66.3 ％,specificity was 100％ and diagnostic accuracy was 74.3％.The area under the ROC curve of the new diagnostic strategy,combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934,which was larger than that of CEUS,EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858,0.814,0.831;all P ＜0.05).The sensitivity,specificity and diagnostic accuracy of new strategy were 94.2％,92.6％ and 93.8％,respectively.Conclusions The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions,which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective To compare the effectiveness of microwave thermosphere ablation( M T A ) and traditional microwave ablation( M WA ) in ex v ivo bovine livers ,and to compare the degree of the heat sink effect in them .Methods T he non‐vessel model and vessel model were established using fresh bovine livers . In non‐vessel model ( n ＝ 48 ) ,the same power‐time settings were used in both M T A group and MWA group ,w hich were 80 W 12 min ,90 W 10 min and 100 W 10 min ,respectively . Long‐axis diameter ( Dl) , short‐axis diameter( Ds1 ,Ds2) ,roundness index ( R) and the time of temperature rising to 60℃ at place of 10 mm from the needle were measured .In vessel model( n ＝144) ,different vessel diameters( 3 mm ,5 mm ,10 mm) and flow rates ( 15 cm/s ,20 cm/s ,30 cm/s) were setted . The maximum radius( Rmax) ,total area of ablation zone( Sz ) ,and the area difference ( Sdiff ) were analyzed ,the temperatures adjacent to the vessel were monitored simultaneously . Results In non‐vessel model ,with the same power and time settings ,the Dl of M T A group was significantly smaller than MWA group ( P ＜ 0 .01 ) , however , there was no significant difference of Ds1 and Ds2 between the two groups( P ＞0 .05) . And M T A group created more spherical ablation zones ,since the R of M T A group were more close to 1 ( P ＜0 .01) . In M T A group ,the time of temperature rising to 60 ℃ at place of 10 mm from the needle was slower than MWA group ( P ＜0 .01) . In vessel model ,the Sdiff of M T A group were hardly affected by the vessel diameters and flow rates ( P ＞0 .05) ,and there was also no statistical significance among different flow rates( P ＞0 .05 ) in M WA group ,but the Sdiff of M WA group was significantly affected by the vessel diameters( P ＜0 .01) . And the Sdiff of M T A group was significantly smaller than M WA group when the vessel diameter was 10 mm ( P ＜0 .05) ,while there was no statistical significance between the two groups w hen the vessel diameter was 3 mm or 5 mm( P ＞0 .05) . Conclusions Compared to M WA ,M T A can produce sizable ,regular and more spherical ablation lesions with the same power and time ,meanwhile ,it is less affected by the heat sink effect .
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Objective To explore the clinical significance of dynamic 3-dimensional contrast-enhanced ultrasound (D-3D-CEUS) in assessing the efficacy of microwave ablation (MWA) therapy of hepatocellular carcinoma (HCC). Methods Two hundred and fifty-one HCC lesions from 185 patients undergoing ultrasound-guided percutaneous MWA were studied by D-3D-CEUS and contrast-enhanced computed tomography(CECT) one month after ablation.Imaging results from two imaging modalities were evaluated independently to determine whether the treated lesions were ablated incompletely (residual lesion) or completely.The final diagnosis standard was biopsy pathology or clinical follow-up results.Results One hundred and eighty-five patients were successfully ablated completely.There was no serious complication observed.The final diagnosis standard identified 93.2% (234/251) of ablated lesions as complete ablation and 6.8% (17/251) as incomplete. With the final diagnosis as the reference standard,the sensitivity, specificity,positive predictive value,negative predictive value,and accuracy of D-3D-CEUS and CECT were 82.4% (14/17) vs 88.2% (15/17),98.3% (230/234) vs 97.4% (228/234),77.8% (14/18) vs 71.4%(15/21),98.7% (230/233) vs 99.1% (228/230),97.2% (244/251) vs 96.8% (243/251),respectively. The difference between the D-3D-CEUS and CECT was not statistically significant(χ2=0.14,P =1.00).The consistency analysis showed that D-3D-CEUS and CECT were highly consistent with the final diagnosis standard (Kappa=0.81,P =0.00).Conclusions D-3D-CEUS imaging can be used for assessment of HCC MWA and be used as a useful supplement for CECT.
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Objective To analyze Glisson system-related complications after percutaneous thermal ablation of liver cancer and the relationship with tumor location.Methods Data of 2 218 case-times of ultrasound-guided percutaneous thermal ablation in 1 879 patients with liver cancer were retrospectively analyzed.Four types were defined according to the relative position between the tumor and Glisson system:Tumor close to the first branch of the portal vein (type Ⅰ),the second branch of the portal vein (type Ⅱ),the third branch of the portal vein (type Ⅲ) and far away from portal vein (type Ⅳ).Types Ⅰ to Ⅲ were classified as close to Glisson system group,while type Ⅳ was classified as far away from Glisson system group.The Glisson system-related complications (cholesteatoma,bile leakage,serious biliary stricture,cholangiobronchial fistula,arterio-venous fistula and arterial aneurysm) were analyzed.Results Glisson system-related severe complications occurred after 20 case-times (20/2 218,0.90 ％) of thermal ablation.The incidence of Glisson system-related severe complications in close to Glisson system group (1.81 ％ [16/886]) was higher than that in far away from Glisson system group (0.30％ [4/1 332],P＜0.001).The incidence of Glisson system-related severe complications of type Ⅰ,Ⅱ,Ⅲ and Ⅳ was 6.35％ (4/63),3.52％ (5/142),1.03％ (7/681) and0.30％ (4/1 332),respectively (P＜0.001).Glisson system-related mild complications included liver function damage (280 case-times),portal thrombosis (156 case-times) and slight cholangiectasis (82 case-times).The incidences of the three Glisson system-related complications mentioned above decreased from type Ⅰ to Ⅳ.Conclusion Percutaneous thermal ablation is safe in treating patients with tumors close to Glisson system.But the risk of incidence of Glisson system-related severe complications is higher when the tumor is close to the more advanced branch of portal vein.
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Objective To compare the diagnostic value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced helical computed tomography (CECT) for hepatocellular carcinoma (HCC) with liver cirrhosis. Methods Two hundreds and forty-one focal liver lesions in 207 patients with Hepatitis B virus (HBV) cirrhosis were detected with CEUS and CECT, respectively. Pathological results were used asgold standardto compare the two methods. Diagnostic results of the two methods were compared with pathological results. Differences were assessed using the McNemar test, and the Kappa test was used for consistency evaluation. Results (1) For 113 liver lesions that were ≤2 cm, the number of HCC lesions was 63, and the number of benign lesions was 50. There were no significant differences in results of CEUS and CECT compared with that of the gold standard of McNemar test results (P = 0.824, P = 0.082). Consistency of the Kappa test results of CEUS and CECT in comparison with the gold standard was general (Kappa = 0.643, Kappa = 0.421). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC diagnosed by CEUS were higher than those of CECT. The rate of arterial enhancement was better for CEUS [87.30% (55/63)] than that for CECT [69.84%(44/63),χ2=5.704, P=0.017]. (2) For 128 liver lesions that were>2 cm, the number of HCC lesions was 77, and the number of benign lesions was 51. There were no significant differences in the diagnostic results between McNemar test and CEUS and CECT tests (P = 0.481, P = 0.167). Consistency of the Kappa test results of CEUS and CECT and gold standard was general (Kappa = 0.710, Kappa = 0.697). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HCC were not different between two diagnostic methods. The rate of arterial enhancement was 89.61%(69/77) for CEUS and 85.71%(66/77) for CECT, and there was no significant difference between the two groups (χ2=0.540, P=0.462). Conclusion For HCC≤2 cm, the diagnostic performance of CEUS is better than that of CECT. For HCC>2 cm, the diagnostic performance is similar for the two diagnostic methods.
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Objective To analyze the safety and efficacy of ultrasound-guided microwave ablation (MWA) for patients with primary hepatocellular carcinoma (HCC) at dangerous locations.Methods Data of 375 patients with HCC underwent MWA were retrospectively analyzed.According to the location of tumors,the patients were classified into dangerous group (distance from vital tissues to lesions ≤5 mm) and non-dangerous group (distance from vital tissues to lesions ＞5 mm).The efficacy of MWA and the incidence of serious complications of the two groups were compared.Results There were 196 patients with 258 lesions in dangerous group and 179 patients with 233 lesions in non-dangerous group.No statistical differences of the completed ablation rate was found between dangerous group (97.67％ [252/258]) and non-dangerous group (97.85％ [228/233],P=0.61).The 1-,3-,5-year local tumor progression (LTP) rates were 9.57％,19.72％,24.18％ in dangerous group and 7.34％,13.44％,14.61％ in non-dangerous group.The 1-,3-,5-year progression free survival (PFS) rates were 68.88％,36.22％,25.37％ in dangerous group and 73.74％,43.17％,19.12％ in non-dangerous group.The 1-,3-,5-year overall survival (OS) rates in dangerous group and non-dangerous group were 90.87％,69.50％,60.05％ and 94.97％,74.24％,64.91％,respectively.No statistically significant differences of the 1-,3-,5-year LTP,OS and PFS rates were found between the two groups (P=0.11,0.19,0.17).The serious complications rates were 3.06 ％ (9/196) and 1.11 ％ (2/179) in dangerous group and non-dangerous group,respectively,which had no statistically significant difference between the two groups (P =0.35).Conclusion Ultrasound-guided percutaneous MWA is safe and effective for patients with HCC at dangerous locations.The adjuvant methods can help MWA to gain the similar local and long-term outcomes for patients with HCC at dangerous locations to those at non-dangerous locations.
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Objective To investigate the clinical application of serum interleukin-6 (IL-6)and interleukin-22 (IL-22) levels in predicting the recurrence of hepatitis B virus (HBV)-related early hepatocellular carcinoma (HCC) after receiving microwave ablation (MWA).Methods Preoperative peripheral blood samples were collected in 49 patients with early-stage HBV-related HCC,and serum concentrations of IL-6 and IL-22 were measured by using ELISA.Thirty healthy volunteers were recruited and used as the control group.The xtile software was used to define the best cut-off value,and the IL-6 and IL-22 levels were divided into highlevel group and low-level group.The tumor-free survivals of high-level and low-level groups were analyzed with Kaplan-Meier analysis,log rank test was adopted to determine the difference,and Cox regression model was employed to screen the risk factors affecting HBV-related HCC recurrence.Results The serum IL-6 and IL-22 levels of HCC group were 13.20 pg/ml (11.87-15.79 pg/ml) and 42.18 pg/ml (34.39-57.44 pg/ml) respectively,which were significantly higher than 10.47 pg/ml (9.50-13.82 pg/ml) and 25.45 pg/ml (22.31-30.12 pg/ml) of the control group (P=0.001 and P＜0.001 respectively).Kaplan-Meier analysis revealed that preoperative lower IL-6,higher total bilirubin and lower albumin levels indicated a shorter disease-free survival (DFS),and IL-22 levels had no statistically significant effect on the recurrence of HCC.Cox regression multivariate analysis showed that lower serum IL-6 level (≤ 13.2 pg/ml;hazard ratio=3.721;95％ CI=1.674-8.272;P=0.001) and lower serum albumin level (≤41.0 g/L;hazard mtio=2.085;95％CI=1.101-3.950;P=0.024) were independent risk factors affecting HBV-related HCC recurrence Conclusion Preoperative serum IL-6 level and serum albumin level can be used as the predictors of HCC recurrence in patients with HBV-related early HCC who are receiving MWA treatment.(J Intervent Radiol,2017,26:232-236)
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Objective To investigate the risk factors of biliary tract complications in patients with liver cancer after thermal ablation and the prevention methods.Methods One thousand seven hundred and ninety-seven patients with liver cancer underwent percutaneous thermal ablation were enrolled in this retrospective study.According to the relative position of the tumor and biliary tract,patients were classified into 4 groups:with the tumor close to the first branch (group Ⅰ),the second branch (group Ⅱ),the third branch of bile duct (group Ⅲ) and far away from the biliary tract (group Ⅳ).The tumor response and complications,especially biliary tract complications after ablation therapy of subgroups were analyzed.Results A total of 2 356 sessions were performed in 1 797 patients with 3 200 lesions.The local progression rates of the tumors close to and far away from biliary were 10.0 ％ and 8.2 ％ (P =0.080) and the rate of complete ablation were 96.5 ％ and 97.2 ％ (P =0.298),respectively.Fourteen patients suffered from major biliary complications after thermal ablation.Biliary complication incidences of the patients with the tumor close to the first,the second biliary tract were 6.5 ％ and 2.9 ％ respectively,which were all higher than those of the patients with the tumor close to the third(0.3％) and far away from biliary duct(0.2％).Conclusions Percutaneous thermal ablation is an efficient and safe method in the treatment of tumors close to biliary tract and with a low incidence of major biliary complications.Patients with a tumor close to the large branch of biliary duct were at high risk of complications.Those tumors,therefore,should be ablated with assisting methods and extra care.
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Objective To investigate the accuracy and availability of three‐dimensional ultrasonography ( 3DUS ) in the Bismuth‐Corlette classification of hilar cholangiocarcinoma ( HCCA ) . Methods Forty‐eight patients who underwent surgery and obtained pathologic diagnosis of HCCA were retrospectively analyzed . All patients underwent 3DUS and magnetic resonance cholangiopancreatography (MRCP) before surgery . With surgical outcomes as the gold standard ,the diagnostic efficacy of two examinations in classification of HCCA were compared . Results Forty‐eight cases of HCCA were divided into 5 types according to surgical results ,including type Ⅰ (8 cases) ,type Ⅱ(13 cases) ,Ⅲa(8 cases) ,Ⅲb (11 cases) and type Ⅳ(8 cases) respectively . Among them ,39 cases accepted radical resection and the rest of 9 cases received palliative resection . The accuracy of the Bismuth classification confirmed by 3DUS was 85 .4% (41/48) . The percentage of underestimated and overestimated classification confirmed by 3DUS were 10 .4% (5/48) and 4 .2% (2/48) respectively . The accuracy of the classification confirmed by MRCP was 87 .4% (42/48) .Both of the percentage of underestimated and overestimated classification confirmed by MRCP were samely 6 .3% (3/48) .The difference between the 3DUS and MRCP was not statistically significant(χ2 =0 .597 ,P=0 .440) . Both the percentage of underestimated and overestimated classification between 3DUS and MRCP were samely not statistically significant ( P =0 .714 , P =1 .000 ,respectively) . Conclusions As a new diagnostic technique ,3DUS was feasible and had significant value in evaluating HCCA classification comparable to MRCP .
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Objective To explore the thoracic and diaphragmatic complications of treating hepatic malignant tumor using thermal ablation techniques.Methods The patients received thermal ablations were involved as subjects from January 2002 to December 2013.The thoracic and diaphragmatic complications of treating hepatic malignant tumor with percutaneous thermal ablation were retrospectively analyzed.Results A total of 1 520 patients with 2 789 hepatic tumors [average largest diameter of tumor (2.30 ± 1 .03)cm] underwent 2 066 thermal ablation treatments.Five hundred and six radiofrequency ablation (RFA)and 1 560 microwave ablation procedures were performed,respectively.The complete ablation rate was 96.8%(2 701/2 789)at 1 month after treatment.The major thoracic and diaphragmatic complication rates were 0.8%(1 7/2 066 ),meanwhile the minor complication rates were 6.5% (134/2 066 ).Conclusions The thoracic and diaphragmatic complication rate of percutaneous thermal ablation is low in the treatment of hepatic malignant tumors.However,the major complications may cause serious consequences.Therefore, the patients of diaphragm-abutting liver tumors are fully assessed before thermal ablation treatments,and relevant prevention measures are completed.Open or laparoscope is used to assist thermal ablation treatment when necessary.
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Objective To explore the value of image fusion guided contrast-enhanced ultrasonography (CEUS) in detecting liver nodules with abnormal blood supply missed by ultrasonography (US) and CEUS.Methods In 35 patients with HBV cirrhosis,forty-two liver nodules with abnormal blood supply which were missed by US and CEUS but detected by contrast-enhanced CT/MRI were analyzed retrospectively.Image fusion guided CEUS was performed after ultrasound and contrast enhanced CT/MRI images were fused.The fusion time,technical success rate,nodule detection rate and diagnosis accuracy rate were analyzed.Results Image fusion was underwent successfully in all 35 patients,the technical success rate was 100％.Average fusion time was (4.1-± 1.8)min(1-17 min).Forty liver nodules with abnormal blood supply were detected by image fusion guided CEUS,and the detection rate was 95.2％ (40/42).One nodule located at the top of right liver was missed because of the influence of lung gas,the other one was invisible due to its deep position.The diagnosis accuracy rate of image fusion guided CEUS was 97.5 ％ (39/40),and two nodules misdiagnosed by contrast-enhanced CT were diagnosed correctly by image fusion guided CEUS.Conclusions Image fusion guided CEUS had a high detection rate and diagnosis accuracy rate for liver nodules with abnormal blood supply missed by US and CEUS.It can improve the clinical diagnosis and guide interventional procedures.