Intrauterine chilled saline instillation reduces endometrial impairment on MRI after ultrasound-guided percutaneous microwave ablation of uterine adenomyosis.

OBJECTIVE: To investigate whether intrauterine chilled saline can reduce endometrial impairment during US-guided percutaneous microwave ablation (PMWA) of adenomyosis. METHODS: An open-label, randomized trial was conducted with sixty symptomatic adenomyosis patients who were randomly assigned (1:1) to receive PMWA treatment assisted by intrauterine saline instillation (study group) or traditional PMWA treatment alone (control group). The primary endpoint was endometrial perfusion impairment grade on post-ablation contrast-enhanced MRI. The secondary endpoints were endometrial dehydration grade, ablation rate, and intra-ablation discomfort. RESULTS: The baseline characteristics of the two groups were similar. The incidence rates of endometrial perfusion impairment on MRI in the study and control groups were 6.7% (2/30) and 46.7% (14/30), respectively (p < 0.001). There were 28 (93.3%), 2 (6.7%), 0, and 0 patients in the study group and 16 (53.3%), 7 (23.3%), 5 (16.7%), and 2 (6.7%) in the control group (p < 0.001) who had grade 0, 1, 2, and 3 perfusion impairment, respectively. Additionally, there were 27 (90%), 3 (10%), and 0 patients in the study group and 19 (63.3%), 10 (33.3%), and 1 (3.3%) in the control group who had grade 0, 1, and 2 endometrial dehydration (p = 0.01). The ablation rates achieved in the study and control groups were 93.3 ± 17% (range: 69.2-139.6%) and 99.7 ± 15.7% (range: 71.5-129.8%), and they were not significantly different (p = 0.14). No significant difference was found in the intra-ablation discomfort. CONCLUSION: Intrauterine chilled saline can effectively reduce endometrial impairment after PMWA treatment for adenomyosis. CRITICAL RELEVANCE STATEMENT: This trial demonstrated that the instillation of intrauterine chilled saline reduced endometrial impairment on MRI during PMWA of adenomyosis. This approach allows more precise and safe ablation in clinical practice. KEY POINTS: Endometrial impairment occurs in the PMWA treatment of adenomyosis. Intrauterine chilled saline can reduce endometrial impairment during PMWA for adenomyosis. An intrauterine catheter is a practical endometrial protecting method during thermal ablation. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100053582. Registered 24 November 2021, www.chictr.org.cn/showproj.html?proj=141090 .

US-guided Percutaneous Radiofrequency Ablation for Secondary Hyperparathyroidism: Long-term Outcomes and Prognostic Factors.

Background Although favorable outcomes have been reported with radiofrequency ablation (RFA) for secondary hyperparathyroidism (SHPT), the long-term efficacy remains insufficiently investigated. Purpose To evaluate the long-term efficacy and safety of US-guided percutaneous RFA in patients with SHPT undergoing dialysis and to identify possible predictors associated with treatment failure. Materials and Methods This retrospective study included consecutive patients with SHPT with at least one enlarged parathyroid gland accessible for RFA who were undergoing dialysis at seven tertiary centers from May 2013 to July 2022. The primary end point was the proportion of patients with parathyroid hormone (PTH) levels less than or equal to 585 pg/mL at the end of follow-up. Secondary end points were the proportion of patients with normal calcium and phosphorus levels, the technical success rate, procedure-related complications, and improvement in self-rated hyperparathyroidism-related symptoms (0-3 ranking scale). The Wilcoxon signed rank test and generalized estimating equation model were used to evaluate treatment outcomes. Univariable and multivariable regression analyses identified variables associated with treatment failure (recurrent or persistent hyperparathyroidism). Results This study included 165 patients (median age, 51 years [IQR, 44-60 years]; 92 female) and 582 glands. RFA effectively reduced PTH, calcium, and phosphorus levels, with targeted ranges achieved in 78.2% (129 of 165), 72.7% (120 of 165), and 60.0% (99 of 165) of patients, respectively, at the end of follow-up (mean, 51 months). For the RFA sessions, the technical success rate was 100% (214 of 214). Median symptom scores (ostealgia, arthralgia, pruritus) decreased (all P < .001). Regarding complications, only hypocalcemia (45.8%, 98 of 214) was common. Treatment failure occurred in 36 patients (recurrent [n = 5] or persistent [n = 31] hyperparathyroidism). The only potential independent predictor of treatment failure was having less than four treated glands (odds ratio, 17.18; 95% CI: 4.34, 67.95; P < .001). Conclusion US-guided percutaneous RFA was effective and safe in the long term as a nonsurgical alternative for patients with SHPT undergoing dialysis; the only potential independent predictor of treatment failure was a lower number (<4) of treated glands. © RSNA, 2024 Supplemental material is available for this article.

Ultrasound-Guided Radiofrequency Ablation in Tertiary Hyperparathyroidism: A Prospective Study.

OBJECTIVE: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). MATERIALS AND METHODS: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. RESULTS: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). CONCLUSION: US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.

Radiofrequency ablation for patients with recurrent or persistent secondary hyperparathyroidism after parathyroidectomy: initial experience.

BACKGROUND: Reoperation for recurrent or persistent secondary hyperparathyroidism (SHPT) after parathyroidectomy is challenging due to surgical scars and postoperative adhesions. Therefore, there is an increasing need to develop a new minimally invasive therapy. OBJECTIVE: To analyze the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with recurrent or persistent SHPT after parathyroidectomy. PATIENTS AND METHODS: From March 2013 to January 2022, 20 enlarged parathyroid glands in 10 patients with recurrent or persistent SHPT were treated with US-guided RFA. The levels of serum intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP), as well as clinical symptoms, were compared before and after RFA. The ablation procedure-related complications were also evaluated. The target range for iPTH levels was approximately 2-9 times the upper limit of normal (130-585 pg/mL). RESULTS: The mean follow-up time was 49.6 ± 34.5 months (range from 6 to101 months). The levels of serum iPTH, Ca, and P decreased significantly one day post-ablation. Six months after RFA, 70% of patients reached the targets for iPTH, and 50% of patients reached targets at the end of follow-up. Two patients underwent repeat ablation at 9 months and 6 years after RFA, respectively, due to persistently elevated iPTH levels, and both had serum iPTH concentrations in the recommended range at the recent follow-up visit. The patients' clinical symptoms significantly improved after ablation. Major complications after RFA included hoarseness (2/10) and permanent hypoparathyroidism (1/10). Severe hypocalcemia occurred in four patients (4/10) after ablation. CONCLUSION: US-guided percutaneous RFA for recurrent or persistent SHPT is safe, efficacious, and repeatable, and can significantly improve hyperparathyroidism-related symptoms.

Tele-Mentored Handheld Ultrasound System for General Practitioners: A Prospective, Descriptive Study in Remote and Rural Communities.

BACKGROUND: Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. METHODS: Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. RESULTS: Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). CONCLUSIONS: The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.

Ultrasound-guided percutaneous microwave ablation for adenomyosis with abnormal uterine bleeding: clinical outcome and associated factors.

OBJECTIVE: To investigate the factors affecting the efficacy of ultrasound (US)-guided percutaneous microwave ablation (PMWA) for adenomyosis with abnormal uterine bleeding (AUB-A). METHODS: Baseline data of patients with AUB-A who underwent US-guided PMWA treatment between October 2020 and October 2021, including demography characteristics, laboratory and imaging examination results were retrospectively analyzed. 3D reconstruction of magnetic resonance imaging (MRI) was applied to quantitatively assess the local treatment responses, including ratio of non-perfusion volume to adenomyosis volume (NPVr), ablation rate of the endometrial-myometrial junction (EMJ), and surface area (SA) of the ablated part of the EMJ. Patients were followed up at 3, 6, and 12 months after treatment, and divided into two groups: group with complete relief (CR), and group with partial relief (PR) or no relief (NR). Data were compared between them. RESULTS: Thirty-one patients were analyzed with a mean age of 38.7 ± 6.8 years (range: 24-48): 48.4% (15/31), 63.3% (19/30), and 65.5% (19/29) achieved CR at 3, 6, and 12 months, respectively. In univariate analysis, compared with the PR/NR group, serum CA125 levels were significantly lower in CR group at 3 months, while ablation rates of EMJ and SA of the ablated part of the EMJ were significantly higher at the three time points. Other baseline characteristics and NPVr did not differ between the two groups. CONCLUSION: Baseline CA125 and ablation rate of the EMJ and SA of the ablated part of the EMJ are associated with the outcome of AUB-A patients after US-guided PMWA treatment.

US-guided percutaneous radiofrequency ablation of secondary hyperparathyroidism as a bridge to renal transplantation.

PURPOSE: Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in patients with end-stage renal disease (ESRD) prior to renal transplantation (RTP), and the successful management of SPHP currently is challenging. In this study, we aimed to investigate the effectiveness of radiofrequency ablation (RFA) for SHPT as a bridge to RTP and to evaluate post-transplantation outcomes. METHODS: Patients with SHPT receiving RFA treatment were retrospectively reviewed, and those underwent RTP after ablation were enrolled. Serum parathyroid hormone (PTH), calcium, and phosphate levels were collected before ablation and at follow-up periods. The primary endpoints are PTH values at time of transplantation and at the final follow-up. The secondary endpoints were RFA-related complications, serum calcium and phosphate concentrations, and allograft function. RESULTS: Eleven patients with 43 enlarged parathyroid glands were treated with 16 RFA sessions and enrolled in the study. Complete ablation was achieved in all glands with transient hoarseness and hypocalcemia occurring in two and five of the treatments, respectively. At time of transplantation, serum PTH levels (246.7 ± 182.6 pg/mL) were significantly lower than that before RFA (1666.55 ± 874.48 pg/mL, p < 0.001) and were all within guideline-oriented range. The median follow-up period was 57.2 months. At last visit, all patients were alive, with normal PTH values and functioning grafts. CONCLUSIONS: Ultrasound-guided RFA is effective for destroying hyperplastic parathyroid tissues in SHPT patients, whose PTH values fall within the guideline-oriented range both pre-and post-transplantation. Percutaneous RFA acts as an effective bridge to RTP and might provide a new management paradigm designed to improve post-transplant outcomes.

Clinical and Economic Evaluation of Ultrasound-Guided Radiofrequency Ablation vs. Parathyroidectomy for Patients with Primary Hyperparathyroidism: A Cohort Study.

RATIONALE AND OBJECTIVES: To compare the clinical and economic effects of ultrasound (US)-guided radiofrequency ablation (RFA) with parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: From April 2014 to April 2021, 123 PHPT patients who received US-guided RFA or PTX were studied. Propensity score (PS) matching was used to balance the baseline data of the two groups. The rates of cure, recurrent and persistent PHPT, and complications were compared. A Chinese healthcare system perspective cost minimization analysis was conducted. RESULTS: After PS matching, 37 patient pairs (1:1) were created for the two groups. Follow-up was 27.2 ± 10.6 months and 28.8 ± 16.1 months for the RFA and PTX groups, respectively. At the last follow-up, there was no evidence of differences regarding clinical cure rate between the two groups (RFA vs. PTX, 91.9% vs. 94.6%, p = 1.000). Recurrent PHPT did not develop in any patient. One patient in each group had persistent PHPT. The incidence of complications and side effects, except postoperative pain (RFA vs. PTX, 16.2% vs. 40.5%, p = 0.020), were no significant difference between the two groups (all, p > 0.05). The incremental cost was -$284.00; thus, RFA was more cost-effective. For patients with employee medical insurance or resident medical insurance, the incremental costs (RFA vs. PTX) were -$391.94 and -$49.43, respectively. CONCLUSION: There were no significant differences in efficacy and safety between RFA and PTX. As the incremental cost for RFA compared with PTX was negative, RFA may be used as a more cost-effective nonsurgical treatment alternative for PHPT.

Effects of lauromacrogol injection under contrast-enhanced ultrasound guidance on cesarean scar pregnancy: a prospective cohort study.

Background: Compared with the current commonly used pretreatment approaches, the therapeutic effect of contrast-enhanced ultrasound-guided sclerotherapy with lauromacrogol injection (CEUSL) on cesarean scar pregnancy (CSP) is not clear. This study aimed to investigate the clinical efficacy and safety of CEUSL compared with gelatin sponge uterine artery embolization (UAE) and UAE combined with methotrexate (UAEM) in the pretreatment of CSP to prevent massive bleeding during subsequent curettage. Methods: Sixty-four patients were divided into the CEUSL (n=20), UAE (n=22), and UAEM (n=22) groups. All patients with CSP underwent curettage and hysteroscopy after CEUSL, UAE, or UAEM pretreatment. The efficacy and safety indicators after pretreatment were analyzed. Results: Time for pretreatment [95% confidence interval (CI): 31.92-39.28] and hospitalization cost (95% CI: 7,852.32-9,063.23) were significantly decreased in the CEUSL group compared with that in the UAE (95% CI: 53.55-59.99% and 95% CI: 12,901.42-15,166.63, respectively) and the UAEM group (95% CI: 52.90-58.83 and 95% CI: 11,324.66-13,302.69, respectively; P<0.001). The beta human chorionic gonadotropin (ß-hCG) percentage decrease 24 hours later and the hospital stay were significantly decreased in the CEUSL group (95% CI: 0.65-0.70 and 95% CI: 3.32-4.58 days, respectively) compared with those in the UAE (95% CI: 0.67-0.74 and 95% CI: 4.06-5.84, respectively) or UAEM (95% CI: 0.62-0.68 and 95% CI: 4.12-5.88, respectively) groups (P<0.05). After pretreatment, there were significantly fewer patients (P<0.05) with fever (95% CI: -0.52 to -0.093), pelvic pain (95% CI: -0.427 to -0.018), increased white blood cell count (95% CI: -0.359 to 0.040), and hypersensitive C-reactive protein (hs-CRP) elevation (95% CI: -0.572 to -0.118) in the CEUSL group than in the UAE or UAEM groups. At follow-up, all patients resumed normal menstruation, with no residual gestational sac on ultrasound imaging or sequel. Conclusions: The pretreatment procedures were all technically successful, with good outcomes in different pretreatment procedures. Compared with UAE with or without methotrexate, CEUSL may be as effective and safe for pretreatment of CSP, with fewer adverse effects and shorter pretreatment time and hospital stay.

Successful Use of a 5G-Based Robot-Assisted Remote Ultrasound System in a Care Center for Disabled Patients in Rural China.

Background: Disability has become a global population health challenge. Due to difficulties in self-care or independent living, patients with disability mainly live in community-based care centers or institutions for long-term care. Nonetheless, these settings often lack basic medical resources, such as ultrasonography. Thus, remote ultrasonic robot technology for clinical applications across wide regions is imperative. To date, few experiences of remote diagnostic systems in rural care centers have been reported. Objective: To assess the feasibility of a fifth-generation cellular technology (5G)-based robot-assisted remote ultrasound system in a care center for disabled patients in rural China. Methods: Patients underwent remote robot-assisted and bedside ultrasound examinations of the liver, gallbladder, spleen, and kidneys. We compared the diagnostic consistency and differences between the two modalities and evaluated the examination duration, image quality, and safety. Results: Forty-nine patients were included (21 men; mean age: 61.0 ± 19.0 [range: 19-91] years). Thirty-nine and ten had positive and negative results, respectively; 67 lesions were detected. Comparing the methods, 41 and 8 patients had consistent and inconsistent diagnoses, respectively. The McNemar and kappa values were 0.727 and 0.601, respectively. The mean duration of remote and bedside examinations was 12.2 ± 4.5 (range: 5-26) min and 7.5 ± 1.8 (range: 5-13) min (p < 0.001), respectively. The median image score for original images on the patient side and transmitted images on the doctor side was 5 points (interquartile range: [IQR]: 4.7-5.0) and 4.7 points (IQR: 4.5-5.0) (p = 0.176), respectively. No obvious complications from the examination were reported. Conclusions: A 5G-based robot-assisted remote ultrasound system is feasible and has comparable diagnostic efficiency to traditional bedside ultrasound. This system may provide a unique solution for basic ultrasound diagnostic services in primary healthcare settings.

Predicting ultrasound-guided thermal ablation benefit in primary hyperparathyroidism.

OBJECTIVES: Ultrasound (US)-guided thermal ablation for primary hyperparathyroidism (PHPT) is a relatively novel minimally invasive treatment. The recurrence rate after ablation is between 10 and 15%. The characteristics of patients who can benefit from thermal ablation therapy are not clear yet. The aim of this research was to investigate the validity of a parathyroid hormone (PTH)-based classifier for stratifying patients with PHPT. METHODS: A total of 171 patients were screened, 148 (86.5%) of whom were eligible and were divided into development (n = 104) and external validation (n = 44) cohorts. The potential relationship between the PTH-based classifier and the cure rate of patients was initially assessed in the primary cohort and then validated in the external validation cohort. The nomogram was computed from the logistic regression model. RESULTS: A cut-off of PTH < 269.1 pg/mL or ≥ 269.1 pg/mL as the optimal prognostic threshold in the training cohort was generated to stratify the patients into low-risk and high-risk groups. Patients with PTH levels < 269.1 pg/mL in the training cohort had a higher cure rate than patients with PTH levels ≥ 269.1 pg/mL (p < 0.001). The PTH level remained the strongest predictor of the cure rate in all cohorts. Furthermore, a nomogram based on the PTH level was developed to predict the cure rate in the training cohort and it performed well in the external validation cohort (AUC: 0.816, 95%CI 0.703 to 0.930; AUC: 0.816, 95%CI 0.677 to 0.956). CONCLUSIONS: The PTH-based classifier may help with individualised treatment planning for selecting patients who may benefit from thermal ablation. KEY POINTS: • This is the first analysis of predictors affecting the outcome of US-guided thermal ablation of primary hyperparathyroidism and the findings can be used to identify the potential beneficiary population of thermal ablation of primary hyperparathyroidism. • Parathyroid hormone (PTH) was confirmed as an independent prognostic factor, as it not only showed good accuracy in stratifying patients into high- and low-risk groups in the training and validation cohorts but also outperformed the clinical model. • This study developed and validated a model to predict the treatment success of thermal ablation of primary hyperparathyroidism.

Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study.

We compared the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) and parathyroidectomy (PTX) for the treatment of secondary hyperparathyroidism (SHPT). In this single-center retrospective study, we divided patients into PTX (n = 53) and RFA (n = 47) groups. The primary outcome was the proportion of patients who achieved the target intact parathyroid hormone (iPTH) concentration range (≤ 300 pg/mL). Secondary outcomes were the differences in the changes in iPTH, calcium, and phosphorus levels over time and prognosis. iPTH concentrations of 82.1% and 64.1% in the PTX and RFA groups, respectively, were within the recommended range at the endpoint (P = 0.07). iPTH concentrations in the PTX and RFA groups dropped sharply after treatment (82 ± 163 pg/mL and 280 ± 307 pg/mL, respectively, P < 0.001). There was no difference in the trends of iPTH, calcium, and phosphorus levels between the two groups (P > 0.05). Survival analysis revealed no differences in all-cause mortality and cumulative response rate between the two groups (P = 0.90, P = 0.14, respectively). Notably, the incidence of infection and length of the hospital stay in the RFA group were significantly lower. The preoperative bone-specific alkaline phosphatase concentration was a risk factor for postoperative hypocalcemia. US-guided RFA is minimally invasive and compared to PTX in terms of long-term efficacy and complications in the treatment of severe SHPT in maintenance dialysis patients. It may be used as an alternative technique to PTX; however, further studies are needed.

Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism: A Prospective Study.

OBJECTIVE: To assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: This prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18-87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation. RESULTS: Complete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0-24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1-3 months. CONCLUSION: US-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.

Ultrasound-guided microwave and radiofrequency ablation for primary hyperparathyroidism: a prospective, multicenter study.

OBJECTIVES: To prospectively investigate the efficacy and safety of ultrasound (US)-guided microwave ablation (MWA) and radiofrequency ablation (RFA) for primary hyperparathyroidism (PHPT). METHODS: We performed a prospective multicenter study of MWA and RFA for PHPT between August 2017 and October 2020 at five centers. Laboratory testing was performed pre- and post-ablation and followed for at least 6 months. The primary outcome was the cure rate. Secondary outcomes were complications and dynamic changes in serum levels of PTH, calcium, phosphorus, and ALP after ablation. RESULTS: A total of 132 participants (mean age, 57.33 ± 13.90 years), with 141 parathyroid nodules (median maximal diameter, 1.55 cm) undergoing either MWA or RFA, were enrolled in the study. The technique success rate was 99.29% (140/141). The follow-up period was 6-36 months (median, 12 months). The cure rate was 80.30% (106/132). Pre-ablation PTH level was the independent factor associated with cure rate (Odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090). There was no difference in cure rate between the MWA group and the RFA group (80.22% vs. 80.49%, p = 0.971). The only main complication was hoarseness (5.30%). CONCLUSIONS: US-guided MWA and RFA for PHPT is an effective and safe procedure in the treatment of PHPT. Pre-ablation PTH level is the key factor affecting the cure rate after MWA and RFA. KEY POINTS: • To our knowledge, this is the first prospective multicenter clinical trial with ultrasound-guided MWA and RFA for primary hyperparathyroidism. • There was no difference in cure rate between the MWA and RFA groups for primary hyperparathyroidism. The overall cure rate was 80.30%. • Pre-ablation PTH level was the independent factor associated with cure rate (odds ratio (OR), 0.22; 95% CI, 0.07-0.69; p = 0.0090).

Radiofrequency ablation for primary hyperparathyroidism and risk factors for postablative eucalcemic parathyroid hormone elevation.

OBJECTIVE: To investigate the efficacy of radiofrequency ablation (RFA) as a treatment option for primary hyperparathyroidism (pHPT) and risk factors for postablative eucalcemic parathyroid hormone elevation (ePTH). METHODS: This retrospective study included 51 patients with pHPT who underwent RFA. The patients were divided into the ePTH and normal PTH groups, based on the serum intact parathyroid hormone (iPTH) level one month after ablation. Serum iPTH, calcium, and phosphorus levels, and the volume reduction rates (VRR) of the parathyroid glands were compared between the groups at each follow-up point. Risk factors for ePTH at one month after ablation were examined. RESULTS: After RFA, one (2%) patient had persistent pHPT, and 50 (98%) patients were cured. The incidence rates of ePTH at 1, 3, 6, and 12 months were 48%, 30%, 20%, and 16%, respectively. Serum iPTH levels in the ePTH group were higher than those in the normal PTH group at each follow-up point (all p < 0.05), except 1 day after ablation (p > 0.05). Serum calcium and phosphorus levels, and the VRR of the glands were comparable in both groups at each follow-up point (all p > 0.05), except for calcium levels 3 days after RFA (p < 0.05). Baseline iPTH (odds ratio, 1.067; p = 0.045) and calcium (odds ratio, 3.923; p = 0.038) levels were independent risk factors for ePTH 1 month after RFA. CONCLUSIONS: RFA is safe and effective for the treatment of pHPT. Moreover, ePTH occurrence after RFA was associated with baseline iPTH and calcium levels and did not increase the risk of recurrent pHPT.

The Performance of Transvaginal Two-Dimensional Fundamental Sonosalpingography Combined with Saline Infusion Pelvic Sonosalpingography for Assessing Fimbrial Part's Morphology and Function of the Fallopian Tubes.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic efficacy of transvaginal two-dimensional fundamental sonosalpingography (2D-FS) combined with saline infusion pelvic sonosalpingography (SIPS) for assessing fimbrial part's morphology and function of the fallopian tubes. METHODS: One hundred and sixty-nine cases underwent 2D-FS combined with SIPS. Among them, 18 cases received laparoscopy and dye test (LDT) within 3 months after the examination and the results were regarded as reference standard. RESULTS: Excluding proximal or middle segment obstructed tubes, the remaining fimbrial parts' display rate by using 2D-FS combined with SIPS was 75.1%. According to the ultrasonic appearance, the fimbrial parts were classified into 4 types: normal, abnormal, suspected abnormal, and unclassifiable. Normal fimbrial parts accounted for 73.8% when the tubes were patent; abnormal fimbrial parts accounted for 74.1% when the tubes were partial obstructed; all became abnormal when the tubes were distal complete obstructed. The fimbrial parts which had been classified by 2D-FS combined with SIPS were compared with LDT further. This combination's accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Youden's index (YI) were 86.4, 87.5, 85.7, 77.8, 92.3, and 0.73%, respectively. The result of consistency analysis showed the combination was essentially consistent with LDT result (Kappa = 0.713). CONCLUSION: 2D-FS combined with SIPS can be a preferred method for assessment of the fimbrial part's morphology and function, with its advantages of non-invasive, intuition, and accuracy. This combination could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.

Phase-Changeable Nanoparticle-Mediated Energy Conversion Promotes Highly Efficient High-Intensity Focused Ultrasound Ablation.

This review describes how phase-changeable nanoparticles enable highly-efficient high-intensity focused ultrasound ablation (HIFU). HIFU is effective in the clinical treatment of solid malignant tumors; however, it has intrinsic disadvantages for treating some deep lesions, such as damage to surrounding normal tissues. When phase-changeable nanoparticles are used in HIFU treatment, they could serve as good synergistic agents because they are transported in the blood and permeated and accumulated effectively in tissues. HIFU's thermal effects can trigger nanoparticles to undergo a special phase transition, thus enhancing HIFU ablation efficiency. Nanoparticles can also carry anticancer agents and release them in the targeted area to achieve chemo-synergistic therapy response. Although the formation of nanoparticles is complicated and HIFU applications are still in an early stage, the potential for their use in synergy with HIFU treatment shows promising results.

Adult pancreatoblastoma: a case report.

Pancreatoblastoma (PB) is a rare epithelial malignancy usually occurring in the paediatric population. Adult PB is rare, and its imaging findings are similar to those of other tumours, making preoperative diagnosis a considerable challenge. We report correlative ultrasound, contrast-enhanced ultrasonography, contrast-enhanced magnetic resonance imaging, and positron emission tomography-computed tomography findings in a 60-year-old woman with PB. PB often presents with uncommon imaging features and should be considered in the differential diagnosis of pancreatic masses. It is important for clinicians to be aware of these differences to provide effective treatment.

Microwave ablation versus radiofrequency ablation for primary hyperparathyroidism: a multicenter retrospective study.

OBJECTIVE: To compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of primary hyperparathyroidism (pHPT). METHOD: This retrospective study included 104 pHPT patients treated by MWA or RFA between January 2015 and March 2020 in four centers. The clinical outcomes including effectiveness and complications were compared between the two groups. Ablation cure was defined as the reestablishment of normal values of serum calcium and intact parathyroid hormone (iPTH) at least more than 6 months. Clinical cure was defined as the reestablishment of normal values of serum calcium and iPTH throughout the entire follow-up period. RESULTS: A total of 77 patients underwent MWA (mean age, 55.5 ± 16.4 years) and 27 underwent RFA (mean age, 58.9 ± 15.6 years). During the follow-up (median, 18.7 months in the MWA group; 12 months in the RFA group), no difference was observed between ablation cure rates (88.3% vs. 88.9%, p = 1.000), clinical cure rates (87.0% vs. 82.3%, p = .880), recurrent pHPT (5.2% vs. 3.7%, p = .447), persistent pHPT (11.7% vs. 11.1%, p = 1.000) and complication rate (9.1% vs. 3.7%, p = .677). A maximum diameter less than 0.7 cm was an independent prognostic factor of uncured pHPT in ablation (hazard ratio, 0.1; 95% confidence interval: 0.02, 0.54; p = .007). Major complication - voice change encountered in five patients (6.5%) in the MWA group and in one patient (3.7%) in the RFA group. CONCLUSION: Both RFA and MWA are safe and effective techniques for patients with pHPT, with comparable clinical outcomes.