The radiomics-clinical nomogram for predicting the response to initial superselective arterial embolization in renal angiomyolipoma, a preliminary study.

Purpose: The aim of this study was to explore a radiomics-clinical model for predicting the response to initial superselective arterial embolization (SAE) in renal angiomyolipoma (RAML). Materials and methods: A total of 78 patients with RAML were retrospectively enrolled. Clinical data were recorded and evaluated. Radiomic features were extracted from preoperative contrast-enhanced CT (CECT). Least absolute shrinkage and selection operator (LASSO) and intra- and inter-class correlation coefficients (ICCs) were used in feature selection. Logistic regression analysis was performed to develop the radiomics, clinical, and combined models where the fivefold cross-validation method was used. The predictive performance and calibration were evaluated by the receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was used to measure clinical usefulness. Results: The tumor shrinkage rate was 29.7% in total, and both fat and angiomyogenic components were significantly reduced. In the radiomics model, 12 significant features were selected. In the clinical model, maximum diameter (p = 0.001), angiomyogenic tissue ratio (p = 0.032), aneurysms (p = 0.048), and post-SAE time (p = 0.002) were significantly associated with greater volume reduction after SAE. Because of the severe linear dependence between radiomics signature and some clinical parameters, the combined model eventually included Rad-score, aneurysm, and post-SAE time. The radiomics-clinical model showed better discrimination (mean AUC = 0.83) than the radiomics model (mean AUC = 0.60) and the clinical model (mean AUC = 0.82). Calibration curve and DCA showed the goodness of fit and clinical usefulness of the radiomics-clinical model. Conclusions: The radiomics-clinical model incorporating radiomics features and clinical parameters can potentially predict the positive response to initial SAE in RAML and provide support for clinical treatment decisions.

Intrahepatic arterial localizer guided transjugular intrahepatic portosystemic shunt placement: Feasibility, efficacy, and technical success assessed by a case series-a STROBE- compliant article.

Transjugular intra-hepatic portosystemic shunts (TIPS) had been considered a standard procedure in patients suffering from portal hypertension. The most challenging step in TIPS placement is blind puncture of the portal vein. We had established a localization method by introducing an Intra-Hepatic Arterial based puncture directing Localizer (IHAL) with the assistance of the enhanced computed tomography (CT) reconstruction. This study aimed to evaluate the feasibility, efficacy, and technical success of this method.From June 2018 to August 2018, 10 consecutive patients suffering from refractory ascites or esophageal gastric bleeding by liver cirrhosis were included in this retrospective study to evaluate feasibility, efficacy, and technical success of enhanced CT assisted IHAL-guided puncture of the portal vein. As a control, 10 patients receiving TIPS placement before Jun 2018 with cone beam CT (CBCT)-guided puncture were included to compare the reduction of portal-systemic pressure gradient (PSPG), portal entry time (PET), the number of puncture, dose area product (DAP) and contrast medium consumption.Technical success was 100% in the study group (IHAL-guided group) and in 90.0% of the control group (CBCT-guided group). Appropriate IHAL point could be achieved in all patients under the enhanced CT reconstruction assistance. The median number of punctures and DAP in IHAL group were significantly less than those in CBCT group. The reduction of PSPG, PET, and contrast medium consumption in IHAL group showed no significant differences than those in CBCT group.Enhanced CT reconstruction assisted IHAL-guided portal vein puncture is technically feasible and a reliable tool for TIPS placement resulting in a significant reduction of the number of punctures and DAP.

Combination of radiofrequency ablation and transcatheter arterial chemoembolization to treat hepatocellular carcinoma: measurement of distance from needle tip to nodule for assessment of local tumor progression.

OBJECTIVE: This study was performed to determine the relationship between the minimum distance from the radiofrequency ablation (RFA) needle tip to the tumor and local tumor progression (LTP) of hepatocellular carcinoma (HCC) nodules and identify prognostic factors for LTP. METHODS: We reviewed 197 patients (197 nodules) who underwent RFA after transcatheter arterial chemoembolization for HCC from January 2010 to January 2015. Three-dimensional registration of images was used to calculate the minimum distance from the tip to the tumor. We then divided the minimum distance into two groups: <2 and ≥2 mm. Contrast-enhanced computed tomography was performed after treatment. The LTP rate was calculated 1 and 3 years after RFA. We performed multivariate analysis to identify independent prognostic factors for LTP. RESULTS: The cumulative 1-year LTP rates in the <2- and ≥2-mm groups were 82.7% and 4.3%, respectively, and the cumulative 3-year LTP rates in the two groups were 94.8% and 10.8%, respectively. The minimum distance from the needle tip to the tumor was an independent prognostic factor for LTP. CONCLUSIONS: A minimum distance of 2 mm from the needle tip to the tumor should be completely ablated along with the tumor.

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience.

OBJECTIVE: This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy. METHODS: From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization. RESULTS: Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization. CONCLUSIONS: Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

Efficacy of ultrasound-guided modified anterior approach to sciatic nerve block for orthopedic sur-gery with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound-guided modified anterior approach to sciatic nerve block ( SNB) for orthopedic surgery with general anesthesia. Methods Ninety American So-ciety of Anesthesiology physical status Ⅰ or Ⅱpatients of both sexes, aged 18-64 yr, weighing 19-28 kg∕m2 , scheduled for elective knee joint or distal orthopedic surgery, were divided into 3 groups ( n=30 each) using a random number table method: modified anterior approach ( the puncture needle was almost perpendicular to the ultrasound beam) group, anterior approach group and posterior approach group. SNB ( injecting 0. 5％ ropivacaine 20 ml) combined with femoral nerve block ( injecting 0. 5％ ropivacaine 15-20 ml) was performed under ultrasound guidance. Surgery was completed under combination of the laryngeal mask and combined intravenous-inhalational anesthesia. When the respiratory rate ≥20 beats∕min and∕or the increase in heart rate was more than 20％ of the baseline value, sufentanil 1μg∕time was intravenously injected. When visual analog scale ( VAS) score ≥4 within 24 h after surgery, celecoxib capsules 0. 2 g was taken orally for analgesia. The depth of sciatic nerve, needling depth, sharpness score of needle ima-ging under ultrasound, and operation time and duration of SNB were recorded. VAS scores at rest and dur-ing activity were recorded at 6, 8, 10, 12 and 24 h after surgery. The amount of sufentanil consumed dur-ing surgery and use of celecoxib capsules within 24 h after surgery were recorded. The development of ad-verse reactions such as hematoma at the puncture site, nausea and vomiting was also recorded after surgery. Results Compared with posterior approach group, the depth of sciatic nerve and needling depth were sig-nificantly increased, the operation time of SNB was prolonged, the duration of SNB was shortened, the in-traoperative consumption of sufentanil was increased, VAS scores at rest and during activity were increased at 10 h after surgery, and the sharpness score of needle imaging was increased in modified anterior approach and anterior approach groups (P<0. 05). Compared with anterior approach group, the sharpness score of needle imaging was significantly increased, and VAS scores during activity were decreased at 24 h after sur-gery in modified anterior approach group ( P<0. 05) . There was no significant difference in the requirement for celecoxib capsules within 24 h after surgery or occurrence of adverse reactions among the three groups ( P>0. 05) . Conclusion Although ultrasound-guided modified anterior approach to SNB provides compara-ble efficacy with anterior approach to SNB and is not as good as posterior approach to SNB when used for or-thopedic surgery with general anesthesia, modified anterior approach to SNB is easy to operate, with clear images under ultrasound.

Transarterial chemoembolization plus multi-imaging-guided radiofrequency ablation for elimination of hepatocellular carcinoma nodules measuring 3.1 to 5.0 cm: a single-center study.

Objective This study was performed to determine whether transarterial chemoembolization (TACE) plus multi-imaging-guided radiofrequency ablation (MIG-RFA) can completely eliminate 3.1- to 5.0-cm hepatocellular carcinoma (HCC) nodules and identify factors that may influence the complete elimination rate (CER) of this therapy. Methods Patients who underwent TACE+MIG-RFA for initial treatment of HCC from January 2008 to January 2016 were retrospectively reviewed. In total, 162 patients with 216 HCC nodules (3.1-5.0 cm) were enrolled. TACE was performed first; MIG-RFA was performed 2 to 4 weeks later. Contrast-enhanced computed tomography was performed 1, 3, 6, and 12 months after TACE+MIG-RFA. If tumor enhancement was not detected by the end of the 12-month follow-up, the lesion was considered completely eliminated. Additional TACE+MIG-RFA was performed for residual lesions. The CER was calculated 12 months after the last therapy. Factors that may influence the CER were analyzed. Results In total, 207 (95.8%) nodules showed no residual lesions and were completely eliminated after one or more TACE+MIG-RFA sessions. Nine (4.2%) nodules were incompletely eliminated even with repeated TACE+MIG-RFA. Tumor location was the only significant prognostic factor influencing the CER. Conclusions TACE+MIG-RFA can eliminate 3.1- to 5.0-cm HCC nodules; the tumor location may affect the treatment outcome.

Super-selective renal arterial embolization in treating huge renal angiomyolipoma / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of super-selective renal arterial embolization (SRAE) for treatment of huge renal angiomyolipoma (RAML).Methods Data of 16 patients with huge RAML treated with SRAE were retrospectively analyzed.The clinical symptoms,tumor size,serum creatinine and complications were compared before and after SRAE.Results A total of 26 SRAE treatments were performed on 16 patients with huge RAML.The technical success rate of SRAE was 100％ (26/26).Seven cases (7/16,43.75 ％) received one SRAE treatment,whereas 8 (8/16,50.00％) required two SRAE treatments.Only one case (1/16,6.25％) received three SRAE treatments.The mean follow-up period was (16.60± 15.60) months.The maximum diameter of the tumor reduced significantly after SRAE at final follow-up than before embolization ([9.00±2.80]cm vs [12.60±2.40]cm,t=12.41,P＜0.01).The symptoms of flank pain and hematuria gradually relieved after SRAE.And there was no statistical difference of mean serum creatinine before and after SRAE ([76.00±14.90]μmol/L] vs [79.10±12.80]μmol/L,t=0.89,P=0.39).Fourteen cases (14/ 16,87.50％) experienced post-embolization syndrome including varying degrees of fever,local pain or nausea on 1-3 days after embolization.No serious complications occurred.Conclusion SRAE is an effective method for stopping bleeding of ruptured huge RAML,as well as relieving symptoms and reserving nephron.

Impact of local lipiodol deposition in liver on necrotic area after microwave ablation in miniature pigs / 中国介入影像与治疗学

Objective To explore the impact of local lipiodol deposition in liver of miniature pigs on the shape and size of the necrotic area after microwave ablation (MWA).Methods Ten healthy miniature pigs were selected and equally divided into experimental group and control group (each n=5).In experimental group,transcatheter hepatic arterial embolization with lipiodol was done before microwave ablation,while only standard microwave ablation was performed in control group.Immediate post-ablation CT images were obtained.Long-axis diameter (LAD),short-axis diameter (SAD),sphericity index (SI=SAD/LAD) and volume of ablation zone were calculated.The size and shape of the ablated areas were compared between two groups.Results The mean LAD,SAD,SI and volume of ablation zone in experimental group ([4.21 ± 0.52]cm,[2.87±0.38]cm,0.69±0.10,[18.72±6.08]cm3) were larger than those in control group ([3.71±0.42]cm,[2.19±0.42]cm,0.60±0.09,[9.44±2.29] cm3;all P＜0.05).Conclusion Local deposition of lipiodol in liver parenchyma of miniature pigs can help to produce larger and rounder necrosis in the ablation zone.

Effect of catheter-based peripheral sympathetic denervation on peripheral artery sympathetic tone of New Zealand rabbits / 中国介入影像与治疗学

Objective To investigate the effect of catheter-based peripheral sympathetic denervation (CPSD) on peripheral artery sympathetic tone of New Zealand rabbits.Methods Twenty New Zealand rabbits were randomly divided into CPSD group and control group (each n =10).Endovascular radiofrequency ablation above the bifurcation of the abdominal aorta was performed on the rabbits in CPSD group.Norepinephrine was infused with continuous trans-arterial pumping in both two groups.And laser Doppler flowmetry was used to measure the peripheral microperfusion and temperature of right hindlimb of rabbits.The changes of the peripheral microperfusion and temperature before (resting state) and after norepinephrine infused (norepinephrine load state) were compared between the two groups.Results Eight rabbits completed the procedure in each group.The change of peripheral microperfusion between resting and norepinephrine load states in CSPD group was lower than that in control group ([-37.19±22.56]％ vs [-57.02％±10.12]％,P=0.04),whereas the change of temperature was not significantly different between the two groups ([0.35±0.50]℃ vs [-0.21± 1.83]℃,P=0.43),while significant difference was noticed when two rabbits with abnormal temperature change in control group were neglected ([0.34± 0.50] ℃ vs [-1.14 ±0.72] ℃,P＜0.01).Conclusion CPSD can be used to decrease the peripheral artery sympathetic tone of New Zealand rabbits,and may play an important role in relieving symptoms of critical limb ischemia.

Brief introduction and compliance research of 2017 Fleischner society lung nodules guidelines / 中国介入影像与治疗学

In this article,2017 Fleischner society lung nodules guidelines for management of lung nodules accidentally discovered and lung nodule measurement were briefly introduced.Electronic questionnaires were sent to doctors nationwide,and their familiarity and consistency with these recommendations were assessed.The results showed relatively high familiarity with the guideline,but the consistency in clinical practice was still unsatisfactory,suggesting that further promotion of these guidelines is necessary in the future.

Clinical value of lidocaine combined with remifentanil intravenous anesthesia in radiofrequency ablation of liver tumors / 中国介入影像与治疗学

Objective To explore the clinical value of lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors.Methods Totally 1 252 patients with hepatic tumors treated by radiofrequency ablation were analyzed.RITA cluster multipole radio needles were used in all cases.Local anesthesia with lidocaine was used before percutaneous puncture,and the dosage was 2 mg/kg of body mass.The initial dose of remifentanil was injected with pump at 0.05 μg/(kg · min) during operation.Mean arterial pressure (MAP),heart rate (HR) and saturation of peripheral oxygen (SPO2) were recorded 24 h before radiofrequency ablation (T0),at the beginning of operation (T1),30 min after operation (T2) and at the end of surgery (T3).Visual analogue scale (VAS) was used to assess the analgesic effect during the whole ablation procedure.Results Radiofrequency ablation were successfully performed in 1 250 patients (1 250/1 252,99.84％).The average time was (59.02 ±14.63) min.The average dosage of remifentanil was (242.22± 22.73)μg.The average VAS score was (2.42± 1.13) points.Compared with the preoperative T0 time point,SPO2 did not change significantly at each time of T1,T2 nor T3,but MAP and HR were significantly higher than those before operation (both P＜0.05).VAS scores were significantly higher in patients with tumors size ＞5 em than those in patients with tumors size ≤5 cm (P＜0.05).VAS scores were significantly higher in patients with lesions under hepatic capsule and in diaphragm dome than in patients with lesions in other parts (both P＜0.05).Severe anesthesia related complications occured in 2 patients,related to the respiratory inhibitory effect of remifentanil,and the patients were completely recovered after corresponding treatment.Conclusion Lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors can effectively relieve the pain in patients.Tumor size and tumor location are the main impact factors on analgesic effect.

Ultrasonographic features of IgG4 positive Hashimoto thyroiditis / 中国介入影像与治疗学

Objective To investigate ultrasonographic manifestations of IgG4 positive Hashimoto thyroiditis.Methods Ultrasonographic and clinical features of histopathologically proved Hashimoto thyroiditis in 72 patients were retrospectively analyzed.The patients were divided into IgG4 positive group (n=19) and IgG4 negative group (n=53) according to immunohistochemical staining results.Echotexture,nodules,blood flow distribution and function status of thyroid were compared between the two groups.Results There were statistically significant differences in thyroid hypoechogenicity,linear echogenic strands and combined carcinomas (all P＜0.05),while no statistically significant differences in nodule number,blood flow distribution nor function status of thyroid between the two groups were found (all P＞0.05).Conclusion Ultrasonography can provide valuable imaging evidences for clinical diagnosis of IgG4 positive Hashimoto thyroiditis.

Super-selective renal artery embolization in treatment of iatrogenic renal pseudoaneurysm and arteriovenous fistula / 中国介入影像与治疗学

Objective To evaluate the efficacy and safety of super-selective renal artery embolization in treatment of iatrogenie renal pseudoaneurysm and arteriovenous fistula.Methods Twenty-nine patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula underwent renal angiography after ineffective conservative treatment.After identifying the location and characteristic of lesions by DSA,super-selective renal artery embolization was performed.Symptoms and signs,renal function changes before and after embolization and complications were recorded to evaluate the therapeutic effect.Results The technical success rate of super-selective renal artery embolization was 100％ (29/29),and clinical success rate was 96.55 ％ (28/29).The serum creatinine level before and after embolotherapy was (93.26 ± 28.79) mmol/L and (91.51 ± 27.68) mmol/L respectively,and there were no significant differences (t=1.28,P=0.22).No serious complications such as nephrapostasis or renal failure occurred in the study.Conclusion Super-selective renal artery embolization has technically and clinically high success rate with limited effect on renal function.It is a safe and effective therapy method in patients with iatrogenic renal pseudoaneurysm and arteriovenous fistula.

Transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of renal cell carcinoma / 中国介入影像与治疗学

Objective To evaluate the safety and effectiveness of TACE with radiofrequency ablation (RFA) in treatment of renal cell carcinoma.Methods Data of 23 cases of renal cell carcinoma were retrospectively analyzed.Firstly all patients were treated with renal TACE,and then RFA under the guidance of ultrasound and CT was performed 3 to 4 weeks later.The therapeutic effects were evaluated by enhanced CT or MR scans during the follow-up period.Meanwhile,the changes of Karnofsky Performance Status (KPS) scores and renal functions between preoperative and postoperative periods were also evaluated.Results To the end of the follow-up,in all 23 patients 21 cases (21/23,91.30％) survived and 2 cases died (2/23,8.70 ％).KPS scores and serum creatinine levels were observed in all 23 patients at the initial stage and the end of the follow-up period,there were no significant differences (all P＞0.05).At the end of follow-up,16 cases were complete remission,5 were partial remission and 2 were progressive disease.Conclusion TACE combined with RFA is a safe and effective method in treatment of renal cell carcinoma with less trauma,less complication and more effective.

Role of endovascular technique in acute arterial hemorrhage of abdominal organs / 中国介入影像与治疗学

Objective To investigate the effectiveness of endovascular technique in treatment of acute arterial hemorrhage of abdominal organs.Methods Totally 159 cases (145 patients) acute arterial hemorrhage of abdominal organs were enrolled.All patients underwent emergency transarterial angiography.Endovascular treatment by spring coil,gelatin sponge,or covered stent were in 40 cases.The success rate of immediate and long-term hemostasis was judged by the postoperative radiography,symptoms and the changes of vital signs and laboratory results.Results The positive signs in angiography were observed in 47 among the total 159 cases (47/159,29.56％).Seventy-seven postoperative hemorrhage cases underwent angiography and 29 cases (29/77,37.66 ％) were positive,82 non-operative hemorrhage cases underwent angiography and 18 cases (18/82,21.95％) were positive.The difference was statistical significant (P＜0.05).Endovascular treat ment were performed in 40 cases (33 by spring coils,4 by gelatin sponge and 3 by covered stent).Hemorrhages were con trolled immediately in all the 40 cases after embolization and the success rate were 100％.Conclusion Endovascular tech nique is minimal invasive,and it is an effective method for treatment of acute arterial hemorrhage in abdominal organs.

Prevention and treatment of complications after radiofrequency ablation for hepatic tumors in high-risk locations / 临床肝胆病杂志

Percutaneous radiofrequency ablation (RFA) has been widely used in the treatment of malignant hepatic tumors and has achieved satisfactory effects.Complications after RFA have been taken seriously and the risk of the development of complications is closely associated with tumor location.It is a great challenge for physicians to perform RFA for hepatic tumors in high-risk locations due to related difficulties and risks.This article reviews the complications after RFA for hepatic tumors in high-risk locations and analyzes related control strategies.

Endovascular treatment of subclavian artery stenosis / 中国医师杂志

Objective To evaluate the safety and efficacy of the endovascular treatment of subclavian artery stenosis.Methods From January 2010 to December 2015,the clinical data of 93 patients with subclavian artery stenosis were analyzed retrospectively.All the patients were received angiography and endovascular treatment.Results The technical success rate was 97.9％.Clinical symptom remission rate was 97.8％ after the treatment.There was no procedure related death.During the procedure,limited arterial dissection was encountered in two cases.One patient had minor cerebellar hemorrhage.The follow-up time was 12 to 60 months.Median follow-up time was 36 months.Restenosis was occurred in nine cases.The patency rate of 5 years was 81.0％.Conclusions Endovascular treatment was a safe and effective treatment as the result of our data.It should be used as the preferred treatment of choice for subclavian artery stenosis.

Diagnosis and treatment of pulmonary arteriovenous malformation with cryptogenic stroke caused by paradoxical embolism as the first manifestation / 中华神经科杂志

Objective To investigate the clinical and radiological features of the patients with cryptogenic stroke as the first manifestation of pulmonary arteriovenous malformation (PAVM),and to explore the mechanism and summarize the diagnostic strategy.Methods Transcmnial Doppler (TCD) bubble tests,non-contrast or contrast-enhanced transthoracic and transesophageal echocardiography,contrast-enhanced thoracic CT and pulmonary angiography were performed in 2 patients with cryptogenic stroke for the detection of right to left shunt (RLS) and the diagnosis of PAVM.Then interventional catheter embolization of PAVM and postoperative follow-up were arranged.Results TCD bubble tests in these 2 patients showed the following characteristics indicating RLS:spontaneous continuous shunt at rest,earlystage shunt appeared rapidly after injection,considerable large amount of shunt volume as a shower of microbubble,the extent of shunt volume not attenuated by Valsalva Maneuver (VM).One patient was diagnosed as PAVM,the other was PAVM plus patent foramen ovale (PFO).Both patients of PAVM were successfully treated with interventional catheter embolizations.Then TCD bubble test was repeated and showed significantly decreased amount of RLS.They remained asymptomatic during the 3-year and 1-year follow-up.Conclusions In patients with cryptogenic stroke due to suspected paradoxical embolism,TCD bubble test should be performed for screening RLS.Besides PFO,a traditional access to intracardiac shunt,PAVM should be considered as a new access to extracardiac shunt in paradoxical embolism.

Radiofrequency ablation combined with transarterial chemoembolization for treating of hepatic metastases / 中华放射学杂志

Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for treating of hepatic metastasis. Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63±12 (42-82) years. Tumor size was (4.5±2.4) cm (min.1.5 cm, max. 12.0 cm). Totally 47 lesions were treated with single metastasis in 29 cases and multiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA+TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and then TACE. For multiple lesions, RFA+TACE was given one by one for each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA+TACE were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA+TACE. Twenty patients were in the partially ablated group. Follow up time was 25±10 (10-40) months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month (95%CI: 24-32 months). Survival ration at 1, 2, 3 years for the whole group was 91.7%(33/36),55.5%(20/36),36.1%(13/36) for the whole group. The 3 years survival for complete and partial ablation group was 75.0%(12/16),5.0%(1/20),there was a significant difference between the two groups(P<0.01). Conclusion For patients with hepatic metastasis, RFA+TACE can effectively control the local lesion. Complete ablation is the key point for a better survival.

Application of Interventional Treatment in Acute Massive Gastrointestinal Hemorrhage / 中国医学影像学杂志

Purpose To investigate the diagnostic and therapeutic value of vascular interventional technology dealing with acute massive gastrointestinal hemorrhage. Materials and methods 59 patients with acute massive gastrointestinal hemorrhage underwent the arteriography of mesenteric arteries and abdominal arteries. When positive signs of bleeding appeared, super-selective catheterization and embolization with micro-coil and gelfoam was applied immediately. Results Positive signs of bleeding were detected in 28 of 59 patients, among which 25 patients underwent embolization, and successful hemostasis was achieved in 21 cases with an achievement ratio of 84%. And there were 10 cases eventually turning to surgery.Conclusion Vascular interventional technology such as arteriography and embolization played an important role in diagnosis and treatment of acute massive gastrointestinal hemorrhage.