Zeng-Hui Han

Extracorporeal Ablation of Uterine Fibroids With High-Intensity Focused Ultrasound Imaging and Histopathologic Evaluation

The purpose of this study was to evaluate the therapeutic efficacy of high‐intensity focused ultrasound (HIFU) in the treatment of uterine fibroids by using imaging and histopathologic examination.

Sonographically guided extracorporeal ablation of uterine fibroids with high-intensity focused ultrasound: midterm results.

To the Editor: In our previous study, we reported the imaging and pathologic results of high-intensity focused ultrasound (HIFU) treatment of uterine fibroids in 119 patients.1 However, we did not mention the follow-up results of these patients. In the following period, we treated another 26 patients. We are very concerned about the follow-up results of these patients, including quality-of-life improvement and symptom recovery. In this study, we mainly focused on the clinical midterm results and complications analysis of these 145 patients. Noninvasive treatment of tumors is highly desirable and provides an alternative to surgery. One such treatment undergoing active research is HIFU.2,3 Although studies have been performed in many different areas, including breast, brain, and liver tumors,4–7 the largest body of work to date has taken place in women with symptomatic uterine fibroids. Most studies in European countries are focused on magnetic resonance imaging–guided HIFU.8–11 In China, however, sonographically guided HIFU is much more popular. In our previous study, we reported our experience using extracorporeal sonographically guided HIFU for the treatment of patients with uterine fibroids and described the imaging and histopathologic evaluation results of the efficacy of HIFU treatment. In this study, we have included more patients and will mainly report the clinical midterm results and complication analysis. Patients with symptomatic fibroids were enrolled in this study at Xijing Hospital of the Fourth Military Medical University, Xi’an, China. Finally, 145 consecutive patients with 220 uterine fibroids underwent HIFU ablation between May 2004 and October 2005. This study was approved by the Institutional Review Board, and written informed consent was obtained from all patients. Table 1 describes the patient data and baseline characteristics of uterine fibroids. An HIFUNIT 9000 tumor therapy system (Shanghai Aishen Technology, Shanghai, China) was used. A schematic diagram of the therapeutic arrangement used in this work is shown in Figure 1. The specific treatment method and treatment parameters are as in the previous study.1 Before treatment, all patients from the study were asked to fill out a questionnaire about fibroid-related symptoms. They were supposed to report the occurrence (yes or no) and intensity (on a scale from 1 to 10, where 1 meant no such symptom and 10 meant maximal severity of the symptom) of the following conditions: (1) menometrorrhagia or hypermenorrhea, (2) dysmenorrheal, (3) dyspareunia, (4) pelvic pain, (5) dysuria, and (6) bulk-related symptoms. Each woman was interviewed 1 week after treatment, and the interest was focused on early complications and the duration until full recovery. Office visits were also planned at 1, 3, 6, and 12 months after HIFU treatment. A telephone interview or office visit also was completed every year thereafter. The women were asked to evalu-

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Objective. The purpose of this study was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety‐four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast‐enhanced sonograms were analyzed using contrast‐specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast‐enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time‐intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast‐specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time‐intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.

Hemostasis of active bleeding from the liver with percutaneous microwave coagulation therapy under contrast-enhanced ultrasonographic guidance: an experimental study.

Objective. The purpose of this study was to investigate the feasibility of percutaneous microwave coagulation therapy (PMCT) guided by contrast‐enhanced ultrasonography (CEUS) for controlling active bleeding in rabbit livers. Methods. Twenty actively bleeding rabbit liver models, produced with an 18‐gauge semiautomatic biopsy needle and confirmed with CEUS, were randomly divided into 2 groups: a PMCT group (n = 10, with a microwave antenna placed into the bleeding site under ultra‐sonographic guidance and worked at 60 W for 30 seconds on average) and a control group (n = 10, with the active bleeding site not treated). After therapy procedures were performed, lactated Ringers solution resuscitation was then performed in both groups to maintain the mean arterial pressure at 70 mm Hg for 1 hour. The intraperitoneal blood loss, total resuscitation volume, mean arterial pressure, and hematocrit value were recorded. Macroscopic and microscopic examinations were performed at the end of the study. Results. After PMCT, the former bleeding site appeared on CEUS as a round or an oval area devoid of contrast. The PMCT group had lower blood loss (30.4 ± 7.2 versus 101.6 ± 18.2 mL; P < .05) and a lower total resuscitation volume (56.5 ± 10 versus 186 ± 36.6 mL; P < .05) than the control group. The mean hematocrit value in the PMCT group was significantly higher than that in the control group (26% ± 4% versus 19% ± 4%; P < .05) at the end of the experiment. Conclusions. Contrast‐enhanced ultrasonographically guided PMCT significantly decreased blood loss in a rabbit model of active liver bleeding. It provides a simple and quick method to control blood loss in liver injuries with active bleeding.

Ultrasound-guided percutaneous laser and ethanol ablation of rabbit VX2 liver tumors

Background Only a small percentage of patients with hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, lots of these patients are in need of local control, such as percutaneous ethanol injection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RF). Purpose To investigate the effects of ultrasound-guided PLA combined with PEI on rabbit VX2 liver tumors, using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE) US, and histologic examination. Material and Methods VX2 tumors were implanted in the livers of 80 rabbits. Fourteen days after implantation, animals were randomly separated into four groups of 20 rabbits. Treatment of the four groups was with: (i) PLA; (ii) PEI; (iii) combined therapy of PLA immediately followed by PEI; and (iv) combined therapy of PEI immediately followed by PLA. Conventional gray-scale US, CD US, PD US, and CE US were performed before and after ablation. The effects on ablated areas were assessed by histologic examination. Results Conventional gray-scale US showed a clear boundary around the ablated area in groups 1, 3, and 4. An isoechoic treated region with an irregular boundary was seen in group 2. On CE US, coagulated areas demonstrated a perfusion defect. Both conventional gray-scale US and CE US showed that the ablated volume in group 4 was larger than that in groups 1, 2, and 3. CD US and PD US demonstrated residual tumor in the periphery of ablated areas in groups 1 and 2, but not in groups 3 and 4. CE US demonstrated no residual tumor in group 4, unlike in groups 1, 2, and 3. Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in the four treatment groups. Residual viable tissue in group 4 was less than that in groups 1, 2, and 3. Conclusion Combined therapy of PEI immediately followed by PLA can coagulate significantly larger volumes of tumor and reduce residual tumor.

Diagnosis of active hemorrhage from the liver with contrast-enhanced ultrasonography after percutaneous transhepatic angioplasty and stent placement for Budd-Chiari syndrome.

Active hemorrhage arising from hepatic injury can be life threatening and necessitates immediate hemostatic intervention. This situation has been encountered more commonly since the increase in percutaneous interventional procedures of the hepatobiliary system. 1 - 3 Low-mechanical index gray scale contrast-enhanced ultrasonography (CEUS) is based on the ability of microbubbles containing gases to produce real-time contrast-related gray scale images. This technique has been largely used in the evaluation of focal lesions in solid organs, which improves the lesion-to-parenchyma conspicuity. 4―6 Recently, some articles reported that CEUS could be used to reveal active post-traumatic intraparenchymal bleeding appearing as a hyperechoic jet that tends to pool dependently. 7―10 However, CEUS can also be very useful in the detection of bleeding caused by medical procedures such as interventional surgery, which usually is the most common and severe complication of most medical procedures. In this report, we present a case of CEUS diagnosis of delayed hemorrhage from the liver capsule 1 day after percutaneous transhepatic angioplasty and stent placement in a patient with Budd-Chiari syndrome. Laparotomy subsequently confirmed the diagnosis, and the bleeding site was successfully sutured.