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Objective:To evaluate the safety and efficacy of radiofrequency ablation guided by CT hepatic arteriography (CTHA) in the treatment of multiple nodular liver metastases of colorectal cancer.Methods:Clinical data of 32 patients with liver metastasis of colorectal cancer who underwent femoral arterial catheterization and percutaneous radiofrequency ablation guided by CT hepatic arteriography (CTHA) at the Affiliated Cancer Hospital of Zhengzhou University from March 2020 to September 2021 were retrospectively analyzed, including 21 males and 11 females, aged (53.2±9.9) years old. Before ablation, the angiography catheter were placed in the common or proper hepatic artery under the digital subtraction angiography (DSA). The patients were then transferred to a CT operating room. Under general anesthesia, contrast agent was injected into the indwelling angiography catheter and percutaneous radiofrequency ablation guided by CTHA was performed. The presentation of lesions, the dosage of contrast agent and complications during ablation were analyzed, and the treatment outcome was followed up outpatient or inpatient review.Results:All 32 patients uneventfully underwent DSA-guided angiography catheter placement, and CTHA-guided radiofrequency ablation was successfully performed in 97 lesions, with a technical success rate of 100% (97/97). The difference between CT values at the lesion enhancement site and peri-tumor hepatic parenchyma were greater than 25 HU. The total amount of contrast agent used during the procedure was 63.9±14.7 ml. All ablation-related complications were graded as A or B according to the Society of Interventional Radiology classification system. The complete ablation rate assessed by CTHA after the ablation was 100% (97/97). The rate of lesion necrosis was 100% evaluated by MRI one month after ablation. All patients were followed up and no recurrence was observed in 97 ablated lesions by the end of follow-up period.Conclusion:Radiofrequency ablation guided by CTHA is safe and feasible for the treatment of multiple nodular liver metastases of colorectal cancer, which could reduce the local recurrence of lesions after ablation.
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Objective:To investigate the feasibility of CT hepatic arteriography(CTHA) guided percutaneous radiofrequency ablation of hepatocellular carcinoma (HCC).Methods:Forty-four patients diagnosed with hepatocellular carcinomas were enrolled in this prospective study from September 2019 to May 2021 in Henan Cancer Hospital. Thirty-three out of the 44 patients were treatment naive, 8 cases recurred after radiofrequency ablation, and the other 3 patients recurred after surgery. The mean size of HCC nodules was 5-44(17±8)mm measured on enhanced MRI images. Each patient was implanted a 5-French Cobra catheter or a 5-French RH angiographic catheter, then was catheterized into common hepatic artery or proper hepatic artery, under DSA monitoring via right femoral artery. Then the patient was transferred to CT operation room. Percutaneous radiofrequency ablation was performed by CTHA guidance using contrast agent injected via the catheter indwelled in hepatic artery. The endpoint of a complete ablation was a non-enhancing ablation necrosis zone in the target tumor and the target tumor margin at least 5 mm on CTHA. At the end of the procedure, the probe was retracted using tract ablation, and the arterial catheter and sheath were removed. The number of HCC lesions showed on the enhanced MRI and CTHA imaging were compared using Wilcoxon rank-sum test. The technical success rate and volume of contrast agent used during the CTHA ablation procedures were summarized.Results:Additional tumors were founded in 13 out of the 44 patients during the CT hepatic arteriography compared with enhanced MRI. The tumors founded by enhanced MRI and CTHA were 64 and 91 respectively, with statistical significance ( Z=-3.24, P=0.001). One patient dropped out of the study after palliative ablation and was transferred to transaterial chemoembolization treatment because the number of lesions showed by CTHA scan was more than 5. The other 43 patients got complete ablation verified by immediate postoperative assessment using CTHA. The technical success rate was 100%. The average volume of contrast agent used in CTHA guided radiofrequency ablation was 30-80(42±14)ml. There was no complications occurred related to the CTHA guided percutaneous radiofrequency ablation procedures. Conclusions:CTHA can demonstrate additional lesions that can not be detected by the enhanced MRI images, which improves the lesion conspicuity and verifies the optimal position of radiofrequency probe. The complete tumor ablation can be verified by CTHA performed immediately after ablation.
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OBJECTIVE: This study proposes a novel reference standard for hypervascular hepatocellular carcinomas (HCCs), established by cone-beam computed tomography-hepatic arteriography (CBCT-HA) and two-year imaging follow-up, and discusses its clinical implication on tumor staging and understanding the intrahepatic distant recurrence (IDR) in relation to dynamic computed tomography (CT).MATERIALS AND METHODS: In this retrospective study, 99 patients were enrolled, who underwent CBCT-HA during initial chemoembolization for HCC suspected on CT. All patients underwent chemoembolization and regular clinical and imaging follow-up for two years. If IDR appeared on follow-up imaging, initial CBCT-HA images were reviewed to determine if a hypervascular focus pre-existed at the site of recurrence. Pre-existing hypervascular foci on CBCT-HA were regarded as HCCs in initial presentation. Initial HCCs were classified into three groups according to their mode of detection (Group I, detected on CT and CBCT-HA; Group II, additionally detected on CBCT-HA; Group III, confirmed by interval growth). We assessed the influence of CBCT-HA and two-year follow-up on initial tumor stage and calculated the proportion of IDR that pre-existed in initial CBCT-HA.RESULTS: A total of 405 nodules were confirmed as HCCs, and 297 nodules initially pre-existed. Of the initial 297 HCCs, 149 (50.2%) lesions were in Group I, 74 (24.9%) lesions were in Group II, and the remaining 74 (24.9%) lesions were in Group III. After applying CBCT-HA findings, 11 patients upstaged in T stage, and 4 patients had a change in Milan criteria. Our reference standard for HCC indicated that 120 of 148 (81.1%) one-year IDR and 148 of 256 (57.8%) two-year IDR existed on initial CBCT-HA.CONCLUSION: The proposed method enabled the confirmation of many sub-centimeter-sized, faintly vascularized HCC nodules that pre-existed initially but clinically manifested as IDR. Our reference standard for HCC helped in understanding the nature of IDR and the early development of HCC as well as the clinical impact of tumor staging and treatment decision.
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Humans , Angiography , Carcinoma, Hepatocellular , Follow-Up Studies , Methods , Neoplasm Staging , Recurrence , Retrospective StudiesABSTRACT
Objective To explore the potential clinical value of mean platelet volume (MPV) in predicting the curative effect of TACE for hepatocellular carcinoma (HCC). Methods The clinical data of 263 HCC patients, who were treated with TACE at authors' hospital during the period from January 2012 to June 2016, were collected. The MPV data before initial TACE, before and after each repeated TACE were recorded. The time of tumor progression (TTP; referring to mRECIST standard), was documented. Based on the MPV determined before initial TACE, the patients were divided into low - MPV group and high - MPV group, and the TTP between the two groups was compared. Results A total of 263 patients were enrolled in this study. In HCC patients, the MPV determined before initial TACE was (9. 45±1. 24) fL, while the MPV determined after initial TACE was (9. 01±1. 11) fL, the difference between the two was statistically significant (t=4. 344, P＜0. 05). The MPV determined at the time when HCC lesion first developed progression was (9. 38±1. 16) fL, which was significantly different with the MPV of (9. 01±1. 11) fL that was obtained after initial TACE (t=3. 498, P＜0. 05). Taking the median value of MPV determined before initial TACE (9. 3 fL) as the cutoff value, the patients were divided into the low - MPV group and the high - MPV group according to patient' s MPV determined before initial TACE. Statistically significant difference in the time when HCC lesion first developed progression existed between the low - MPV group and the high - MPV group (P＜0. 05). COX regression analysis showed that BCLC stage B and C, MPV value before initial TACE were the independent risk predictors of tumor progression. Conclusion The pre-TACE and post-TACE MPV values in HCC patients treated with TACE has certain clinical significance in evaluating the curative effect of TACE. Moreover, MPV value before initial TACE has some value in predicting the time of HCC progression after TACE. (J Intervent Radiol, 2018, 27:257-262)
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Objective To accurately judge the tumor-feeding artery is the most important basis for a successful treatment of hepatocellular carcinoma (HCC) with super-selective hepatic arterial chemoembo lization therapy. This study aims to assess the clinical value of cone-beam CT hepatic arteriography (CBCT-HA) in detecting tumor-feeding arteries during the performance of conventional transarterial chemoembo lization (TACE), and to compare the diagnostic effects between CBCT-HA and non-selective hepatic DSA. Methods Twenty-three consecutive patients with inoperable HCC were enrolled in this study. TACE was carried out in all patients. During the performance of TACE, the DSA-HA, CBCT-HA, Lipiodol-TACE and Lipiodol-CBCT were performed separately. The imaging materials, including DSA-HA and CBCT-HA, were analyzed by two experienced interventional physicians together to judge the tumor-feeding arteries. Statistic analysis was conducted by using chi square test. Results Tumor stain and lipiodol accumulation were regarded as the “gold standard” of the presence of tumor-feeding artery, based on which the tumor-feeding artery was confirmed in 75 lesions. DSA-HA demonstrated positive tumor-feeding artery in 40 lesions, among which true-positive tumor-feeding artery was seen in 32 and false-positive one in 8. CBCT-HA showed positive tumor-feeding artery in 72 lesions, which included true-positive tumor-feeding artery in 68 and false-positive one in 4. The sensitivity of CBCT-HA in judging tumor-feeding artery was 90.7% (68/75), which was much higher than that of DSA-HA (42.6%, 32/75), the difference was statistically significant(P<0.001). The positive predictive value of CBCT-HA in detecting tumor-feeding artery was also higher than that of DSA-HA (94.4% vs. 80.0%; P=0.040). Conclusion Cone-beam CT hepatic arteriography is obviously superior to DSA hepatic arteriography in identifying tumor-feeding arteries, which is very helpful in guiding super-selective TACE for HCC.
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ObjectiveTo study the role of hepatic arteriography before precise hepatectomy in primary liver cancer,Methods207 patients with primary liver cancers resected from 2005 to 2010 at Air Force General Hospital of Chinese PLA were studied retrospectively.There were 81 patients who received routine hepatectomy and 126 who received precise hepatectomy with hepatic arteriography before surgery.ResultsAnalysis showed that precise hepatectomy was superior to routine hepatectomy for lesions less than 1.0 cm (81.48％ vs 18.18％),with less operative time (168.20±35.81 min vs 221.75±30.33 min),volume of resection,blood loss (168.20±35.81 min vs 221.75±30.33 min),transfusion rate (256.13±185.24 ml vs 436.97±590.12 ml),and hospital stay (20.53± 12.41 d vs 25.72±17.27 d),(all P＜0.05).Hepatic arteriography did not affect liver function before precise hepatectomy.ConclusionsHepatic arteriography was significantly better in showing blood vessels of the primary liver cancer,and in detecting liver metastases or satellite lesions of less than 1.0 cm before surgery.
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Objective The application of CTHA/CTAP in examination of liver cancer relapse after interventional therapy were retrospectively analyzed.Methods The CTHA/CTAP and DSA were performed on 19 patients with primary hepatic cancer after receiving TACE procedure followed by obvious rising of AFP.Results CTHA/CTAP discovered 14 recurrent lesions in the peripheral region of the embolized tumors,and 15 new lesions.In comparison,DSA only discovered 6 recurrent lesions and 8 new lesions.Conclusion Comparing with DSA,CTHA/CTAP is a more sensitive and reliable method in detection of liver cancer relapse after interventional therapy.
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BACKGROUND/AIMS: Combined computed tomography during arterial portography(CfAP) and computed tomography during hepatic arteriography(CBiA) are more sensitive methods compared to conventional spiral CT in detecting small hepatocellular carcinoma. However, there are few data available on the influence of combined CTAP and CTHA on decision making for treatment of hepatocellular carcinoma. We aimed to evaluate the usefulness of CTAP and CfHA as a preoperative study of hepatocellular carcinoma for surgical treatment. METHODS: Eighty-two patients with histologically proven hepatocellular carcinoma who were considered to be surgical candidates on spiral CT and angiography were included. CfAP and CTHA were performed as the routine protocol. The findings of CTAP and CTHA were analyzed and compared to conventianal spiral Cl and angiography. ReESULTS: 1) 105 nodules were found on spiral Cf plus angiography, whereas, 138 nodules found on combined CIAP and CTHA: 33 additional nodules were found in 23 cases(28%). 2) The treatment plan changed from surgery to nonsurgical treatment in 10(12%) cases: 9 cases(10%) with bilobar involvement, and 1 case (1%) with more than three nodules. 3) The larger the tumor nodules on the spiral CT, the more additional tumor nodules were found on CTAP and CTHA: combined CTAP and CTHA were able to find more nodules in 21% of tumor 10cm on spiral CI' (p=0.03). CONCLUSION: Compared to spiral CT plus angiography, CI'AP and CfHA may be useful in avoiding unnecessary operation of hepatocellular carcinoma, especially in large tumors.
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Humans , Angiography , Carcinoma, Hepatocellular , Decision Making , Tomography, Spiral ComputedABSTRACT
Background: CT scan of hepatic carcinoma after transarterial embolization with Lipiodol (LP-TAE) will be influenced. A comparative study was made between CT scan and hepatoarteriography in hepatic carcinomas fully filled with Lipiodol after TAE for the purpose of demonstrating the difference. Materials and Methods: 20 cases of hepatic carcinoma fully filled with Lipiodol after TAE 1 to 8 months, confirmed by CT scans. Hepatoarteriography were then done 1 to 14 days afterwards. The demonstration of the original and new foci were thus be compared respec- tively by these methods. Results: The original tumor lesions were all stable on CT scans and new tumor lesions were found in 5 cases. Three features were found in arteriographies of the original tumor lesions: (1) stable, no obvious tumor vessels and stain; (2) tumor vessels and stains confined within the LP accumulated areas; (3) largely increased lesions exceeding the LP accumulated areas; (3)largely increased lesions exceeding the LP accumulated areas. Also other three features were found in new tumor lesion: (1) multiple intrahepatic daughter nodules; (2)small arterioportal shunts; (3) new masses. Conclusion: (1) Although good results had been archieved, but the lesions were not stabe in many of them. Long interval follow-up and TAE were not suitable. (2) Stage-Ⅱ surgical resection should be taken cautiously. (3) New techniques of CT scan and superselective he- patic arteriography with high flow rate should be adopted to improve the accuracy rate of de- monstrating tumor lesion.
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The hepatic arteriographic findings and interventional treatment results in forty cases with recurrent primary liver cancer after surgery were reported.The angiograph- ic manifestations were divided into three types:type Ⅰ recurrence on edge,11 cases (27. 5%);type Ⅱ intrahepatic diffusion),23 cases (57.5%);type Ⅲ (insidious recurrence),6 cases (15%).The characters of angiographic findings were as follows:the feeding vessels relatively not rich pale staining of tumor nodules,the common multiple focuses and small tu- mor nodule (diameter of tumor