Guidance and control of percutaneous treatments with contrast-enhanced ultrasound.
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Carcinoma, Hepatocellular↗
Biomedical subjects
T Ierace
Publications and source records attributed to T Ierace.
Extrahepatic recurrence and second malignancies after treatment of hepatocellular carcinoma: spectrum of imaging findings.
PURPOSE: To describe diagnostic imaging features (with a focus on CT findings) of extrahepatic relapses of treated hepatocellular carcinoma and to propose a post-treatment follow-up protocol. MATERIAL AND METHODS: During a six-year span, 226 patients (aged 32-88 years) with chronic hepatitis/cirrhosis were diagnosed as having hepatocellular carcinoma confined to the liver and treated percutaneously with radiofrequency (RF) ablation. A total of 313 treatment sessions were performed. Post-therapeutic follow-up is based upon clinical evaluation, laboratory and imaging (with CT holding the key role) studies. RESULTS: Mean duration of follow-up was 17 months. After successful treatment, actuarial probability of neoplastic relapse is 30.7% after 1 year and 58.5% after 2 years. Eighty-eight patients had recurrence of hepatocellular carcinoma after a variable time interval (mean 7.3 months). Extrahepatic neoplastic relapse was observed in 14 patients, half of these without active hepatic disease. Distribution of extrahepatic sites of recurrence was as follows: abdominal lymph nodes (6 cases), bone (3), peritoneum (2), adrenal (2), lung (1). Five patients (2.2%) had a second primary neoplasm. CONCLUSIONS: Extrahepatic hepatocellular carcinoma is uncommon and occurs in advanced stages, but may represent a pattern of post-treatment relapse. The distinctive hypervascularity of this tumour histology may be observed in adenopathies and adrenal metastases. Second primary neoplasms should be considered in the differential diagnosis of lesions observed during follow-up.
Adult↗
Radiofrequency thermal ablation of hepatic metastases.
Percutaneous radiofrequency (RF) ablation is a promising therapeutic option for liver metastases, which may result in prolonged survival and chance for cure. Recent technological advancements provide larger coagulation volumes, allowing treatment of medium- and large-size metastases. Candidates are patients with metachronous liver metastases from colorectal or other primary cancers, in whom surgery is contraindicated and with one to four nodules each smaller than approx. 4 cm. We treated 109 patients with 172 colorectal metastases in the liver. Local control was obtained in 70.4% of lesions. Recurrence was significantly more frequent in lesions >3 cm. One major complication occurred (0.6% of sessions), a large bowel perforation requiring surgery. Seven minor complications did not require therapy. New metastases developed at follow-up in 50.4% of patients. Survival rates are 67% and 33% after 2 and 3 years, respectively; estimated median survival being 30 months. RF ablation advantages include minimal-invasiveness (no mortality, significantly lower complications), reduced costs and hospital stays compared to surgery, feasibility in non-surgical candidates, and the potential of repeated treatment if local recurrence occurs or new metastases develop.
Adult↗
Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.
PURPOSE: To describe the results of an ongoing radio-frequency (RF) ablation study in patients with hepatic metastases from colorectal carcinoma. MATERIALS AND METHODS: In 117 patients, 179 metachronous colorectal carcinoma hepatic metastases (0.9-9.6 cm in diameter) were treated with RF ablation by using 17-gauge internally cooled electrodes. Computed tomographic follow-up was performed every 4-6 months. Recurrent tumors were retreated when feasible. Time to new metastases and death for each patient and time to local recurrence for individual lesions were modeled with Kaplan-Meier analysis. Modeling determined the effect of number of metastases on the time to new metastases and death and effect of tumor size on local recurrence. RESULTS: Estimated median survival was 36 months (95% CI; 28, 52 months). Estimated 1, 2, and 3-year survival rates were 93%, 69%, and 46%, respectively. Survival was not significantly related to number of metastases treated. In 77 (66%) of 117 patients, new metastases were observed at follow-up. Estimated median time until new metastases was 12 months (95% CI; 10, 18 months). Percentages of patients with no new metastases after initial treatment at 1 and 2 years were 49% and 35%, respectively. Time to new metastases was not significantly related to number of metastases. Seventy (39%) of 179 lesions developed local recurrence after treatment. Of these, 54 were observed by 6 months and 67 by 1 year. No local recurrence was observed after 18 months. Frequency and time to local recurrence were related to lesion size (P < or =.001). CONCLUSION: RF ablation is an effective method to treat hepatic metastases from colorectal carcinoma.
Adult↗
Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients.
PURPOSE: To evaluate the authors' initial experience in a consecutive series of 24 patients with breast cancer liver metastases treated with radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-four consecutive patients with 64 metastases measuring 1.0--6.6 cm in diameter (mean, 1.9 cm) underwent ultrasonography-guided percutaneous RF ablation with 18-gauge, internally cooled electrodes. Treatment was performed with the patient under conscious sedation and analgesia or general anesthesia. A single lesion was treated in 16 patients, and multiple lesions were treated in eight patients. Follow-up with serial computed tomography ranged from 4 to 44 months (mean, 10 months; median, 19 months). RESULTS: Complete necrosis was achieved in 59 (92%) of 64 lesions. Among the 59 lesions, complete necrosis required a single treatment session in 58 lesions (92%) and two treatment sessions in one lesion (2%). In 14 (58%) of 24 patients, new metastases developed during follow-up. Ten (71%) of these 14 patients developed new liver metastases. Currently, 10 (63%) of 16 patients whose lesions were initially confined to the liver are free of disease. One patient died of progressive brain metastases. No major complications occurred. Two minor complications were observed. CONCLUSION: On the basis of preliminary study results, percutaneous RF ablation appears to be a simple, safe, and effective treatment for focal liver metastases in selected patients with breast cancer.
Adult↗
Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions.
PURPOSE: To study local therapeutic efficacy, side effects, and complications of radio-frequency (RF) ablation in the treatment of medium and large hepatocellular carcinoma (HCC) lesions in patients with cirrhosis or chronic hepatitis. MATERIALS AND METHODS: One-hundred fourteen patients who were under conscious sedation or general anesthesia had 126 HCCs greater than 3.0 cm in diameter treated with RF by using an internally cooled electrode. Eighty tumors were medium (3.1-5.0 cm), and 46 were large (5.1-9.5 cm). The mean diameter for all tumors was 5.4 cm. At imaging, 75 tumors were considered noninfiltrating, and 51 were considered infiltrating. RESULTS: Complete necrosis was attained in 60 lesions (47.6%), nearly complete (90%-99%) necrosis in 40 lesions (31.7%), and partial (50%-89%) necrosis in the remaining 26 lesions (20.6%). Medium and/or noninfiltrating tumors were treated successfully significantly more often than large and/or infiltrating tumors. Two major complications (death, hemorrhage requiring laparotomy) and five minor complications (self-limited hemorrhage, persistent pain) were observed. The single death was due to a break in sterile technique rather than to the RF procedure itself. CONCLUSION: RF ablation appears to be an effective, safe, and relatively simple procedure for the treatment of medium and large HCCs.
Aged↗
Liver cancer imaging: the need for accurate detection of intrahepatic disease spread.
The last ten years have seen dramatic changes in the therapeutic approach to both primary (i.e., hepatocellular carcinoma: HCC) and secondary (i.e., metastatic lesions) focal liver malignancies. This has been due to the increasing proliferation of new modalities, including percutaneous ablative therapies (ethanol injection: PEI; radiofrequency: RF; laser; microwaves), angiographic therapies (segmental chemoembolization; hypoxic perfusion) and liver transplantation (OLT), in addition to a greater acceptance of pre-existing modalities (resection; systemic chemotherapy). Thus, a main aim of current medical management is to select for each patient the therapeutic modality which will provide the highest success rate, fewest risks and lowest costs for each given situation. However, in order to decide on the appropriate therapeutic choice, the accurate diagnosis of neoplastic lesions by means of one or more imaging modalities (ultrasound: US; computed tomography: CT; magnetic resonance: MR) is mandatory. This imaging work-up can be viewed as having three purposes: lesion detection, lesion characterization, intrahepatic and extrahepatic cancer staging. The present paper is concerned primarily with the imaging approach to liver lesion detection.
Carcinoma, Hepatocellular↗
Radio-frequency ablation of hepatic metastases: postprocedural assessment with a US microbubble contrast agent--early experience.
PURPOSE: To evaluate contrast agent-enhanced ultrasonography (US) in the detection of untreated tumor after radio-frequency (RF) ablation of hepatic metastases. MATERIALS AND METHODS: Twenty patients with solitary colorectal liver metastases underwent percutaneous RF tumor ablation. Pre- and postablation imaging was performed with nonenhanced and enhanced color and power Doppler US and contrast-enhanced helical computed tomography (CT). Initial follow-up CT and US were performed 24 hours after ablation. The findings at US and CT were compared. RESULTS: Nonenhanced US demonstrated intratumoral signal in 15 of 20 metastases before ablation. This signal increased after contrast agent administration. Contrast-enhanced US performed 24 hours after ablation demonstrated residual foci of enhancement in three tumors, whereas no US signals were seen in any tumor on nonenhanced scans. CT demonstrated small (< 3-mm) persistent foci of residual enhancement in these three tumors and in three additional lesions that were not seen at US (US sensitivity, 50%; specificity, 100%; diagnostic agreement with CT, 85%). All six patients with evidence of residual tumor underwent repeat RF ablation. CONCLUSION: Contrast-enhanced US may depict residual tumor after RF application and thereby enable additional directed therapy. The potential reduction in treatment sessions and/or ancillary imaging procedures might increase the ease and practicality of percutaneous ablation of focal hepatic metastases.
Aged↗
[Neuroleptanalgesia in patients undergoing percutaneous, ultrasound-directed radiofrequency for primary or secondary, single or multiple hepatic neoplasms].
BACKGROUND: The use of percutaneous ultrasound-directed radiofrequency is a recent technique in non-surgical therapy of some neoplastic liver lesions. Purpose of this study is to demonstrate that the use of a narcosis-free analgesia allows to perform this procedure, which is generally painful and badly by the patient. METHODS: We treated 51 patients for a total of 126 procedures; the first 17 patients underwent a mono- or multipolar technique with uncooled electrodes, while the remaining 34 patients have been treated with double perfusion lumen electrodes with the chance of tipcooling. We used diidrobenzoperydol and fentanyl with a mean dose for each session of 209 micrograms for the first 17 patients and 109 micrograms for the other 34. RESULTS: Using VAS, we obtained a painless procedure in 42 patients and mild-pain sensations in 9 patients, while one hour after the procedure painless or light-pain sensation were observed in 49 patients and mild-pain in 2 patients, which required the use of FANS i.v. At discharge, all patients were pain-free or with very light pain sensation. We reduced the intra-hospital observation of patients from 5 to 3 hours, once the technique has been modified. 4 patients complained about nausea and 1 of these emesis. We did not observe any cardiovascular, respiratory and/or neurological complications. CONCLUSIONS: The use of neuroleptanalgesia allowed us to perform the described procedure with a good feeling by the patients.
Aged↗
Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients.
PURPOSE: To determine the potential efficacy of radio-frequency (RF) ablation of liver metastases during long-term follow-up. MATERIALS AND METHODS: Sixteen patients with 31 hepatic metastases were treated with percutaneous, ultrasound-guided RF ablation. RF was applied to monopolar electrodes (2-3-cm tip exposure) either individually or within a multiprobe array (two to four probes) for 6 minutes at 90 degrees C over one to four treatment sessions per metastasis. RESULTS: In only one of 75 sessions, a moderate complication, self-limited intraperitoneal hemorrhage, was observed. Four patients (four lesions) underwent surgical resection 15-60 days after RF treatment. Residual, viable tumor was seen in all of these patients. The remaining 12 patients were followed up for 9-29 months (mean, 18.1 months). In these patients, 18 of 27 lesions remained stable or decreased in size and showed no enhancement at computed tomography and/or magnetic resonance imaging for at least 9 months. Two patients died of disseminated disease at 13 months and one at 16 months. Disease-free survival was achieved in eight patients. CONCLUSIONS: RF ablation appears to be a simple, safe, and potentially effective treatment for selected patients with liver metastases and may become a less invasive alternative to surgical therapy.
Aged↗
Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes.
PURPOSE: To assess the feasibility and safety of using cooled-tip electrodes to increase the volume of coagulation necrosis obtained or reduce the number of treatment sessions necessary with percutaneous tumor radio-frequency (RF) ablation. MATERIALS AND METHODS: Twenty-nine patients with 44 hepatic metastases (1.3-5.1 cm diameter) from colorectal (n = 22), gastric (n = 5), pancreatic (n = 1), or breast (n = 1) carcinoma were treated with RF ablation using cooled-tip, 18-gauge electrodes with 2-3 cm tip exposure. Each tumor was treated in one or two treatment sessions. RESULTS: Technical success, ablation of all visualized tumor, was achieved in 40 (91%) metastases. Findings at computed tomography (CT) and magnetic resonance (MR) imaging performed 3-6 months after treatment confirmed complete necrosis of the entire metastasis in 66%. Disease-free survival was 50% at 12 months and 33% at 18 months, with localized progression of disease in 34% of treated lesions. Overall survival was 100%, 94%, and 89% at 6, 12, and 18 months, respectively. Only one complication, self-limited hemorrhage, was seen. CONCLUSION: Use of cooled-tip electrodes was a safe and feasible adjunct for tumor RF ablation therapy that produced larger volumes of coagulation necrosis with fewer electrode insertions than is produced with other RF ablation techniques.
Aged↗
Adjuvant therapy with essential fatty acids (EFAs) for primary liver tumors: some hypotheses.
Hepatocarcinoma is responsible for approximately 1 million deaths annually. It is usually discovered at an advanced stage and, if inoperable, has a poor prognosis. New therapies combining chemotherapy, hyperthermia, radiotherapy and immunomodulators have been recently attempted with various levels of success. Once the tumor is detected at an early stage, some possibilities of cure seem to emerge either by intratumoral percutaneous injection (PEI) of alcohol or by chemoembolization and interstitial hyperthermia. When the tumor volume is more than 5 cm, these therapies are less successful and radiotherapy can be used. All the techniques described have some limits; PEI, for instance, does not achieve a complete eradication of lesions > 3 cm and a non-homogenous alcohol distribution within the tumor leads to areas of necrosis. Radiotherapy, even if effective, is limited by dose-related radiation hepatitis. Another important limiting factor is the incomplete response to therapy and tumor recurrence. Essential fatty acids, especially gamma linolenic acid (GLA) and eicosapentaenoic acid (EPA) are discussed here for their ability to control primary tumor proliferation and increase response to chemotherapy, radiotherapy and hyperthermic treatment, thanks to their effects on cellular membranes (increased lipoperoxidation and modification of tumor stroma).
Animals↗
The sonographic appearance of duodenal lesions.
The sonographic findings in 17 patients with duodenal tumors and in one patient with a benign ulcer and stricture of the duodenum were reviewed. An abdominal mass was detected sonographically in all patients; in 15 of 18 cases, such lesions presented high-level central echoes and hypoechoic periphery. Identification of the duodenal origin of the disease was possible by sonography in only 16 of 18 patients: by evaluation of the relationship of the mass with abdominal vessels in eight patients; by demonstrating that the lesion was continuous with a normal duodenum in seven patients; or by demonstrating the mass within the duodenum itself in one patient. Signs and symptoms of duodenal tumors are usually nonspecific, and sonography can be used as the first imaging method in these cases. A careful analysis of the relationship of the tumor to surrounding structures may allow correct identification of its origin.
Adenocarcinoma↗
Fine-needle biopsy of hepatic hemangioma with sonographic guidance.
Thirty-three focal hepatic lesions later proven to be hemangiomas underwent sonographically guided fine-needle aspiration biopsy. Indications for cytologic assessment were an atypical sonographic pattern in 11 cases, the need to differentiate from liver metastases in 12 patients with a history of neoplasm, and other indications in 10. The aspirated material consisted of blood alone in 24 cases; in the other nine cases, endothelial cells and/or agglomerates of capillaries were demonstrated also, and this was considered to be diagnostic. In one case, intratumoral bleeding was demonstrated sonographically, but no treatment was needed. The possible angiomatous nature of an hepatic lesion should not be considered an absolute contraindication to biopsy, provided that a fine needle is used and the optimal route to the lesion is chosen.
Adult↗
High-resolution sonography of the recurrent laryngeal nerve: anatomic and pathologic considerations.
During sonographic examination of the neck using high-resolution small-parts equipment, the minor neurovascular bundle may be identified in virtually all patients. Postmortem studies in three cadavers demonstrated that this structure is actually the recurrent laryngeal nerve (RLN). Furthermore, findings observed during sonographic examinations of the neck in nine patients with RLN paralysis of unknown origin were reviewed. Compression, displacement, or infiltration of the nerve from thyroid (seven cases) or parathyroid (two cases) nodules were noted, and this allowed the site and cause of the paralysis to be identified.
Humans↗
Parathyroid ultrasonography and fine-needle aspiration biopsy in the diagnosis of secondary hyperparathyroidism.
Parathyroid tumours were sonographically detected in 24 out of 72 uraemic patients with clinical and biochemical findings of secondary hyperparathyroidism. In 12 out of 24 cases ultrasonically guided fine-needle aspiration biopsy of the tumours was performed in order to obtain a cytological specimen. In the eight patients who subsequently had surgical exploration of the neck, diagnostic accuracy of both ultrasonography and biopsy combined was 87 per cent.
Biopsy, Needle↗
Fine-needle aspiration biopsy of liver focal lesions ultrasonically guided with a real-time probe. Report on 126 cases.
Ultrasonically guided fine-needle biopsy of focal liver lesions was performed in 126 patients to obtain a definitive diagnosis. Percutaneous target puncture and tissue aspiration were guided by a real-time linear-array probe with a central canal for needle insertion. The procedure is simple and rapidly performed; a correct cytological diagnosis was established in 94% of the punctured masses. No adverse reactions of clinical significance were observed. Fine-needle biopsy with ultrasound guidance by real-time scanning may be the procedure of choice to obtain a tissue diagnosis in patients with hepatic masses.
Adult↗
Percutaneous ethanol injection of autonomously functioning thyroid nodule.
Percutaneous ethanol injection (PEI) is proposed for treatment of autonomously functioning thyroid nodule, especially for small-mid-sized solitary nodules, for patients refusing the other methods or not proving responsive to radioiodine, or for patients with non toxic nodule. The injection is performed under color Doppler sonography guidance, evaluating the most vascularized areas of the tumor where to primarily inject ethanol solution with 21-22 gauge needles. Serum TSH, FT4, FT3 and TG levels are measured before each treatment session and 3,6,12,24 and 36 months after the end of therapy. Complete remission was achieved by different authors in 86% of cases and the efficacy of response was shown to be inversely proportional to the nodule volume. When TSH remains undetectable, a second cycle of PEI can be performed. If there is complete lack of blood flow signals on color or power Doppler with persisting thyroid hyperfunction, sonographic contrast media can be administered i.v. to assess residual areas of intranodal hypervascularity. In patients with unsuppressed TSH levels before treatment, hormonal changes cannot be used as marker response. Disappearance of nodular hypervascularity at color Doppler sonography and complete normalization of the scintigraphic pattern is usually observed in all cases. PEI is generally well tolerated; no recurrences of the disease and no cases of hypothyroidism have been reported.
Ethanol↗