H.-X. Xu

Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study.

BackgroundPercutaneous microwave ablation and radiofrequency ablation are two commonly used modalities for the treatment of hepatocellular carcinoma; however, comparisons of them have not been documented adequately.MethodsOf 102 patients with biopsy-proved hepatocellular carcinoma, 49 (98 nodules) were treated percutaneously with microwave ablation and 53 (72 nodules) with radiofrequency ablation. The local tumor control, complications related to treatment, and long-term results of the two modalities were compared retrospectively.ResultsThe complete ablation rates were 94.9% (93/98) using microwave ablation vs 93.1% (67/72) using radiofrequency ablation (P = 0.75), and no significant differences were found either in the ablation of tumors of 3.0u2009cm or less (P = 1.00) or in those of more than 3.0u2009cm (P = 1.00) between the two modalities. The local recurrence rates were 11.8% (11/93) using microwave ablation vs 20.9% (14/67) using radiofrequency ablation (P = 0.12), and there were no significant differences between the two modalities either in tumors of 3.0u2009cm or less (P = 0.36) or in those of more than 3.0u2009cm (P = 0.82). The rates of major complications associated with microwave ablation and radiofrequency ablation were 8.2% (4/49) vs 5.7% (3/53; P = 0.71). The disease-free survival rates in the microwave ablation group were 45.9%, 26.9%, 26.9%, and 13.4% at 1, 2, 3, and 4 years, respectively, and those in the radiofrequency ablation group were 37.2%, 20.7%, and 15.5% at 1, 2 and 3 years, respectively (P = 0.53). The 1-, 2-, 3-, and 4-year cumulative survival rates for patients who underwent microwave ablation were 81.6%, 61.2%, 50.5%, and 36.8%, respectively, and for patients who underwent radiofrequency ablation the rates were 71.7%, 47.2%, 37.6%, and 24.2%, respectively (P = 0.12).ConclusionsPercutaneous microwave ablation and radiofrequency ablation are both effective methods in treating hepatocellular carcinomas. The local tumor control, complications related to treatment, and long-term survivals were equivalent for the two modalities.

Characterization of small focal liver lesions using real-time contrast-enhanced sonography: diagnostic performance analysis in 200 patients.

Objective. The purpose of this study was to assess the diagnostic performance of real‐time contrast‐enhanced sonography in characterization of small focal liver lesions (FLLs; ≤3.0 cm in diameter). Methods. Two hundred small FLLs in 200 patients were examined by contrast‐enhanced sonography using a contrast‐specific mode of contrast pulse sequencing and a sulfur hexafluoride–filled microbubble contrast agent. The sonographic images were reviewed by 2 independent readers. A 5‐point confidence level was used to discriminate malignant from benign FLLs, and specific diagnoses were recorded. The diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis, and the interobserver agreement was analyzed by weighted κ statistics. Results. After review of contrast‐enhanced sonography, ROC analysis revealed significant improvement in differentiating between malignant and benign small FLLs that the areas under the ROC curve were 0.856 at baseline sonography versus 0.954 at contrast‐enhanced sonography for reader 1 (P < .001) and 0.857 versus 0.954 for reader 2 (P = .003). The sensitivity, negative predictive value, and accuracy for both readers also improved significantly after contrast agent administration (all P < .001). A better result of specific diagnosis was obtained (38.5% [77/200] at baseline sonography versus 80.5% [161/200] at contrast‐enhanced sonography for reader 1 and 34.5% [69/200] versus 80.5% [161/200] for reader 2; both P < .001) after contrast agent administration, and a better interobserver agreement was achieved (κ = 0.425 at baseline sonography versus 0.716 at contrast‐enhanced sonography). Conclusions. Real‐time contrast‐enhanced sonography improves the diagnostic performance in small FLLs compared with baseline sonography.

Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy

Tumour ablation using a thermal energy source has shown promising results, and is particularly suitable for recurrent hepatocellular carcinoma (HCC). The present study evaluated long‐term outcomes after percutaneous thermal ablation for recurrent HCC following liver resection.

Imaging features of intrahepatic biliary cystadenoma and cystadenocarcinoma on B-mode and contrast-enhanced ultrasound.

PURPOSEnTo investigate the imaging features of intrahepatic biliary cystadenoma and cystadenocarcinoma on B-mode and contrast-enhanced ultrasound.nnnMATERIALS AND METHODSnThe B-mode and contrast-enhanced ultrasound features of 6 intrahepatic biliary cystadenomas and 7 intrahepatic biliary cystadenocarcinomas were retrospectively analyzed, and the differences between cystadenomas and cystadenocarcinomas were compared.nnnRESULTSnThere were no significant differences between cystadenomas and cystadenocarcinomas in terms of patient gender, age, lesion location, size, and shape (all pu200a>u200a0.05). On conventional ultrasound, biliary cystadenomas were more likely to be multilocular (6/6 for cystadenoma vs. 2/7 for cystadenocarcinoma) and cystadenocarcinomas more likely presented the features of a mural or septal nodule and a nodule diameter >u200a1.0u200acm (0/6 for cystadenoma vs. 5/7 for cystadenocarcinoma). On contrast-enhanced ultrasound, hyper-enhancement (nu200a=u200a4) or iso-enhancement (nu200a=u200a2) was present in the cystic wall, septations or mural nodules of the cystadenomas during the arterial phase and the enhancement washed out to hypo-enhancement (nu200a=u200a6) during the late phase. Cystadenocarcinomas also showed hyper-enhancement (nu200a=u200a4) or iso-enhancement (nu200a=u200a3) in the cystic wall, septations or mural nodules during the arterial phase and iso-enhancement (nu200a=u200a1) or hypo-enhancement (nu200a=u200a6) during the late phase.nnnCONCLUSIONnIntrahepatic biliary cystadenomas are more typically multilocular cystic lesions. A mural or septal nodule and a nodule diameter greater than 1.0u200acm on conventional ultrasound are suggestive of cystadenocarcinomas. Contrast-enhanced ultrasound is helpful for depicting the vascularity of the lesions but there was no significant difference between cystadenomas and cystadenocarcinomas.

Magnetic navigation in ultrasound-guided interventional radiology procedures

AIMnTo evaluate the usefulness of magnetic navigation in ultrasound (US)-guided interventional procedures.nnnMATERIALS AND METHODSnThirty-seven patients who were scheduled for US-guided interventional procedures (20 liver cancer ablation procedures and 17 other procedures) were included. Magnetic navigation with three-dimensional (3D) computed tomography (CT), magnetic resonance imaging (MRI), 3D US, and position-marking magnetic navigation were used for guidance. The influence on clinical outcome was also evaluated.nnnRESULTSnMagnetic navigation facilitated applicator placement in 15 of 20 ablation procedures for liver cancer in which multiple ablations were performed; enhanced guidance in two small liver cancers invisible on conventional US but visible at CT or MRI; and depicted the residual viable tumour after transcatheter arterial chemoembolization for liver cancer in one procedure. In four of 17 other interventional procedures, position-marking magnetic navigation increased the visualization of the needle tip. Magnetic navigation was beneficial in 11 (55%) of 20 ablation procedures; increased confidence but did not change management in five (25%); added some information but did not change management in two (10%); and made no change in two (10%). In the other 17 interventional procedures, the corresponding numbers were 1 (5.9%), 2 (11.7%), 7 (41.2%), and 7 (41.2%), respectively (p=0.002).nnnCONCLUSIONnMagnetic navigation in US-guided interventional procedure provides solutions in some difficult cases in which conventional US guidance is not suitable. It is especially useful in complicated interventional procedures such as ablation for liver cancer.

Ultrasound Findings of Intraductal Papillary Neoplasm in Bile Duct and the Added Value of Contrast-Enhanced Ultrasound.

PURPOSEnTo investigate the imaging features of intraductal papillary neoplasm in bile duct (IPNB) on baseline ultrasound and contrast-enhanced ultrasound (CEUS).nnnMATERIALS AND METHODSnThe imaging features on baseline ultrasound and CEUS in 16 pathologically proven IPNB lesions in 15 patients were retrospectively analyzed. Real-time contrast specific modes and contrast agent of SonoVue were used for CEUS.nnnRESULTSnBile duct dilation was present in all patients. The mean lengths for the intraductal papillary adenomas and adenocarcinomas were 2.5u200a± 1.1 (range, 1.2u200a-u200a4.2u200acm) and 5.6u200a±u200a2.0u200acm (range, 3.3u200a-u200a9.8u200acm) (Pu200a=u200a0.004). Three imaging types of IPNB on ultrasound were depicted: bile duct dilation with intraductal mass (nu200a=u200a8), bile duct dilation without intraductal mass (nu200a=u200a3), and cystic-solid mixed type (nu200a=u200a5). On CEUS, solid components of 13 lesions appeared hyper- (nu200a=u200a12) or iso-enhancement (nu200a=u200a1) in the arterial phase whereas all showed hypo-enhancement in the portal and late phases. For 3 lesions of bile duct dilation without intraductal mass, CEUS showed non-enhancement during all phases. Pre-surgical CEUS and conventional ultrasound made correct diagnoses in 12 (75.0u200a%) and 5(31.3u200a%) of 16 IPNBs respectively (Pu200a=u200a0.04). For CECT, correct diagnosis was also achieved in 12 (75.0u200a%) of 16 lesions (Pu200a=u200a1.00, in comparison with CEUS).nnnCONCLUSIONSnIPNB should be taken into consideration when intraductal mass or cystic-solid mass with bile duct dilation, or remarkable bile duct dilation without intraductal mass, are found on US.u200aIntraductal mass length >u200a3.0u200acm is more commonly found in malignant IPNB. CEUS might facilitate the diagnosis of IPNB by easily excluding the possibility of commonly found sludge, nonshadowing stones, or blood clots.