A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

OBJECTIVE: The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). METHODS: A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. RESULTS: Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. CONCLUSION: The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Perfluoropentane/apatinib-encapsulated metal-organic framework nanoparticles enhanced the microwave ablation of hepatocellular carcinoma.

Microwave ablation (MWA) is a promising minimally invasive therapy for hepatocellular carcinoma (HCC). However, the efficiency of MWA in treating HCC is evidently limited by the incomplete ablation of large tumors and tumors in high-risk locations. Here we designed an iron-based metal-organic framework nanomedicine (PFP-Apa-MOF) by loading perfluoropentane (PFP) and apatinib (Apa). After being absorbed by HCC, iron could induce ferroptosis. PFP could be activated into bubbles and act as an ultrasound agent for detecting the ablation margin. As an effective antiangiogenic drug, Apa could inhibit tumor residual growth after MWA. The high efficiency of PFP-Apa-MOF was fully demonstrated in vitro and in vivo. The results showed that MWA combined with PFP-Apa-MOF clearly enhanced the ablation efficiency, leading to apparent tumor inhibition, and increased tumor apoptosis and lipid peroxide. PFP-Apa-MOF could play a valuable role in enhancing MWA to achieve better therapeutic efficacy in HCC.

Radiomics Based on Contrast-Enhanced Ultrasound Images for Diagnosis of Pancreatic Serous Cystadenoma.

OBJECTIVE: The purpose of the study was to develop and validate a radiomics model by using contrast-enhanced ultrasound (CEUS) data for pre-operative differential diagnosis of pancreatic cystic neoplasms (PCNs), especially pancreatic serous cystadenoma (SCA). METHODS: Patients with pathologically confirmed PCNs who underwent CEUS examination at Chinese PLA hospital from May 2015 to August 2022 were retrospectively collected. Radiomic features were extracted from the regions of interest, which were obtained based on CEUS images. A support vector machine algorithm was used to construct a radiomics model. Moreover, based on the CEUS image features, the CEUS and the combined models were constructed using logistic regression. The performance and clinical utility of the optimal model were evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity and decision curve analysis. RESULTS: A total of 113 patients were randomly split into the training (n = 79) and test cohorts (n = 34). These patients were pathologically diagnosed with SCA, mucinous cystadenoma, intraductal papillary mucinous neoplasm and solid-pseudopapillary tumor. The radiomics model achieved an AUC of 0.875 and 0.862 in the training and test cohorts, respectively. The sensitivity and specificity of the radiomics model were 81.5% and 86.5% in the training cohort and 81.8% and 91.3% in the test cohort, respectively, which were higher than or comparable with that of the CEUS model and the combined model. CONCLUSION: The radiomics model based on CEUS images had a favorable differential diagnostic performance in distinguishing SCA from other PCNs, which may be beneficial for the exploration of personalized management strategies.

Nomogram based on Sonazoid contrast-enhanced ultrasound to differentiate intrahepatic cholangiocarcinoma and poorly differentiated hepatocellular carcinoma: a prospective multicenter study.

OBJECTIVES: The aim of this study was to develop a predictive model based on Sonazoid contrast-enhanced ultrasound (SCEUS) and clinical features to discriminate poorly differentiated hepatocellular carcinoma (P-HCC) from intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHOD: Forty-one ICC and forty-nine P-HCC patients were enrolled in this study. The CEUS LI-RADS category was assigned according to CEUS LI-RADS version 2017. Based on SCEUS and clinical features, a predicated model was established. Multivariate logistic regression analysis and LASSO logistic regression were used to identify the most valuable features, 400 times repeated 3-fold cross-validation was performed on the nomogram model and the model performance was determined by its discrimination, calibration, and clinical usefulness. RESULTS: Multivariate logistic regression and LASSO logistic regression indicated that age (> 51 y), viral hepatitis (No), AFP level (≤  20 µg/L), washout time (≤  45 s), and enhancement level in the Kupffer phase (Defect) were valuable predictors related to ICC. The area under the receiver operating characteristic (AUC) of the nomogram was 0.930 (95% CI: 0.856-0.973), much higher than the subjective assessment by the sonographers and CEUS LI-RADS categories. The calibration curve showed that the predicted incidence was more consistent with the actual incidence of ICC, and 400 times repeated 3-fold cross-validation revealed good discrimination with a mean AUC of 0.851. Decision curve analysis showed that the nomogram could increase the net benefit for patients. CONCLUSIONS: The nomogram based on SCEUS and clinical features can effectively differentiate P-HCC from ICC.

Analysis of Sonazoid contrast-enhanced ultrasound for predicting the risk of microvascular invasion in hepatocellular carcinoma: a prospective multicenter study.

OBJECTIVES: The aim of this study was to evaluate the potential of Sonazoid contrast-enhanced ultrasound (SNZ-CEUS) as an imaging biomarker for preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). METHODS: From August 2020 to March 2021, we conducted a prospective multicenter study on the clinical application of Sonazoid in liver tumor; a MVI prediction model was developed and validated by integrating clinical and imaging variables. Multivariate logistic regression analysis was used to establish the MVI prediction model; three models were developed: a clinical model, a SNZ-CEUS model, and a combined model and conduct external validation. We conducted subgroup analysis to investigate the performance of the SNZ-CEUS model in non-invasive prediction of MVI. RESULTS: Overall, 211 patients were evaluated. All patients were split into derivation (n = 170) and external validation (n = 41) cohorts. Patients who had MVI accounted for 89 of 211 (42.2%) patients. Multivariate analysis revealed that tumor size (> 49.2 mm), pathology differentiation, arterial phase heterogeneous enhancement pattern, non-single nodular gross morphology, washout time (< 90 s), and gray value ratio (≤ 0.50) were significantly associated with MVI. Combining these factors, the area under the receiver operating characteristic (AUROC) of the combined model in the derivation and external validation cohorts was 0.859 (95% confidence interval (CI): 0.803-0.914) and 0.812 (95% CI: 0.691-0.915), respectively. In subgroup analysis, the AUROC of the SNZ-CEUS model in diameter ≤ 30 mm and ˃ 30 mm cohorts were 0.819 (95% CI: 0.698-0.941) and 0.747 (95% CI: 0.670-0.824). CONCLUSIONS: Our model predicted the risk of MVI in HCC patients with high accuracy preoperatively. CLINICAL RELEVANCE STATEMENT: Sonazoid, a novel second-generation ultrasound contrast agent, can accumulate in the endothelial network and form a unique Kupffer phase in liver imaging. The preoperative non-invasive prediction model based on Sonazoid for MVI is helpful for clinicians to make individualized treatment decisions. KEY POINTS: • This is the first prospective multicenter study to analyze the possibility of SNZ-CEUS preoperatively predicting MVI. • The model established by combining SNZ-CEUS image features and clinical features has high predictive performance in both derivation cohort and external validation cohort. • The findings can help clinicians predict MVI in HCC patients before surgery and provide a basis for optimizing surgical management and monitoring strategies for HCC patients.

Diagnostic efficiency of [68 Ga]Ga-DOTA-FAPI-04 in differentiating periprosthetic hip joint infection and aseptic failure.

PURPOSE: To assess the efficiency of [68 Ga]Ga-DOTA-FAPI-04 in diagnosing periprosthetic hip joint infection and establish a diagnostic standard of clinical significance based on uptake pattern. METHODS: [68 Ga]Ga-DOTA-FAPI-04 PET/CT was performed in patients with symptomatic hip arthroplasty from December 2019 to July 2022. The reference standard was based on the 2018 Evidence-Based and Validation Criteria. Two diagnostic criteria, SUVmax and uptake pattern, were used to diagnose PJI. Meanwhile, original data were imported into IKT-snap to draw the view of interest, A.K. was used to extract features of clinical cases, and unsupervised clustering analysis was applied according to the groups. RESULTS: A total of 103 patients were included, 28 of whom had PJI. The area under the curve of SUVmax was 0.898, which was better than that of all of the serological tests. The cutoff value of SUVmax was 7.53, and the sensitivity and specificity were 100 and 72%, respectively. The sensitivity, specificity and accuracy of the uptake pattern were 100, 93.1 and 95%, respectively. In radiomics analysis, the features of PJI were significantly different from those of aseptic failure. CONCLUSION: The efficiency of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in diagnosing PJI showed promising results, and the diagnostic criteria of the uptake pattern were more clinically instructive. Radiomics also showed certain application prospects in the field of PJI. TRIAL REGISTRATION NUMBER: Trial registration: ChiCTR2000041204. Registered 24 September 2019.

Different uptake patterns of 68Ga-FAPI in aseptic loosening and periprosthetic joint infection of hip arthroplasty: A case series and literature review.

Background: The diagnosis of a periprosthetic joint infection (PJI) is always a difficult point in research on the surgery of joints. The current diagnostic criteria include a comprehensive analysis of multiple tests; however, there are no effective visual examinations yet that can differentiate between aseptic loosening and the PJI. Case presentation: This case report describes four patients with symptomatic total hip arthroplasty (THA), two cases of loosening and two cases of infection. Although the four cases were correctly diagnosed by the tissue culture, preoperative tests and pathological examination could not effectively distinguish an infection from a non-infection. Based on a preclinical study and theoretical feasibility, gallium-68 (68Ga)-labeled fibroblast activation protein inhibitor positron emission tomography/computed tomography (68Ga-FAPI PET/CT) was performed. Through 68Ga-FAPI PET/CT scanning, not only were the causes diagnosed correctly but the lesions were also located. Conclusion: When the lesion is located between the bone and the prosthesis, 68Ga-FAPI PET/CT could differentiate aseptic loosening from periprosthetic joint infection (PJI). 68Ga-FAPI PET/CT has clear advantages over routine examinations and has a prospective application in detecting PJI.

Comparison of percutaneous microwave ablation and surgical resection for hepatocellular carcinoma in the caudate lobe.

Background: This study aims to compare the clinical efficacy and safety between ultrasound (US)-guided percutaneous microwave ablation (MWA) assisted with a three-dimensional (3D) visualization preoperative planning system and surgical resection (SR) for hepatocellular carcinoma (HCC) in the caudate lobe. Materials and Methods: Forty-nine patients diagnosed with caudate lobe HCC, who underwent US-guided percutaneous MWA (29 patients) or SR (20 patients), were enrolled between November 2005 and December 2018. Follow-up was performed at 1, 3, 6, 12, 18, 24, and 36 months after ablation or resection. The follow-up endpoint was recurrence or patient death. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes, whereas local tumor progression (LTP), intrahepatic recurrence, and extrahepatic metastasis were the secondary ones. Results: The mean age of the two groups was 61.4 ± 9.1 (MWA) and 53.1 ± 6.8 (SR), respectively, with a significant difference (P < 0.01). There were no significant differences in OS (69.0% in the MWA group and 75.0% in the SR group) and PFS (62.1% in the MWA group and 35.3% in the SR group). LTP, intrahepatic recurrence, and extrahepatic recurrence were 6.9% (2/29), 31.0% (9/29), and 20.7% (6/29) in the MWA group and 5.0% (1/20), 60.0% (12/20), and 5.0% (1/20) in the SR group. The MWA group was more cost-effective and required less hospitalization time. No major complications were observed. Conclusions: US-guided percutaneous MWA for HCC in the caudate lobe assisted with a 3D visualization preoperative planning system is an optional treatment with less expenses and shorter hospitalization than SR.

18F-FDG and 68 Ga-FAPI PET/CT for the evaluation of periprosthetic joint infection and aseptic loosening in rabbit models.

PURPOSE: We built a joint replacement loosening model based on the original rabbit model of infection and evaluated the performance characteristics of 18F-FDG and 68 Ga-FAPI in evaluating infection and loosening. METHODS: After surgery, the rabbits were divided into four groups, with six individuals in the control group and 10 each in the aseptic loosening, S. aureus and S. epidermidis groups. PET/CT and serological examination were performed three times at two-week intervals. After the rabbits were euthanized, micro-CT, tissue pathology, pullout tests and scanning electron microscopy (SEM) were performed. RESULTS: The pullout test and SEM showed the feasibility of the aseptic loosening model. 18F-FDG showed similar performance in the control and loosening groups. The SUVmax of the S. aureus group was consistently higher than that of the S. epidermidis group. As for 68 Ga-FAPI, the SUVmax of the control group was lowest in the second week and gradually increased over subsequent weeks. The SUVmax of the loosening group began to exceed that of the control group after the second week. The SUVmax of the S. aureus group in the second week was the lowest among the four groups and increased as the number of weeks increased. The pathology results showed concordance with the performance of PET/CT. Linear regressions between SUVmax and serology showed that 18F-FDG was positively correlated with CRP and IL-6, while 68 Ga-FAPI revealed negative correlations with CRP and IL-6 in the second week and positive correlations in the sixth week. In addition, the SUVmax and MT(target)V of both 18F-FDG and 68 Ga-FAPI were negatively correlated with bone volume/trabecular volume (TV) and bone surface area/TV. CONCLUSION: In this longitudinal observation, 68 Ga-FAPI showed greater sensitivity than 18F-FDG in detecting diseases, and 68 Ga-FAPI had no intestinal or muscular uptake. The MT(target)V of 68 Ga-FAPI was larger than that of 18F-FDG, which meant that 68 Ga-FAPI had the potential to define the scope of lesions more accurately. Finally, the SUVmax of 68 Ga-FAPI could not differentiate between loosening and infection; further study of the diagnostic criteria is warranted.

Using 18F-flurodeoxyglucose and 68Ga-fibroblast activation protein inhibitor PET/CT to evaluate a new periprosthetic joint infection model of rabbit due to Staphylococcus aureus.

PURPOSE: The existing periprosthetic joint infection (PJI) models have obvious limitations, and studies of PJI on animal models using PET/computed tomography (CT) for diagnosis are still lacking. Thus, the aim of this study was to establish a new PJI model and 18F-fluorodeoxyglucose (FDG) and 68Ga-fibroblast activation protein inhibitor (FAPI) were employed to study their performance. METHODS: A novel PJI model of rabbit was developed by placing two screws in the tibia and femur. Based on bacteria concentration, the animals were divided into five groups, control, 104, 105, 106 and 107. 18F-FDG and 68Ga-FAPI PET/CT were performed continuously in next 2 weeks and maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic target volume (MTV) and total lesion glycolysis/total lesion fibrosis were calculated as the metrics. RESULTS: As for SUVmax, all data of 18F-FDG were larger than that of 68Ga-FAPI in the same group for both weeks. For the performance of 18F-FDG, no definitive conclusion could be drawn for SUVmax and SUVmean. As for 68Ga-FAPI, the 104 group was significantly larger than 105, 106 and 107 groups for SUVmax and SUVmean in both weeks (P < 0.05). MTV of 68Ga-FAPI was found to be almost always larger than that of 18F-FDG in the same group. CONCLUSION: The mechanism of 68Ga-FAPI is totally different from 18F-FDG and this unique property of 68Ga-FAPI shows a promising prospect in detecting infection boundary and may even distinguish a small number or a large number of bacterial infections.

An inverse planning simulated annealing algorithm with adaptive weight adjustment for LDR pancreatic brachytherapy.

PURPOSE: The inverse planning simulated annealing (IPSA) algorithm has shown good results in cancer surgical treatment planning. However, an adaptive approach has not well been proposed for different shapes and sizes of tumors. The purpose of this study was to propose an adaptive, efficient and safe algorithm to get high-quality treatment dose planning, which is presented for pancreatic cancer. METHODS: An algorithm employs an optimized IPSA and an adaptive process for adjusting the weight of organs at risk (OAR) and tumor. The algorithm, which was combined with ant colony optimization, was further optimized to reduce the number of needles. It could meet the clinical dose objectives within the tumors, reduce the dose distribution within the OAR and minimize the number of needles. Ten clinical cases were chosen randomly from patients, previously successfully treated in clinic to test our method. The algorithm was validated against clinical cases, using clinically relevant dose parameters. RESULTS: The results were compared with clinical results in ten cases, indicating that the dose distribution within the tumor meets the clinical dose objectives. The dose received by OAR had been greatly reduced, and the number of needles could be reduced by about 50%. It was a significant improvement over the clinical treatment planning. CONCLUSIONS: In this paper, we have devised an algorithm to optimize the treatment planning in brachytherapy. The method in this paper could meet the clinical dose objectives and reduce the difficulty of operation. The results were clinically acceptable. This algorithm is also applicable to other cancers such as lung cancer.

DVH-based inverse planning for LDR pancreatic brachytherapy.

PURPOSE: Pancreatic cancer is one of the common types of malignant cancer. Low-dose-rate (LDR) brachytherapy has shown great efficacy in curing pancreatic cancer. However, a long preoperative planning time and an insufficient tumor dose are common issues. In this paper, we present and validate a method for inverse planning using simulated annealing (SA) for the treatment of pancreatic cancer. METHODS: The SA method was used for the inverse planning process. With the help of parallel computation and a quick dose field estimation algorithm. This method allowed inverse planning to be performed quickly. A novel length-control method was used to consider and limit the dose of the organ at risk. The effect of this system was validated by calculating the dose-volume histogram metric and time consumption. RESULTS: Regarding the percentage of the volume receiving 100% of the prescribed dose (V100), this approach yielded an average difference in V100 of 5.01% for the tumor and of 1.32% for the organ at risk in the small tumor group; in the large tumor group, the average difference in V100 was 2.3% for the tumor and - 4.49% for the organ at risk. The average time required for inverse planning was 1.63 ± 0.26 s for small tumors and 3.81 ± 0.51 s for large tumors. Compared with other inverse planning methods, the optimal quality of the plans yielded by this method was further improved. CONCLUSION: This paper presents a new type of inverse planning method for the treatment of pancreatic cancer based on SA. Compared with other LDR inverse planning methods, the method presented here can provide the prescribed dose to the tumor while considering the dose of the organ at risk. Also, the required time is significantly lower than other methods. All the experimental results indicate that this method is ready to be applied in further clinical studies.

Ultrasound-guided percutaneous microwave ablation of bilateral renal cell carcinomas: Focus upon safety and efficacy.

OBJECTIVE: To retrospectively review the safety and efficacy of ultrasound (US)-guided percutaneous microwave ablation (MWA) of bilateral renal cell carcinomas (BRCCs). PATIENTS AND METHODS: In this study, eight patients of BRCCs with 20 lesions seen from November 2012 to October 2018 were enrolled retrospectively. The patients were treated with US -guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging. RESULTS: Technical success was achieved 20 tumors. The 18 lesions were performed to ablate 90%; 2 lesions were repeated because of detecting residual ablated tumor. Except six patients were noted fever, no severe complications occurred. The median follow-up time was 24 months (range 7-59 months). Among the eight patients, there was no local tumor recurrence in 6 of 8 completely ablated tumor lesions. One patient was retreated by MWA 6 months after ablation, and another was retreated after 19 months due to local tumor recurrence. No patients have obvious change of renal function and lost their life. CONCLUSION: US-guided percutaneous MWA is a beneficial treatment for BRCC.

A finite element analysis of relationship between fracture, implant and tibial tunnel.

The purpose of this article was to use finite element analysis (FEA) to study the relationship of tibial tunnel (TT) with fracture pattern and implants. A computed tomography scan of full-length tibia and fibula was obtained. Models were built after three-dimensional reconstruction. The corresponding plates and screws were constructed and assembled together with fracture models. FEA was performed and contourplots were output. The Von Mises stresses of nodes and displacements of elements were extracted. Student's t test was used to compare the values of Von Mises stresses and displacements between corresponding models. Differences in Von Mises stresses and displacements of fragments and implants between models with and without TT were nearly all statistically significant. However, the displacements of fragments and implants for all models were < 2 mm. TT in fracture models had larger Von Mises stresses than TT in intact tibial model. However, displacements of TT in fracture models showed similar or even smaller results to those in intact tibial model. Although almost all the tested parameters were statistically significant, differences were small and values were all below the clinical threshold. This study could promote open reduction and internal fixation with one-stage reconstruction for treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) ruptures.

Comparative Diagnostic Evaluation with Contrast-Enhanced Ultrasound, Computed Tomography and Magnetic Resonance Imaging in Patients with Pancreatic Cystic Neoplasms.

PURPOSE: The purpose of our study was to evaluate the role of contrast-enhanced ultrasound (CEUS) with magnetic resonance imaging (MRI) and computed tomography (CT) in the pathological diagnosis of pancreatic cystic neoplasms (PCNs). METHODS: A total of 90 patients (66 women, 24 men) aged 18-71 years were studied prospectively. CEUS was performed in all patients, whereas MRI was performed in 85 patients and CT in 69 patients. We analyzed the sensitivity and accuracy of these three imaging modalities to diagnose the PCNs. Neoplasm size, location, shape, intralesional mural nodules, septa and duct dilatation were also assessed by different radiologists. RESULTS: There were no significant differences in sensitivity for discriminating PCNs from pancreatic cystic lesions between CEUS and MRI (p=0.614) or between CEUS and CT (p=0.479). The diagnostic accuracy of CEUS for classifying PCNs was 64.4% (58/90), which was higher than that of CT (53.6%, 37/69, P=0.017), and lower than that of MRI (70.6%, 60/85, p=0.791). Regarding tumor size for lesions larger than 3 cm, CEUS was superior to CT in differentiating the specific type of PCN (p=0.041), and CEUS had the same value as MRI (p=0.774). Furthermore, CEUS is valuable for precisely characterizing internal structures, for instance, septa (p=0.003, compared with CT; p=0.443, compared with MRI) and nodules (p= 0.018, compared with CT; p=0.033, compared with MRI). The number of septa (p=0.033) and cyst morphology (p=0.016) were meaningful indicators in differentiating serous and mucinous adenoma. There was no significant difference in evaluating size and detecting duct dilatation among the three imaging methods. CONCLUSION: CEUS compares favorably with MRI in displaying the inner structure of PCNs and offers advantages over CT. CEUS can contribute in an important way to the diagnosis of pancreatic cystic neoplasms.

Microwave ablation of benign breast tumors: a prospective study with minimum 12 months follow-up.

PURPOSE: This prospective study was to evaluate clinical outcomes of microwave ablation (MWA) of benign breast tumors with minimum 12 months follow up. METHODS: With approval of the institutional ethics committee and written informed consent, 56 patients with 107 biopsy-proved breast benign tumors were recruited from November, 2013 to April, 2017. MWA with ultrasound (US) guidance was performed under local anesthesia. During the procedure, pull-back technique was used for tumors larger than 1.0 cm in diameter and hydro-dissection technique was used for tumors adjacent to skin, pectoralis and areola. Clinical outcomes were followed up by physical examination and medical images including US, contrast enhanced US and MR. RESULTS: The maximum diameter of these tumors was 1.6 ± 0.8 cm. MWA was successfully performed with the median 120 s of duration (ranging 20-1100 s). Technical success was achieved in all patients. At the median follow-up of 20.5 months (ranging 12-53 months), the mean volume reduction ratios (mVRRs) of tumors were 77.1 ± 8.2%, 84.3 ± 10.6%, 93.3 ± 8.2% at follow-up of 12, 18, 24 months (p < .0001), respectively. Compared with 92% of masses were palpable before ablation, mass palpabilities were 40%, 11%, 5% at follow-up of 12, 18, 24 months (p < .001), respectively. Cosmetic satisfaction was reported excellent or good in 100% of patients. CONCLUSIONS: As a safe and effective minimally invasive modality for inactivating benign breast tumors in situ, MWA achieved optimistic clinical outcomes on volume reduction and cosmetic satisfaction after minimum 12 months follow-up.

The application of a three-dimensional visualized seed planning and navigation system in 125I seed implantation for pancreatic cancer.

OBJECTIVES: To evaluate the effectiveness of iodine-125 (125I) seed implantation for pancreatic cancer (PC), and preliminarily evaluate the clinical value of a self-developed three-dimensional (3D) visualized seed planning and navigation system in 125I seed implantation for treatment of PC. PATIENTS AND METHODS: Our team retrospectively reviewed 25 PC patients who underwent 125I seed implantation between December 2010 and November 2016. The patients were divided into two groups: 3D visualization preoperative planning group (12 patients, 13 lesions) and two-dimensional (2D) regular group (13 patients, 14 lesions). We compared and analyzed the parameters of the two groups, such as number of needle insertions, one-time treatment success rate, proportion of added seeds, local control rate, rate of complications, rate of pain relief, and the survival rate and risk factors of the two groups. There was no significant difference in clinical data of the two groups. RESULTS: 125I seed implantation was performed successfully in all PC patients, with no occurrence of serious complications during and after the procedure. The one-time treatment success rate of 3D group (80%) was higher than that of 2D group (45.5%) (P<0.05), and the proportion of added seed number of 3D group was lower than that of 2D group (P<0.05). The local control rate of 3D group (76.9%) was higher than that of 2D group (35.7%) (P<0.05). The survival rate of 3D group was significantly higher than that of 2D group (P=0.026), and the median survival of 2D group vs 3D group was 5.00 vs 10.80 months. The median survival of all 25 patients was 7.10 months (95% confidence interval: 4.43-9.77). The rate of pain relief was 77.8% (7/9) in 2D group and 88.9% (8/9) in 3D group. CONCLUSION: Ultrasound-guided, 3D visualized seed planning and navigation system assisted 125I seed implantation is a safe and effective method for the treatment of PC, with a prolonged survival of patients and better local control of tumor.