CT-guided argon-helium cryoablation for the treatment of leiomyosarcoma: observation of clinical efficacy / 介入放射学杂志

Objective To discuss the safety and curative effect of CT -guided percutaneous argon -helium cryoablation in treating leiomyosarcoma. Methods A total of 25 patients with leiomyosarcoma, who were treated at authors' hospital during the period from January 2012 to January 2016, were included in this study. CT-guided percutaneous argon-helium cryoablation was performed in all patients. The local changes of target lesions, the progression - free survival (PFS) and the survival rate were dynamically checked, and the complications were recorded. Results CT examination performed immediately after argon- helium cryoablation indicated that radical frozen ablation was achieved in 13 patients (52％), significant tumor -reductive frozen ablation in 11 patients (44％), effective tumor-reductive frozen ablation in one patient (4％), and invalid tumor-reductive frozen ablation in 0 patient. Follow - up CT examination performed at 3 months after argon - helium cryoablation showed that, based on solid tumor evaluation criteria, complete remission (CR) was obtained in 14 patients, partial remission (PR) in 8 patients and stable disease (SD) in one patient, the total remission rate (CR+PR) was 88％. The local PFS time was (9. 4±6. 2) months. The one-, 2-and 3-year survival rates were 64％, 48％ and 32％ respectively. In this group of cases, neither serious complications such as haemorrhage or tumor lysis syndrome nor procedure-related death occurred. Postoperative mild and moderate complications included fever, skin frostbite, immediate postoperative local pain exacerbation, nerve damage, etc., all of which disappeared or became relived after symptomatic treatment. Conclusion For the treatment of leiomyosarcoma, CT-guided percutaneous targeted argon-helium cryoablation has certain and definite short-term curative effect. CT-guided argon-helium cryoablation is a safe, reliable and minimally-invasive treatment, this technique is worth popularizing in clinical practice. (J Intervent Radiol, 2018, 27:228-232)

CT spectral imaging for monitoring and predicting the therapeutic efficacy of axitinib in rabbit VX2 liver tumors / 中华放射学杂志

Objective To evaluate the CT spectral imaging in assessing the therapeutic efficacy of axitinib in rabbit VX2 liver tumors. Methods Thirty-two VX2 liver tumor-bearing rabbits (diameter 1.0 to 2.5 cm) were prospectively and randomly assigned into the study group (axitinib treated group, n=16) or the control group (pseudo-therapy group, n=16). They were treated with axitinib or saline by using the gastric tube respectively. All the rabbits underwent unenhanced, arterial-phase (AP) and portal-phase (PP) contrast enhanced CT examinations by using spectral CT at different time points (baseline, 2, 4, 7, 10 and 14 days after treatment). Tumor size (TS) at each time point was recorded to calculate the percentage change (ΔTS)after treatment relative to baseline. Iodine concentration (IC) of the entire tumor, the peripheral hypervascular region and the center of the tumor were measured and normalized to aorta (NIC) to generate the difference for the NIC (NICD) between a given time and baseline. The tumorΔTS and NICD between the control and treated groups were compared by using Mann-Whitney U test. Serial changes in NICD at different time points were evaluated by using Wilcoxon signed rank test. Correlations between the NICD andΔTS, between NIC and microvessel density (MVD) were analyzed. Results The tumorΔTS after treatment in the control group and study group increased continuously. The tumorΔTS was significantly smaller in the treated group than that in the control group at day 7, 10 and 14. At day 2 , 4 and 10 after treatment, each tumor NICD in the study group was smaller compared with the control group(P0.05).Conclusion CT spectral imaging allows the evaluation and early prediction of tumor response to axitinib in rabbit VX2 liver tumors.

Clinical Investigation on CT guided cryoablation for treating invasive chest wall or pleural tumors / 中华肿瘤杂志

Objective@#To evaluate the feasibility and short-term effect of CT guided cryoablation for malignant chest wall or pleural involvement.@*Methods@#To follow up 22 patients with chest wall or pleural involvement of various malignancies who underwent cryoablation from January 2012 to January 2015 by conducting postoperative 1-, 3- and 6-month enhanced CT, MRI or PET-CT examinations, respectively, evaluate local curative effect, and observe their progression-free survival (PFS), postoperative pain remission and complications after the cryoablation.@*Results@#A total of 22 patients with 27 lesions received 26 times of argon-helium cryoablation. According to the coverage situation of immediate postoperative ice balls on the lesions, they were divided into a complete coverage group (Group A with 18 patients) and a partial coverage group (Group B with 4 patients). 1 month later, 15 patients′ tumors were completely ablated, and 3 had residue and thus received the second cryoablation in Group A, while all patients′ tumors had residue in Group B. 3 months later, 17 patients′ tumors were completely ablated, and 1 had residue and thus received another cryoablation in Group A, while all patients′ residual tumors enlarged in different extent in group B. 6 months later, all lesions were ablated in group A while all patients′ residual tumors enlarged in group B. For the 22 patients, their preoperative, and postoperative 1-week, 1-month, 3-month, and 6-month VAS scores were 4.95±0.57, 1.45±0.35, 1.45±0.35, 1.64±1.71, and 2.00±2.35, respectively. The differences in the preoperative, postoperative 1-week, and postoperative 1-month scores are significant statistically (P<0.05), and the difference in the postoperative 1-month and 6-month scores is also with statistical significance (P=0.03). For all patients, their post-operative 1-week, 1-month, 3-monte and 6-month pain remission rates are 90.9%(20/22), 90.9%(20/22), 86.4% (19/22)and 81.8%(18/22), respectively. With a median follow-up of 13.5 months, the median PFS is 7 months. The adverse effect after argon-helium cryoablation involved transitory worsened pain (16 cases), pleural effusion (5 cases, including 3 underwent closed drainage), fever (5 cases), and hemoptysis (3 cases).@*Conclusion@#CT guided argon-helium cryoablation is a safe and effective method to treat malignant chest wall or pleural involvement.

CT findings of cases diagnosed with pulmonary fungal disease in non-immunosuppressed patients / 中华放射学杂志

Objective To investigate the CT findings of three types of pulmonary fungal disease in non-immunosuppressed patients. Methods We retrospectively collected 109 cases diagnosed with pulmonary fungal disease with pathological evidence which between January 2011 and October 2015 in the First Affiliated Hospital of Zhengzhou University, among which pulmonary aspergillosis were 48 cases, pulmonary cryptococcosis 45 cases and pulmonary mucormycosis 16 cases. Each patient underwent a chest MSCT scan. The data were analyzed that including underlying diseases, lesion types, lesion size, number, accompanying signs of CT scan, etc. χ2 test or Fisher exact test were used when compared underlying disease, lesion types, various of CT signs etc between different types of pulmonary fungal disease. Kruskal-Wallis H test were used when compared the incidence rate of lesions numbers and diameter. The ROC curve was used to analyze probability of predicting the fungal types by combined signs. Results The incidence of pulmonary mucormycosis with diabetes was higher than pulmonary aspergillosis and pulmonary cryptococcosis(χ2=2.704, 17.509, P<0.017) .The incidence of pulmonary mucormycosis with no underlying disease was lower than pulmonary aspergillosis and pulmonary cryptococcosis(Fisher test, P<0.017). Nodular or mass were main CT findings in the three pulmonary fungal disease. Consolidation, ground glass opacity and other manifestations were rare. Nodular or mass lesions in pulmonary aspergillosis accompany with CT signs like tree-in-bud, bronchogram sign, cavities, the air crescent sign, halo sign, the reversed-halo sign were rspectively 18, 10, 19, 10, 23, 0 cases;To pulmonary cryptococcosis were 4, 14, 6, 0, 11, 0 cases. To pulmonary mucormycosis were 2, 0, 4, 0, 4, 6 cases. Lesion number's distribution had a statistically difference between pulmonary aspergillosis and pulmonary cryptococcosis in nodular or mass lesions(P<0.05). Lesions size's distribution had statistically differences respectively between pulmonary mucormycosis and pulmonary aspergillosis, pulmonary cryptococcosis(P<0.05). Nodular lesions of pulmonary aspergillosis had higher incidence of tree-in-bud, cavity and air-crescent compared to pulmonary cryptococcosis(χ2=9.972,21.841,8.047,P<0.017). Reversed halo sign was mostly seen in pulmonary mucormycosis than in pulmonary aspergillosis and pulmonary cryptococcosis(Continuous correctionχ2=23.936,21.374, P<0.017). The area under the ROC curve for the combined signs predictive fungal disease type was 0.819. Conclusions Nodules or masses are the most common image findings in pulmonary aspergillosis, pulmonary cryptococcosis and pulmonary mucormycosis. The distribution of size and numbers and CT accompanied signs have a higher diagnostic efficacy in diagnosing and distinguishing pulmonary fungal disease.