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Objective:To investigate the safety and efficacy of MR-guided focused ultrasound surgery (MRgFUS) in treating localized prostate cancer.Methods:Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study. The patients were all over 18 years old, with an average age of (68±10) years, and had not received any prior treatment for prostate cancer. Pretreatment pelvic MR and CT scans were performed to determine the region of treatment (ROT). Different urinary catheterization measures were given based on the location of the lesion. Under general anesthesia, the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed. The patients were followed up at 1, 3, and 6 months after treatment and annually thereafter. During follow-up, prostate-specific antigen (PSA) levels, pelvic MR scans, International Prostate Symptom Score (IPSS), International Index of Erectile Function-15 (IIEF-15) scores, and adverse events were assessed.Results:(1) All six patients underwent MRgFUS treatment for six lesions, with an average duration of (126±56) minutes, an average number of (7.3±3.2) focal ultrasound pulses per lesion, and an average non-perfusion volume of (3.8±1.1) cm 3, which covered the entire treatment target area. No treatment-related adverse events were reported. (2) The PSA levels at baseline, 1, 3, 6, and 12 months after treatment were (6.6±0.8), (3.6±1.3), (3.4±3.0), (2.5±1.7), and (2.3±1.8) ng/ml, respectively. PSA levels increased in 2 out of 6 patients during follow-up, and pelvic MR scan revealed recurrent lesions, while PSA levels continued to decrease in the remaining 4 patients, and pelvic MR scan were normal. (3) The IPSS scores at baseline, 1, and 3 months after treatment were 13.0 (4.0, 16.0), 10.0 (4.0, 12.0), and 5.0 (3.0, 6.0) points, respectively. For the three sexually active patients, the IIEF-15 scores at baseline were 40, 51, and 14 points, respectively, and IIEF-15 at 1 month after treatment were 9, 8, and 14 points, respectively, and at 3 months after treatment were 9, 66 and 26 points, respectively. (4) One patient was diagnosed with recurrence 10 months after treatment, and another patient was found to have a new lesion 6 months after treatment. Conclusions:MRgFUS might be a safe, non-invasive, and effective treatment for localized prostate cancer, but regular follow-up is vital for detecting tumor recurrence.
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Objective To investigate the applicative value of micro-surgery in the treatment of cerebral aneurysms.Methods During January 2011 to January 2013 in our hospital,90 patients with cerebral aneurysm were randomly divided into the endovascular group and the microsurgical clipping group (n =45 each).The endovascular group were treated with endovascular interventional treatment,and the patients of the microsurgical clipping group were treated with microsurgical clipping treatment.The aneurysm occlusion rate and recurrence,time of hospital stay,complications and prognosis were compared between the two groups.Results The complete occlusion rate was higher [97.8％ (44/45) vs.88.9％ (40/45) and the recurrence rate was lower 2.2％ (1/45) vs.13.3％(6/45) in microsurgical clipping group than in endovascular intervention group x2 =4.34 and 3.54,P=0.031 and 0.042),all P＜0.o5.The average time of hospital stay was longer in the endovascular intervention group than in the microsurgical clipping group [(19.3 4.4) days vs.(16.34.9) days,t 1.93,P=0.035].The good rate was higher in microsurgical clipping group than in endovascular intervention group [91.1％ (41/45) vs.77.8％ (35/45),x2=6.325,P=0.012].Conclusions Microsurgical clipping surgery can significantly raise the complete occlusion of cerebral aneurysms,reduce recurrence in patients with cerebral aneurysm,decrease the hospitalization time,and improve prognosis,which is worthy of clinical application.
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Objective To investigate the significance of change of fluid-attenuated inversion recovery(FLAIR) hyperintense vessel sign(HVS) after endovascular recanalization in acute ischemic stroke. Methods The clinical and imaging data of the patients with acute middle cerebral artery(MCA) occlusion treated by mechanical thrombectomy with Solitaire AB from January 2013 to october 2014 were analyzed retrospectively. The inclusion criteria: (1) The preoperative MRI included conventional non-enhanced MR, diffusion-weighted imaging (DWI), magnetic resonance angiography(MRA) and perfusion-weighted imaging (PWI), and HVS was observed on preoperative FLAIR images; (2) acute MCA occlusion verified by conventional angiography;(3) postoperative similar MR images examination was performed within 48 hours. The relationships among postoperative changes in the HVS, DWI and Thrombolysis In Cerebral Ischemia (TICI) scale (1—3) were assessed. Results After endovascular therapy, HVS of the 11 cases were showed to be disappeared(n = 9) and decreased (n = 2). All the 9 patients with disappeared HVS achieved high grade flow (TICI 3), and minor decrease of ischemic area on DWI in 1 case, minor progression in 6, and significant progression in 2. However, of the 2 patients with decreased HVS, one achieved relatively low grade flow (TICI 2a) and the other was found to be relatively high grade flow (TICI 2b), but severe MCA stenosis. DWI demonstrated significant progression in both two cases. Conclusion Our data indicate that endovascular recanalization of acute MCA occlusion was effective for decreasing HVS. Postoperative decrease and disappear in HVS can be considered as a marker for hemodynamic improvement.
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Objective To analyze the clinical effect and complication of trans-radial and femoral artery for percutaneous coronary intervention (PCI) in patients with coronary heart disease.Methods Totally 153 patients with coronary heart disease undergoing PCI were divided into radial artery and femoral artery groups.X-ray exposure time,operation time,the success rates of puncture and operation,in-bed time and complication were recorded. Results There were no significant differences in X-ray exposure time[(17±5)min vs.(16±6)min,t=0.61,P=0.57],operation time [(49± 9) min vs. (48 ± 11) min,t=0.59,P =0.61],the success rates of puncture (98.7％ vs.100.0％,x2 =0.47,P=0.53) and operation (96.0％ vs.96.2％,x2 =0.14,P=0.64) between radial artery and femoral artery groups.However,the complication rates was higher in femoral artery group than in radial artery group (17.9％ vs.2.7 ％,x2 =9.54,P=0.002),in-bed time was shorter in radial artery group than in femoral artery group [(4.5 ± 1.2)h vs.(13.2 ±4.6)h,t=2.12,P =0.003]. Conclusions The trans-radial artery PCI is safe,effective and feasible,with less complications and shorter in-bed time.
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Objective The study was to investigate the feasibility of using an intravascular Loopless Monopole Antenna (ILMA) for 3.0 T MR imaging of water bath and deep-seated arterial walls of experimental animal.Methods A novel intravascular loopless monopole antenna (ILMA) was developed,including a non-shield loach guide-wire and a matching circuit.The non-shield loach guide-wire is used as a receive antenna,with the diameter of 0.019 in( 1 in =2.54 cm) and length of 23.11 in.During the MR scanning,the ILMA was used as a receive-only probe,while body coil was used to transmit the RF pulses.Utilizing the coil in water bath and in-vivo animal experiment,we measured signal-to-noise ratio (SNR) and contrast-to-noise ratio(CNR) of artery wall using the same scanning parameter compared with phased-array coil.Results In the study,the developed novel ILMA conduced to improved SNR of imaging and much higher space resolution( 313 μm).First,the feasibility of acquiring the wall images was demonstrated on phantoms.The SNRs map generated by the matlab software showed that in comparison with the phased-array coil,ILMA generated higher SNR of the phantom wall when using the same sequences,parameters,and slices (86.8 ±0.8 vs.9.9 ±0.1,P ＜0.01 ).When imaging the aorta wall with the ILMA and phased-array coil,the SNRs of the arterial wall with the ILMA is 60.4 ±20.9,61.3 ±22.5,59.8 ±20.4,32.3 ±22.6 (T1WI),51.2 ±21.6,49.8 ± 15.5,50.4 ± 17.2,22.4 ± 18.3 (T2WI),the CNRs of the aorta wall with theILMA is 19.8±8.1,18.9±9.2,19.6±11.8,20.7 ± 13.3(T1WI),17.7±6.4,18.6±6.9,17.2 ± 6.4,17.2 ± 6.4 ( T2 WI),compared with phased-array coil,t values SNR:6.36,3.84,3.51,6.92(T1 WI),3.47,4.89,6.35,4.21 (T2WI),CNR:3.56,3.97,-0.71,4.74 (T1WI),3.99,3.01,4.27,5.03(T2 WI,P ＜ 0.05 ),respectively.Conclusion The study demonstrates the capability of using an MR ILMA to generate 3.0 T MR in-vivo experiments,the developed novel ILMA conduces to increased SNR compared with the conventional phased-array coil.
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Objective To evaluate the feasibility, accuracy and its clinical value of MRI-guided needle biopsy of lung lesions. Methods A total of 137 patients with pulmonary nodules or masses underwent lung biopsy in low-field open MRI equipped with iPath 200 optical tracking systems. Among them, 103 cases had solitary pulmonary lesion; the other 34 cases had multiple foci. The maximum diameter of the lesion was not smaller than 3.5 cm ( ≥ 3.5 cm) in 57 patients, between 1.5 cm and 3.4 cm( 1.5-3.4 cm) in 71 patients, not greater than 1.4 cm ( ≤ 1.4 cm) in 9 patients. Results The puncture success rate was 100.0% (57/57) for lesions ≥3.5 cm, 98.6% (70/71) for lesions 1.5-3.4 cm,77.8% (7/9) for lesions ≤1.4 cm and 97. 8% (134/137) for total cases, respectively. According to the pathological results, pulmonary lesions were malignant in 98 cases and benign in 39 cases. The sensitivity,specificity, accuracy, positive predictive value and negative predictive value of MRI-guided lung biopsy were 94.2%(98/104), 100.0% (33/33), 95.6% (131/137), 100.0% (98/98) and 84.6% (33/39),respectively. Conclusion MRI-guided needle biopsy of lung lesion can be performed precisely in a lowfield open MRI with a low risk of complications. As a supplement to US or CT-guided biopsy, it is worth further promotion and application.
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Objective To verify the feasibility of eryoablation on rabbit brain tumor under interventional MRI guidance.Methods The procedures were performed under general anaesthesia.Twenty-two New Zealand white rabbit'S brains were inoculated with VX,tumor tissue through cranial holes. MR-guided cryoablation were conducted as preliminary experiment when diameter of brain tumor grew up to 0.8 cm in size.Cryoablation lasted two cycles of 5 minutes freezing, in 2 rabbits.and of 10 minutes freezing in another 2 rabbits.After procedure and MR scanning.rabbits were executed.Specimens of rabbit'S brain showed complete necrosis pathologically after cryoablation of cycles of 10 minutes freezing.The optimal parameters of eryoablation were defined.Except for the two rabbits that died of infection,the other 16 rabbits were divided into control group and therapeutic group.According to the optimal parameters of cryoablation,cryoablation of 10 minutes freezing were performed for rabbit brain tumors in therapeutic group.Venous injeetion of 20%mannitol and subcutaneous injection of dexamethasone were used for dehydration.None of rabbit brain tumors in the control group were treated.After cryoablation,MRI scanning Was performed immediately,7 days later,14 days later and 60 days later,to observe the ablative area and the pathologic changes.The survival time wag recorded.Resuits Brain tumors could be found in all New Zealand white rabbits after inoculation except two died of inflammation.The maximum diameter of brain tumors Was from 0.7 to 1.0 elEL The tumors showed slight low signal on T1WI and slight high signal on T2WI as well as comrast enhancement after injection of Gd-DTPA.Pathologically coagulative necrosis were observed after cryoablation immediately,7 days and 14 days later,and liquefactive necrosis was found 60 days later.The correlation between MRI and pathologic appearance of tmnors are consistent.The therapeutic area ranged from 1.0 to 1.5 em.,The maximium diameter of ice ball ranged from 1.5 to 2.0 cm Conclusion CiToablation for brain tumor iS a safe and feasible therapy.