Interventional radiology under the era of coronavirus disease 2019: Recommendations from the Chinese College of Interventionalists.

The pandemic of coronavirus disease 2019 (COVID-19) has become a major public health threat to the whole world. Although the control of COVID-19 has been in the forefront of interventional practice, most interventional radiologists (IRs) are not equipped adequately to cope with such a crisis. In this review, we share our experience from Chinese IRs' perspective, report on the acute measures instituted within interventional radiology (IR) units, and give recommendations to the prevention and control of COVID-19.

[Correlations between serum hypoxia inducible factor-1α, vascular endothelial growth factor and computed tomography perfusion imaging at pre-and post-TACE in patients with primary hepatic carcinoma].

OBJECTIVE: To explore the correlations between the serum levels of hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and computed tomography (CT) perfusion parameters at pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC). METHODS: A total of 22 PHC patients were recruited.Their serum levels of HIF-1α and VEGF were measured and CT perfusion imaging (CTPI) was performed at Day 1 pre- and Days 32-40 post-TACE to compare and analyze the relevance of the changes of serum levels of HIF-1α, VEGF, tumor's hepatic artery perfusion (HAP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) at pre- and post-TACE. RESULTS: They were divided into stable and tumor residual/recurrent groups according to the efficacy of TACE. No significant differences existed between two groups with respects to serum levels of HIF-1α, VEGF, tumor's HAP, PVP and HPI pre-TACE. The serum levels of HIF-1α and VEGF decreased in stable group and there was significant difference in serum level of VEGF at Days 32-40 post-TACE (P < 0.05). There was no perfusion signal of HAP or PVP in tumor tissue.The serum levels of HIF-1α and VEGF were significantly higher while HAP and HPI were significantly lower than that pre-TACE in tumor residual/recurrent group and had statistical significance (P < 0.05), but PVP had no change.Positive correlations existed between serum levels of HIF-1α, VEGF and tumor's HAP, HPI at 32-40 days post-TACE. CONCLUSION: Serum levels of HIF-1α and VEGF may indirectly reflect the status of neovascularization and CTPI acts as the intuitive and quantitative responses of hemodynamic changes at post-TACE.Positive correlations exist between serum levels of HIF-1α, VEGF, HAP and HPI. In short, a combination of serum levels of HIF-1α, VEGF and CTPI contributes to the efficacy evaluation of TACE and has great reference significance of determining timing of a second therapy.

Cerebral lipiodol embolism after transarterial chemoembolization for hepatic carcinoma: a case report.

We report a case of cerebral lipiodol embolism (CLE) after transarterial chemoembolization (TACE) for unresectable hepatic carcinoma (HCC). A 54-year-old man with unresectable HCC underwent TACE via the right hepatic artery and right inferior phrenic artery using a mixture of 40 mg pirarubicin and 30 mL lipiodol. His level of consciousness deteriorated after TACE, and non-contrast computed tomography revealed a CLE. The cerebral conditions improved after supportive therapy. The complication might have been due to hepatic arterio-pulmonary vein shunt caused by direct invasion of the tumor. Even though CLE is an uncommon complication of TACE, we should be aware of these rare complications in patients with high risk factors.

Serum HIF-1alpha and VEGF levels pre- and post-TACE in patients with primary liver cancer.

OBJECTIVE: To investigate the expression levels of serum hypoxia inducible factor 1 alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) pre- and post-transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC), and correlations between prognosis factors and serum HIF-1alpha as well asVEGF levels. METHODS: Forty consecutive patients fulfilling diagnostic criteria for PLC undergoing TACE from March 2008 to May 2009 were enrolled into the study. The serum HIF-1alpha and VEGF levels of PLC patients pre- and 1 day, 1 week, 1 month post-TACE were analyzed using ELISA, and compared with that of 20 healthy volunteers. Patients were divided into complete response (CR) and partial response (PR), stable disease (SD), progressive disease (PD) groups according to the therapeutic efficacy. Pearson correlation was used to analyze the correlation between different clinical variables and serum HIF- 1alpha and VEGF levels before TACE, and correlation between serum HIF-1alpha and VEGF levels was also evaluated. RESULTS: The expression levels of serum HIF-1alpha and VEGF in PLC patients were 154.94 +/- 83.29 and 264.00 +/- 148.10 pg/mL pre-TACE, and both of them were significantly higher than those in control group (23.84 +/- 8.15 and 69.78 +/- 21.42 pg/mL, all P<0.01). One day after TACE, both serum HIF-1alpha (570.64 +/- 230.87 pg/mL) and VEGF levels (362.07 +/- 102.25 pg/mL) reached the peak values (all P<0.01). One week post-TACE, expression levels of them were decreased (198.62 +/- 92.11 and 283.52 +/- 145.46 pg/mL respectively), but still significantly higher than those before TACE (all P<0.01). The levels of both HIF-1alpha (133.96 +/- 57.02 vs. 255.74 +/- 123.44 pg/mL) and VEGF (150.96 +/- 84.89 vs. 368.95 +/- 161.90 pg/mL) in CR group 1 month post-TACE were significantly lower than those in PR+SD+PD group (all P<0.01). The level of serum HIF-1alpha was positively correlated with serum VEGF level (r=0.42, P<0.001). Both serum HIF-1alpha and VEGF levels were observed to be correlated with portal vein tumor thrombi (P<0.05) and metastasis (P<0.05). CONCLUSION: The HIF- 1alpha and VEGF might play an important role in relapse of PLC. They might be considered as predictors of the efficacy ofTACE and metastasis of PLC.