Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The b... more Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for perso... more Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
In this series of papers on comments and illustrations of the World Federation for Medicine and B... more In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
To retrospectively assess the diagnostic accuracy of immediate postprocedural CEUS, 24-h CEUS, an... more To retrospectively assess the diagnostic accuracy of immediate postprocedural CEUS, 24-h CEUS, and 24-h CT in verifying the effectiveness of thermal ablation of liver tumors ablation, using the combined results of 3-month post-procedure CEUS and MDCT as the reference standard. Materials and methods: From our database, we selected patients who had immediate postprocedural CEUS and 24-h CEUS and MDCT examinations after undergoing thermal ablation of a liver tumor between January 2009 and March 2010. The study population consisted of 53 subjects and 55 tumors (44 HCC and 11 metastasis) were evaluated. Thirty-seven tumors were treated with radiofrequency and 18 with microwave ablation. Post-procedural CEUS, 24-h CEUS and MDCT, and 3-month follow-up CEUS and MDCT images were blindly reviewed by two radiologists, who measured the size of the ablation area on the post-procedural and 24-h studies. They also evaluated the ability of each of these three index tests to predict the outcome (residual tumor vs. no residual tumor) using imaging studies done at the 3-month follow-up as the reference standard. Results: Mean tumor diameter on preablation CEUS (the day before treatment) was 20 AE 9 mm. Mean diameter of the necrotic area was 29 AE 9 mm on post-procedural CEUS, 34 AE 11 mm on 24-h CEUS, and 36 AE 11 mm on 24-h MDCT. Diameters of the necrotic area (mean and maximum) on post-procedural CEUS were significantly smaller than those measured on 24-h CEUS or 24-h MDCT, which were not significantly different. For predicting the presence of residual tumor at the 3-month follow-up, post-procedural CEUS, 24-h CEUS, and 24-h MDCT displayed sensitivity of 33%, 33%, and 42%; specificity of 92%, 97%, and 97%; negative predictive value of 84%, 85%, and 83%. The accuracy parameters of these three imaging modalities were * SIUMB Award for the Best Poster at the National SIUMB Congress 2010.
OBJECTIVE. Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which sign... more OBJECTIVE. Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which significantly differs from conventional HCC. This article reviews the molecular cytogenetics, pathology, imaging features, and management of this relatively rare tumor. CONCLUSION. Fibrolamellar HCC predominantly occurs in young patients without underlying hepatitis or cirrhosis. Serum α-fetoproteins are not elevated in most cases, and hence imaging plays an important role in diagnosis, staging, and surveillance.
There is currently no consensus regarding preferred clinical outcome measures following image-gui... more There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research.
Human brucellosis commonly involves the liver and manifests as nonspecific or granulomatous hepat... more Human brucellosis commonly involves the liver and manifests as nonspecific or granulomatous hepatitis. Although the development of a brucellar hepatic abscess is rare, it can be difficult to accurately diagnose given that histopathologic analysis is often not diagnostic, and the bacterium is seldom isolated from pus cultures. Therefore, serologic tests and imaging play an important role in the diagnosis of a brucellar abscess. The characteristics of a brucellar abscess on conventional ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) have been reported previously. 1,2 However, to the best of our knowledge, the features of a brucellar hepatic abscess on contrast-enhanced ultrasonography (CEUS) have not been described previously.
Journal of Vascular and Interventional Radiology, Nov 1, 2014
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The b... more Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for perso... more Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Contrast‐enhanced ultrasonography (CEUS) plays an important role in the management of patients tr... more Contrast‐enhanced ultrasonography (CEUS) plays an important role in the management of patients treated with ablation therapies, in the diagnostic, therapeutic and monitoring phases.
Ultraschall in der Medizin (Stuttgart, Germany : 1980), Jan 12, 2017
To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS)... more To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS) as a guidance technique for the biopsy of liver target lesions (LTLs) at six interventional ultrasound centers. The six participating centers retrospectively selected all patients in whom biopsy needles were positioned in LTLs during CEUS. The prevalence of CEUS-guided biopsies at each center between 2005 and 2016, contrast agent consumption, procedure indications, diagnostic yield and complications were assessed. Informed consent was obtained for all patients. CEUS-guided biopsy of LTLs was carried out in 103 patients (68 M/35 F, median age: 69 yrs) with 103 liver target lesions (median size: 20 mm) using cutting needles (18 - 20 g) in 94 cases (91.2 %). CEUS-guided biopsy represented 2.6 % (range: 0.8 - 7.7 %) of 3818 biopsies on LTLs carried out at the participating centers. Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (27.2 %), improvement...
Radiofrequency ablation (RFA) is currently indicated for the treatment of primary and metastatic ... more Radiofrequency ablation (RFA) is currently indicated for the treatment of primary and metastatic hepatic malignancies. Real-time ultrasound (US) is generally used during the procedure to guide electrode placement, but for evaluating the results of treatment, contrast-enhanced computed tomography and magnetic resonance imaging have traditionally been considered more effective. This view has changed, however, with the recent development of contrast-enhanced ultrasound (CEUS) (eg, using sulfur hexafluoride microbubbles), which can provide valuable information on the effects of RFA more rapidly and economically than computed tomography or magnetic resonance imaging without exposing the patient to ionizing radiation. In our center, CEUS is performed in patients with liver tumors before and immediately after RFA, in selected cases during the procedure as well, and in the follow-up. Between January 2003 and June 2005, we performed CEUS on 350 patients scheduled for RFA of primary or metast...
Objecti6e: Radiofrequency (RF) has been demonstrated as a relatively safe procedure in the treatm... more Objecti6e: Radiofrequency (RF) has been demonstrated as a relatively safe procedure in the treatment of hepatocellular carcinoma (HCC). Methods: A 60-year-old man with liver cirrhosis presented with a large, infiltrating HCC close to the right colon. The patient was treated with internally cooled RF. Results: On the 8th day post-ablation, a complication of right colon perforation was diagnosed. Conclusion: RF can induce untoward thermal damage, and may not be indicated in large infiltrating lesions abutting the gastrointestinal tract.
To retrospectively assess the local control and intermediate-and long-term survival of patients w... more To retrospectively assess the local control and intermediate-and long-term survival of patients with liver metastases from breast cancer who have undergone percutaneous ultrasonography (US)-guided radiofrequency (RF) ablation. Materials and Methods: This study was approved by the hospital ethics committee, and all patients provided written informed consent. RF ablation was used to treat 87 breast cancer liver metastases (mean diameter, 2.5 cm) in 52 female patients (median age, 55 years). Inclusion criteria were as follows: fewer than five tumors, maximum tumor diameter of 5 cm or smaller, and disease either confined to the liver or stable with medical therapy. Forty-five (90%) of 50 patients had previously undergone chemotherapy, hormonal therapy, or both, and had no response or an incomplete response to the treatment. Contrast material-enhanced computed tomography and US were performed to evaluate complications and technical success and to assess for local tumor progression during follow-up. The Kaplan-Meier method was used to assess survival, and results were compared between groups with a log-rank test. Cox regression analysis was used to assess independent prognostic factors that affected survival. Results: Complete tumor necrosis was achieved in 97% of tumors. Two (4%) minor complications occurred. Median time to follow-up from diagnosis of liver metastasis and from RF ablation was 37.2 and 19.1 months, respectively. Local tumor progression occurred in 25% of patients. New intrahepatic metastases developed in 53% of patients. From the time of first RF ablation, overall median survival time and 5-year survival rate were 29.9 months and 27%, respectively. From the time the first liver metastasis was diagnosed, overall median survival time was 42 months, and the 5-year survival rate was 32%. Patients with tumors 2.5 cm in diameter or larger had a worse prognosis (hazard ratio, 2.1) than did patients with tumors smaller than 2.5 cm in diameter. Conclusion: Survival rates in selected patients with breast cancer liver metastases treated with RF ablation are comparable to those reported in the literature that were achieved with surgery or laser ablation.
Abstract 2-Chloro-4′,4″-di(2-imidazolin-2-yl)terephthalanilide (NSC 60339) has been compared with... more Abstract 2-Chloro-4′,4″-di(2-imidazolin-2-yl)terephthalanilide (NSC 60339) has been compared with oligomycin and 2,4-dinitrophenol in its effects on a rat liver mitochondrial swelling system. The substituted phthalanilide and oligomycin are equivalent in their effects in the following swelling experiments. Neither alters spontaneous or calcium- or phosphate-induced swelling; both inhibit succinate-induced swelling; both prevent ATP inhibition of calcium- and phosphate-induced swelling; and both inhibit ATP reversal of calcium-induced swelling in fresh or aged mitochondria. The known binding ofphthalanilides to specific phospholipids and the inhibitory effects described suggest that NSC 60339 may be useful in studies on the nature and role oflipids in mitochondrial swelling and oxidative phosphorylation.
We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-g... more We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.
Journal of gastrointestinal and liver diseases : JGLD, 2015
In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imag... more In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imaging techniques in the detection and the characterization of focal liver lesions. Since the publication of these guidelines in 2008, several studies relating to this topic have been published. Thus, we felt the need to assess whether interval research and new advancements in diagnostic imaging have yielded new evidence that should modify the recommendations that were previously issued. The literature search confirmed the appropriateness of the current guidelines. Although most modalities did not show substantial changes, interval introduction of DW-MRI is a valuable technique with a high diagnostic accuracy in the detection and characterization of FLLs, and its sensitivity is higher when combined with MRI.
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The b... more Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for perso... more Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
In this series of papers on comments and illustrations of the World Federation for Medicine and B... more In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
To retrospectively assess the diagnostic accuracy of immediate postprocedural CEUS, 24-h CEUS, an... more To retrospectively assess the diagnostic accuracy of immediate postprocedural CEUS, 24-h CEUS, and 24-h CT in verifying the effectiveness of thermal ablation of liver tumors ablation, using the combined results of 3-month post-procedure CEUS and MDCT as the reference standard. Materials and methods: From our database, we selected patients who had immediate postprocedural CEUS and 24-h CEUS and MDCT examinations after undergoing thermal ablation of a liver tumor between January 2009 and March 2010. The study population consisted of 53 subjects and 55 tumors (44 HCC and 11 metastasis) were evaluated. Thirty-seven tumors were treated with radiofrequency and 18 with microwave ablation. Post-procedural CEUS, 24-h CEUS and MDCT, and 3-month follow-up CEUS and MDCT images were blindly reviewed by two radiologists, who measured the size of the ablation area on the post-procedural and 24-h studies. They also evaluated the ability of each of these three index tests to predict the outcome (residual tumor vs. no residual tumor) using imaging studies done at the 3-month follow-up as the reference standard. Results: Mean tumor diameter on preablation CEUS (the day before treatment) was 20 AE 9 mm. Mean diameter of the necrotic area was 29 AE 9 mm on post-procedural CEUS, 34 AE 11 mm on 24-h CEUS, and 36 AE 11 mm on 24-h MDCT. Diameters of the necrotic area (mean and maximum) on post-procedural CEUS were significantly smaller than those measured on 24-h CEUS or 24-h MDCT, which were not significantly different. For predicting the presence of residual tumor at the 3-month follow-up, post-procedural CEUS, 24-h CEUS, and 24-h MDCT displayed sensitivity of 33%, 33%, and 42%; specificity of 92%, 97%, and 97%; negative predictive value of 84%, 85%, and 83%. The accuracy parameters of these three imaging modalities were * SIUMB Award for the Best Poster at the National SIUMB Congress 2010.
OBJECTIVE. Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which sign... more OBJECTIVE. Fibrolamellar hepatocellular carcinoma (HCC) is a rare primary liver tumor, which significantly differs from conventional HCC. This article reviews the molecular cytogenetics, pathology, imaging features, and management of this relatively rare tumor. CONCLUSION. Fibrolamellar HCC predominantly occurs in young patients without underlying hepatitis or cirrhosis. Serum α-fetoproteins are not elevated in most cases, and hence imaging plays an important role in diagnosis, staging, and surveillance.
There is currently no consensus regarding preferred clinical outcome measures following image-gui... more There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research.
Human brucellosis commonly involves the liver and manifests as nonspecific or granulomatous hepat... more Human brucellosis commonly involves the liver and manifests as nonspecific or granulomatous hepatitis. Although the development of a brucellar hepatic abscess is rare, it can be difficult to accurately diagnose given that histopathologic analysis is often not diagnostic, and the bacterium is seldom isolated from pus cultures. Therefore, serologic tests and imaging play an important role in the diagnosis of a brucellar abscess. The characteristics of a brucellar abscess on conventional ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) have been reported previously. 1,2 However, to the best of our knowledge, the features of a brucellar hepatic abscess on contrast-enhanced ultrasonography (CEUS) have not been described previously.
Journal of Vascular and Interventional Radiology, Nov 1, 2014
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The b... more Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for perso... more Dietrich CF et al. Guidelines and Good… Ultraschall in Med This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Contrast‐enhanced ultrasonography (CEUS) plays an important role in the management of patients tr... more Contrast‐enhanced ultrasonography (CEUS) plays an important role in the management of patients treated with ablation therapies, in the diagnostic, therapeutic and monitoring phases.
Ultraschall in der Medizin (Stuttgart, Germany : 1980), Jan 12, 2017
To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS)... more To retrospectively characterize the prevalence and impact of contrast-enhanced ultrasound (CEUS) as a guidance technique for the biopsy of liver target lesions (LTLs) at six interventional ultrasound centers. The six participating centers retrospectively selected all patients in whom biopsy needles were positioned in LTLs during CEUS. The prevalence of CEUS-guided biopsies at each center between 2005 and 2016, contrast agent consumption, procedure indications, diagnostic yield and complications were assessed. Informed consent was obtained for all patients. CEUS-guided biopsy of LTLs was carried out in 103 patients (68 M/35 F, median age: 69 yrs) with 103 liver target lesions (median size: 20 mm) using cutting needles (18 - 20 g) in 94 cases (91.2 %). CEUS-guided biopsy represented 2.6 % (range: 0.8 - 7.7 %) of 3818 biopsies on LTLs carried out at the participating centers. Indications to CEUS-guided biopsy were: a target lesion not visible on non-enhanced US (27.2 %), improvement...
Radiofrequency ablation (RFA) is currently indicated for the treatment of primary and metastatic ... more Radiofrequency ablation (RFA) is currently indicated for the treatment of primary and metastatic hepatic malignancies. Real-time ultrasound (US) is generally used during the procedure to guide electrode placement, but for evaluating the results of treatment, contrast-enhanced computed tomography and magnetic resonance imaging have traditionally been considered more effective. This view has changed, however, with the recent development of contrast-enhanced ultrasound (CEUS) (eg, using sulfur hexafluoride microbubbles), which can provide valuable information on the effects of RFA more rapidly and economically than computed tomography or magnetic resonance imaging without exposing the patient to ionizing radiation. In our center, CEUS is performed in patients with liver tumors before and immediately after RFA, in selected cases during the procedure as well, and in the follow-up. Between January 2003 and June 2005, we performed CEUS on 350 patients scheduled for RFA of primary or metast...
Objecti6e: Radiofrequency (RF) has been demonstrated as a relatively safe procedure in the treatm... more Objecti6e: Radiofrequency (RF) has been demonstrated as a relatively safe procedure in the treatment of hepatocellular carcinoma (HCC). Methods: A 60-year-old man with liver cirrhosis presented with a large, infiltrating HCC close to the right colon. The patient was treated with internally cooled RF. Results: On the 8th day post-ablation, a complication of right colon perforation was diagnosed. Conclusion: RF can induce untoward thermal damage, and may not be indicated in large infiltrating lesions abutting the gastrointestinal tract.
To retrospectively assess the local control and intermediate-and long-term survival of patients w... more To retrospectively assess the local control and intermediate-and long-term survival of patients with liver metastases from breast cancer who have undergone percutaneous ultrasonography (US)-guided radiofrequency (RF) ablation. Materials and Methods: This study was approved by the hospital ethics committee, and all patients provided written informed consent. RF ablation was used to treat 87 breast cancer liver metastases (mean diameter, 2.5 cm) in 52 female patients (median age, 55 years). Inclusion criteria were as follows: fewer than five tumors, maximum tumor diameter of 5 cm or smaller, and disease either confined to the liver or stable with medical therapy. Forty-five (90%) of 50 patients had previously undergone chemotherapy, hormonal therapy, or both, and had no response or an incomplete response to the treatment. Contrast material-enhanced computed tomography and US were performed to evaluate complications and technical success and to assess for local tumor progression during follow-up. The Kaplan-Meier method was used to assess survival, and results were compared between groups with a log-rank test. Cox regression analysis was used to assess independent prognostic factors that affected survival. Results: Complete tumor necrosis was achieved in 97% of tumors. Two (4%) minor complications occurred. Median time to follow-up from diagnosis of liver metastasis and from RF ablation was 37.2 and 19.1 months, respectively. Local tumor progression occurred in 25% of patients. New intrahepatic metastases developed in 53% of patients. From the time of first RF ablation, overall median survival time and 5-year survival rate were 29.9 months and 27%, respectively. From the time the first liver metastasis was diagnosed, overall median survival time was 42 months, and the 5-year survival rate was 32%. Patients with tumors 2.5 cm in diameter or larger had a worse prognosis (hazard ratio, 2.1) than did patients with tumors smaller than 2.5 cm in diameter. Conclusion: Survival rates in selected patients with breast cancer liver metastases treated with RF ablation are comparable to those reported in the literature that were achieved with surgery or laser ablation.
Abstract 2-Chloro-4′,4″-di(2-imidazolin-2-yl)terephthalanilide (NSC 60339) has been compared with... more Abstract 2-Chloro-4′,4″-di(2-imidazolin-2-yl)terephthalanilide (NSC 60339) has been compared with oligomycin and 2,4-dinitrophenol in its effects on a rat liver mitochondrial swelling system. The substituted phthalanilide and oligomycin are equivalent in their effects in the following swelling experiments. Neither alters spontaneous or calcium- or phosphate-induced swelling; both inhibit succinate-induced swelling; both prevent ATP inhibition of calcium- and phosphate-induced swelling; and both inhibit ATP reversal of calcium-induced swelling in fresh or aged mitochondria. The known binding ofphthalanilides to specific phospholipids and the inhibitory effects described suggest that NSC 60339 may be useful in studies on the nature and role oflipids in mitochondrial swelling and oxidative phosphorylation.
We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-g... more We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.
Journal of gastrointestinal and liver diseases : JGLD, 2015
In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imag... more In 2007 the Italian National Institute of Health issued Guidelines for the use of diagnostic imaging techniques in the detection and the characterization of focal liver lesions. Since the publication of these guidelines in 2008, several studies relating to this topic have been published. Thus, we felt the need to assess whether interval research and new advancements in diagnostic imaging have yielded new evidence that should modify the recommendations that were previously issued. The literature search confirmed the appropriateness of the current guidelines. Although most modalities did not show substantial changes, interval introduction of DW-MRI is a valuable technique with a high diagnostic accuracy in the detection and characterization of FLLs, and its sensitivity is higher when combined with MRI.
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