Clinical research on ultrasonically guided intrahepatic injections of HAS in interventional treatment of liver carcinomas.

PURPOSE: To study the clinical value of intrahepatic injections of Highly Agglutinative Staphylococcin (HAS) in the interventional treatment of liver carcinomas. METHODS: Under ultrasonic guidance, intrahepatic injections of HAS were administered in 22 cases of pathologically diagnosed liver carcinomas, 3 days, 7 days, 30 days, 3 months, 6 months, 9 months, and 12 months after microwave coagulation therapy. The dose of each injection was 2000U. RESULTS: Immunohistochemical staining of the sample from the tumor site after HAS administrations demonstrated a significant increase in the number of antitumor immune cells compared with that before the injections (p<0.01) and an improvement in local immune status. One-year survival rate and recurrence rate, which were determined by Kaplan- Meier method, were 93.8% and 81.9% respectively. CONCLUSIONS: As a new route of administration, intrahepatic injections of HAS are a safe and effective procedure and deserves further clinical research and discussion.

Ultrasound-guided percutaneous microwave ablation for hepatic malignancy adjacent to the gallbladder.

PURPOSE: The study was performed to assess the safety and efficacy of ultrasound (US)-guided percutaneous microwave (MW) ablation for hepatic malignancy adjacent to the gallbladder. MATERIALS AND METHODS: From January 2011 to December 2013, 49 patients with 51 hepatic tumours adjacent to the gallbladder who underwent US-guided percutaneous MW ablation were included in the study group. A total of 106 patients with 117 hepatic tumours not adjacent to the gallbladder who underwent US-guided percutaneous MW ablation were included in the control group. In the study group the temperature of marginal ablation tissue proximal to the gallbladder was monitored and controlled at 45-54 °C for 5-10 min during the ablation. Ethanol (4.5-13 mL) was injected into the marginal tissue in 27 of 51 tumours of the study group. We compared the results of ablation between the two groups. RESULTS: All patients were successfully treated. A total of 47 of 51 tumours in the study group (92.2%) and 110 of 117 tumours in the control group (94.0%) achieved complete ablation (p = 0.93). Local tumour progression was found in nine (17.6%) tumours in the study group and 15 (12.8%) tumours in the control group during follow-up after MW ablation (p = 0.41). No peri-procedural major complications occurred in either group. CONCLUSIONS: Under strict temperature monitoring, US-guided percutaneous MW ablation assisted with ethanol injection appears to be safe and can achieve a high rate of complete ablation for the treatment of hepatic malignant tumours adjacent to the gallbladder.

Percutaneous microwave ablation for liver cancer adjacent to the diaphragm.

PURPOSE: The aim of the study was to prospectively evaluate the safety and effectiveness of percutaneous microwave (MW) ablation for liver cancer adjacent to the diaphragm. MATERIALS AND METHODS: From May 2005 to June 2008, 89 patients with 96 hepatic lesions adjacent to the diaphragm (the shortest distance from the lesion margin to the diaphragm less than 5 mm), who underwent ultrasound (US)-guided percutaneous MW ablation, were included in the study group. A total of 100 patients with 127 hepatic lesions not adjacent to the diaphragm (the shortest distance from the lesion to the diaphragm and the first or second branch of the hepatic vessels more than 10 mm), who underwent US-guided percutaneous MW ablation, were included in the control group. During the ablation the temperature of marginal ablation tissue proximal to the diaphragm was monitored and controlled at 50°-60°C for more than 10 min in the study group. We compared the results of ablation between the two groups. RESULTS: A total of 91 of 96 tumours (94.8%) in the study group and 123 of 127 tumours (96.9%) in the control group achieved complete ablation (P > 0.05). Local tumour progression was found in 18 of 96 tumours (18.8%) in the study group and 21 of 127 tumours (16.5%) in the control group during follow-up after MW ablation (P > 0.05). No major complications occurred in either group. CONCLUSIONS: Under strict temperature monitoring, percutaneous MW ablation is safe and can achieve a high complete ablation rate for the treatment of hepatic tumours adjacent to the diaphragm.

Contrast-enhanced ultrasound-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional ultrasound.

OBJECTIVE: To evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional US. MATERIALS AND METHODS: From March 2006 to February 2010, 107 patients (93 male, 14 female; mean age 58.9±11.0 years) with 107 hepatocellular carcinoma (HCC) nodules (mean maximum diameter 19.5±8.5 mm) inconspicuous on conventional US underwent microwave (MW) ablation under CEUS guidance in this study. US contrast agent was SonoVue (Bracco, Milan, Italy), a second-generation contrast agent. CEUS was performed first, and then MW ablation was carried out by means of CEUS guidance under unconscious intravenous anaesthesia if the tumours were displayed on CEUS. RESULTS: 105 tumours were successfully visualised on CEUS by using 1-2 times contrast agent injection and MW ablation was performed under CEUS guidance. The technical success rate was 98.13% (105/107). The number of antenna insertions for each tumour was 1.89±0.92, and the mean session of MW ablation for each tumour was 1.08±0.28. The mean duration of energy application for each tumour was 7.05±4.03 min. The follow-up time was 12-54 months (median 18 months). The technique effectiveness rate was 99.05% (104/105). The local tumour progression rate was 1.9% (2/105). There were no severe complications in any patients. CONCLUSION: CEUS-guided MW ablation is an efficient and feasible treatment method for patients with hepatocellular carcinoma inconspicuous on conventional US.

Long-term results of a phase II clinical trial of superantigen therapy with staphylococcal enterotoxin C after microwave ablation in hepatocellular carcinoma.

PURPOSE: To prospectively evaluate safety and effectiveness of intratumoural injection of superantigen staphylococcal enterotoxin C (SEC) for hepatocellular carcinoma (HCC) after percutaneous microwave ablation (PMWA). METHODS: HCC patients (260) with tumours of 60 mm or less (average 29.2 ± 11.1 mm) that achieved technique effectiveness evidenced on imagings within one week of PMWA were enrolled. The SEC group consisted of 45 patients with 2000 U SEC injected into the marginal area of ablated tumour under ultrasound guidance on day 24, 28 and month 2, 5, and 7 after PMWA. The control group consisted of 215 patients receiving PMWA alone. RESULTS: The overall survival rates for 1, 3, and 5 years were 93.3%, 72.9%, 60.8% in the SEC group and 94%, 66%, 44.4% in the control group. The overall survival time had significant difference (p = 0.032). Treatment method was prognostic significance for overall survival on univariate (p = 0.045) and multivariate (p = 0.049) analyses. The disease-free survival time of the SEC group was longer than the control group (p = 0.195). The disease free survival rates at 1 and 3 years were 62% versus 56.6%, 37% versus 9.4% in the SEC and control subgroup of larger (D > 30 mm) tumours, and disease free survival time had significant difference (p = 0.032). Treatment method was a prognostic significance factor for disease free survival of larger tumours on univariate (p = 0.03) and multivariate (p = 0.023) analyses but was not for small tumours. No serious adverse event related to SEC injection happened. CONCLUSIONS: Local superantigen injection at ablated HCC early after PMWA is safe, and achieves longer overall survival as well as disease free survival of larger tumours.

Malignant liver tumors: treatment with percutaneous microwave ablation--complications among cohort of 1136 patients.

PURPOSE: To report the complications for percutaneous microwave (MW) ablation for the treatment of malignant liver tumors and the possible risk factors for complications in a large series of patients. MATERIALS AND METHODS: The study was approved by the institutional review board; informed consent was waived because of the retrospective design. Over a 13-year period, 1136 patients with 1928 malignant liver tumors underwent ultrasonographically guided percutaneous MW ablation (583 with a noncooled-shaft antenna and 553 with a cooled-shaft antenna). A total of 3697 MW ablation sessions (average, 1.8 sessions per patient) were performed. Mortality and treatment-related major and minor complications were documented. Data were subsequently analyzed to determine whether the major complication rate was related to antenna type, tumor size, tumor location, or number of MW sessions. RESULTS: Two deaths not directly attributable to MW ablation were encountered. Major complications occurred in 30 (2.6%) patients and included liver abscess and empyema (n = 5), bile duct injury (n = 2), perforation of the colon (n = 2), tumor seeding (n = 5), pleural effusion requiring thoracentesis (n = 12), hemorrhage requiring arterial embolization (n = 1), and skin burn requiring resection (n = 3). Minor complications included fever; pain; asymptomatic pleural effusion, gallbladder wall thickening, and arterioportal shunt; small stricture of the bile duct; and skin burn requiring no treatment. Use of noncooled-shaft antenna and an increased number of MW ablation sessions were associated with a higher rate of major complications (P < .05). CONCLUSION: MW ablation is a well-tolerated technique with an acceptably low rate of major complications for treatment of malignant liver tumors. Use of a cooled-shaft antenna, as well as fewer MW sessions, may help minimize major complications.

Percutaneous microwave ablation or nephrectomy for VX-2 carcinoma in rabbit kidney.

PURPOSE: We compared the effectiveness of percutaneous microwave ablation and radical nephrectomy for implanted VX-2 carcinoma in rabbit kidneys. MATERIALS AND METHODS: VX-2 tumors were surgically implanted into the left lower pole parenchyma of 26 New Zealand White rabbit kidneys. At 12 days after implantation implanted rabbits were randomly assigned to 1 of 3 groups according to therapy type, including percutaneous microwave ablation, nephrectomy and no treatment. The anticancer effect and safety were compared among the groups. Histopathological changes in tumor tissue with time after microwave ablation were evaluated. RESULTS: The survival rate in the percutaneous microwave ablation group was significantly higher than that in the no treatment group and showed no statistically significant difference compared with that in the nephrectomy group. Serum creatinine did not increase after microwave therapy but we noted a statistically significant serum creatinine increase in the nephrectomy group. Histological analysis revealed completely coagulative necrosis of the tumor in 10 of 12 rabbits (83.3%) after microwave ablation. Two rabbits died, including 1 of peritonitis in the nephrectomy group and 1 of intestinal fistula due to heat injury in the percutaneous microwave ablation group. CONCLUSIONS: This study shows that percutaneous microwave ablation can achieve effects similar to those of radical nephrectomy. It caused no significant changes in renal function when treating implanted VX-2 renal tumors. Percutaneous microwave ablation has the potential of being a minimally invasive treatment for small renal tumors.

Focal hypoechoic tumors of Fatty liver: characterization of conventional and contrast-enhanced ultrasonography.

OBJECTIVE: The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). METHODS: Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. CONCLUSIONS: With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.

[Local cellular immune response induced by ultrasound-guided tumor bed superantigen injection after percutaneous microwave coagulation therapy for liver cancer].

OBJECTIVE: To investigate the local cellular immune response after injection of superantigen, the highly agglutinative staphylococin (HAS), into the tumor bed after ultrasound-guided percutaneous microwave coagulation therapy (PMCT) in the liver cancer patients. METHODS: Ninety-two patients with pathologically proven primary liver cancer were divided into two groups: 45 in group A were treated by PMCT alone and 47 in the group B by combined with ultrasound-guided percutaneous injection of highly agglutinative staphylococin (HAS). Before and after PMCT and HAS treatment, the patients underwent ultrasound-guided percutaneous biopsy from the tumor bed and the samples were examined by pathology and immunohistochemistry. The infiltration of CD3+, CD4+, CD57+ and CD68+ lymphocytes in treatment zone was compared between the two groups. Moreover, the infiltrating immunocytes were observed by transmission electron microscopy. RESULTS: One week after HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, respectively. All the above mentioned parameters increased significantly in varying degrees compared with that before PMCT or HAS injection (P < 0.05). Four weeks after HAS injection, the density of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 32.67 +/- 10.42, 23.43 +/- 6.99, 18.63 +/- 7.89 and 30.01 +/- 11.05, respectively, still significantly higher than those before PMCT (P < 0.05). Five weeks after PMCT and HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, versus 32.03 +/- 8.11, 15.67 +/- 8.32, 15.23 +/- 8.26 and 29.67 +/- 11.98 in the group A, respectively, still with a significant difference between the two groups (P < 0.05). A lot of lysosomes, endoplasmic reticulum and mitochondria in the immune cells after injection of HAS were observed by transmission electron microscopy. CONCLUSION: The local cellular immunity in liver cancer treatment area can be significantly improved by ultrasound-guided injection of highly agglutinative staphylococin after percutaneous microwave coagulation therapy.

Evaluation of focal fatty infiltration of the liver using color Doppler and contrast-enhanced sonography.

PURPOSE: To investigate the vascular characteristics of focal fatty infiltration (FFI) in the liver using color Doppler sonography (CDUS) and contrast-enhanced sonography (CEUS). METHODS: We prospectively examined 25 areas of FFI of the liver in 20 patients via conventional gray-scale sonography, CDUS, and CEUS. Cadence contrast pulse sequencing and the contrast agent SonoVue were used for CEUS examination. CEUS criteria for diagnosis of FFI were isoenhancement or hypoenhancement in the arterial phase and homogeneous isoenhancement in the portal and late phases. RESULTS: CDUS revealed a draining vein in 4 of 9 (44%) lesions in the hepatic hilum, whereas CEUS revealed a draining vein in 8 (89%) lesions. A vein was associated with the 2 lesions located at the edge of segment II on both CDUS and CEUS. Blood flow was seen on both CDUS and CEUS in the 2 lesions adjacent to the falciform ligament. In one patient, CDUS and CEUS revealed the mid-hepatic vein coursing between 2 FFIs. In the arterial phase of CEUS, the lesions were hypoenhancing in 44% (11/25), iso-enhancing in 44% (11/25), and hyperenhancing in 12% (3/25). In the portal phase and in the late vascular phase, all 25 lesions (100%) were iso-enhancing. Sensitivity of combined sonography and CDUS in the diagnosis of FFI was 44%, and overall accuracy was 81%. The sensitivity of CEUS in the diagnosis of FFI was 88%, and its overall accuracy was 96%. CONCLUSION: FFI in the porta hepatis is correlated with aberrant venous drainage. FFI around the falciform ligament may be related to divergence of the portal vein or unusual blood supply. In the arterial phase of CEUS, FFI lesions were iso-enhancing as often as they were hypoenhancing.

Ultrasonographic portography with low mechanical index gray-scale imaging in hepatic VX2 tumor.

To evaluate the characteristics of portal blood supply of hepatic tumors by ultrasonographic portography (USP), an in vivo model was studied using SonoVue, a second-generation ultrasound contrast agent (UCA) and low mechanical index (MI), gray-scale harmonic imaging. SonoVue (0.05 mL) was administrated through catheter placed into the main trunk of portal vein at laparotomy, followed by a 0.5 mL saline flush, in 12 rabbits with hepatic VX2 tumor, implanted by VX2 tumor tissue cubes of approximately 1 mm3 from carrier rabbit. Results showed that low MI gray-scale imaging delineated clearly the dynamic enhancement of tumors and liver parenchyma. Among 22 tumors, seven tumors were diffusely increased, with the intensity of enhancement weaker than that of the surrounding liver parenchyma. The UCA was washed out earlier from tumors than from surrounding liver parenchyma. Three tumors showed the branches of portal vein. Five tumors showed peripheral contrast enhancement and a central coarse unenhanced hypoechoic area. Seven tumors displayed no actual enhancement. All lesions (100% [22 of 22]) were depicted clearly in the whole duration of enhancement, especially in the early and late phase, regardless of enhancement pattern, and portal blood flow was manifested in 15 of 22 (68%) tumors, by USP. The enhancement pattern of the tumors corresponded to the pathologic findings. The results indicated that ultrasonographic portography, combined with low MI levels and second-generation UCA, is a sensitive and safe method to study portal blood supply for liver cancer. It may contribute to improvement of the detectability and diagnostic ability and assist the choice of a therapeutic strategy for treatment of liver cancer. However, applicability of the method to human may be problematic because of high invasiveness and great difficulty in administering contrast medium.

[Influence of microwave ablation and surgical resection of small primary hepatocellular carcinoma on hematogenous dissemination of tumor cells].

OBJECTIVE: To study the influence of percutaneous microwave ablation (PMA) and surgical resection for patients with small primary hepatocellular carcinoma (PHC) on dissemination of tumor cells in peripheral blood determined by AFP mRNA. METHODS: Forty patients with small PHC (The maximal diameter < or = 5 cm) confirmed histologically were included in this study. All the patients had single tumor nodule only without metastasis. Of the 40 patients, 19 were treated by PMA and 21 by surgical resection. Blood samples were collected and tested immediately before treatment, 30 min after the mass ablated/resected, 1 d and 7 d later by RTD-Nested-RT-PCR for AFP mRNA. The CD3, CD4, CD8 and CD4/CD8 in blood, and hepatic function were tested at the same time points as well. RESULTS: After treatment, ALT and AST in peripheral blood increased in both groups, but more intensely in the surgical group. The CD3, CD4 and CD4/CD8 in peripheral blood decreased at 30 min, 1 day and 7 days after surgical resection, and the lowest value was at 30 min after surgery. The immune function was kept at the same level as pre-treatment in the PMA group. AFP mRNA copies in blood could be detected in 27 of 40 patients (67.5%) in two groups before treatment, and the copy number was increased after treatment. There was no significant difference between the two groups. The patients were followed up for 1 - 16 months. AFP mRNA copies in blood could be detected persistently in the 4 patients with extrahepatic metastasis or liver recurrence. CONCLUSION: Surgical resection and microwave ablation may cause PHC cells dissemination into the blood circulation in patients with small PHC, and there was no difference between the two treatment groups. The cellular immune function in peripheral blood is decreased after surgical resection, but is maintained at the same level as pre-treatment in the PMA group. The impairment of liver function is less severe after PMA treatment than surgical resection. PMA may provide certain value for clinical management of small hepatocellular carcinoma.

[Long-term results of percutaneous sonographically-guided microwave ablation therapy of early-stage hepatocellular carcinoma].

OBJECTIVE: To evaluate the long-term results of percutaneous microwave coagulation therapy in the treatment of early hepatocellular carcinoma. METHODS: From May 1994 to June 2004, a total of 216 patients with 275 nodules of hepatocellular carcinoma whose diameter

[Evaluation of long-term therapeutic effects of ultrasound-guided percutaneous microwave ablation of liver metastases].

OBJECTIVE: To explore therapeutic results of local microwave ablation for hepatic metastasis and the factors influencing the survival after percutaneous microwave ablation therapy. METHODS: From July 1995 to June 2005 128 patients with 282 hepatic metastases nodules with the primary diseases of upper gastrointestinal tumor (n = 26), colorectal tumor (n = 44), breast carcinoma (n = 19), pulmonary carcinoma (n = 15), and malignant tumor in other part of the body (n = 24), underwent percutaneous microwave ablation therapy and were followed up for 29.7 +/- 19.9 months (1 - 103 months). The largest diameter of the metastatic nodules was 3.5 +/- 1.6 cm (0.7 - 8.6 cm). Sixty-four cases had 140 nodules 3.0 cm in diameter. Forty-seven patients had single nodule, 44 patients had 2 nodules, and 93 patients had 3 or more nodules. Fifty-seven patients had tumor of low differentiation, 53 had tumor of middle differentiation, and 18 had highly differentiated tumors. Kaplan-Meier method was used to calculate the cumulative survival rate. Statistical comparison of the effects of potential predictive factors on survival rate was performed using log-rank analysis. Multivariate analysis of the survival rates was performed by using Cox's proportional hazard model. RESULTS: The 1, 2, 3, 4, and 5-year cumulative survival rates of all 128 patients were 90.88%, 73.84%, 51.09%, 36.14%, and 31.89% respectively. Univariate analysis showed that tumor size (P = 0.028), tumor differentiation (P = 0.026) and local recurrence or new metastases (P < 0.001) significantly affected the survival. Multivariate analysis revealed that tumor size (P = 0.035), recurrence or new metastases (P = 0.001) and tumor differentiation (P = 0.038) each had a significant effect on survival. CONCLUSION: There is a significantly higher probability of long-term survival for patients with well-differentiated tumors 3.0 cm or less in diameter and without recurrence or new metastasis after percutaneous microwave ablation.

Construction and clinical significance of a predictive system for prognosis of hepatocellular carcinoma.

AIM: The aims of this study were to explore individualized treatment method for hepatocellular carcinoma (HCC) patients whose maximum tumor size was less than 5 cm to improve prognosis and survival quality. METHODS: Thirty cases of primary HCC patients undergoing tumor resection were retrospectively analyzed (resection group). All the tumors were proved as primary HCC with pathologic examination. The patients were divided into two groups according to follow-up results: group A, with tumor recurrence within 1 year after resection; group B, without tumor recurrence within 1 year. Immunohistochemical stainings were performed using 11 kinds of monoclonal antibodies (AFP, c-erbB2, c-met, c-myc, HBsAg, HCV, Ki-67, MMP-2, nm23-H1, P53, and VEGF), and expressing intensities were quantitatively analyzed. Regression equation using factors affecting prognosis of HCC was constructed with binary logistic method. HCC patients undergoing percutaneous microwave coagulation therapy (PMCT) were also retrospectively analyzed (PMCT group). Immunohistochemical stainings of tumor biopsy samples were performed with molecules related to HCC prognosis, staining intensities were quantitatively analyzed, coincidence rate of prediction was calculated. RESULTS: In resection group, the expressing intensities of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 2.97, P = 0.01; t = 2.42, P = 0.03<0.05; t = 2.57, P = 0.02<0.05; t = 3.43, P = 0.004<0.01, respectively); the expressing intensities of 11 kinds of detected molecules in para-cancer tissue in groups A and B were not significantly different (P>0.05). The regression equation predicting prognosis of HCC is as follows: P(1) = 1/[1+e(-(3.663-0.412mycc-2.187Ki-67c-0.397vegfc))]. It demonstrates that prognosis of HCC in resection group was related with c-myc, Ki-67 and VEGF expressing intensity in cancer tissue. In PMCT group, the expressing intensities of c-myc, Ki-67 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 4.57, P = 0.000<0.01; t = 2.08, P = 0.04<0.05; t = 2.38, P = 0.02<0.05, respectively); the expressing intensities of c-myc, Ki-67 and VEGF in para-cancer tissue in groups A and B were not significantly different (P>0.05). The coincidence rate of patients undergoing PMCT in group A was 88.00% (22/25), in group B 68.75% (11/16), the total coincidence rate was 80.49% (33/41). CONCLUSION: The regression equation is accurate and feasible and could be used for predicting prognosis of HCC, it helps to select treatment method (resection or PMCT) for HCC patients to realize individualized treatment to improve prognosis.

Grey-scale contrast enhancement in rabbit liver with SonoVue at different doses.

To evaluate the dose of ultrasound (US) contrast agent (UCA) in relation to the contrast-enhancement effect, an in vivo model of perfusion was studied using SonoVue, a second-generation UCA, and low mechanical index (MI) grey-scale harmonic imaging. SonoVue, at eight different doses (0.02, 0.04, 0.06, 0.08, 0.10, 0.12, 0.14 and 0.16 mL/kg BW), was applied in five normal rabbits. Flow-related parameters obtained from time-intensity curves were calculated and plotted over the contrast agent doses, and nonlinear curve fitting was performed. Results showed that, along with an increase of the administrated contrast agent dose, the enhancement duration (ED) and the area under the curve (AUC) increased logarithmically, and the time to enhancement (ET) decreased logarithmically. There was a progressive increase of the peak signal intensity (PSI) following an increase of SonoVue dose only in the dose range of 0.02 up to 0.10 mL/kg body weight (BW) in the portal vein and in the dose range of 0.02 up to 0.12 mL/kg BW in the liver parenchyma. Moreover, a good correlation was observed between the parameters obtained from liver parenchyma and those obtained from the portal vein. The results indicated that SonoVue in conjunction with continuous harmonic low-MI grey-scale imaging has the capability of flow quantification on both vessels and parenchyma. The parameters of time-intensity curve were influenced intensely by different contrast agent doses.

Comparison of 3D ultrasound and magnetic resonance imaging for microwave ablation in the canine splenomegaly model.

PURPOSE: Microwave ablation is used for the treatment of hypersplenism. Image guidance and ablation volume assessment is important to ensure that the ablation is successful. The accuracy of 3D ultrasound (US) and magnetic resonance imaging (MRI) in determining the parameters for microwave ablation were compared in a canine splenomegaly model. METHODS: Microwave ablation of the spleen was performed on 13 dogs with congestive splenomegaly. Several combinations of power output and ablation time were used: 60 W for 300 s, 50 W for 360 s and 40 W for 450 s. The ablation zone volume was measured by 3D US and 3D MRI immediately after microwave ablation, and at 1, 2 and 8 weeks thereafter. RESULTS: Compared with 3D MRI, the ablation zone reconstruction rate was lower with 3D US (92 vs. 100%). However, there was no significant difference was found in the ablation volume calculated soon after the treatment and 1 week and 2 months later. CONCLUSION: 3D US may be useful for quantifying the volume of microwave ablation zones in the spleens of experimental animals and appears promising as an alterative modality to MRI for clinical examinations.

Effect of c-myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma patients undergoing tumor resection.

AIM: To explore the effect of c-myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma (HCC) patients undergoing tumor resection. METHODS: Primary HCC patients underwent tumor resection were retrospectively analysed. The maximum size of the tumor was less than 5 cm, there was only one nodule in each patient. No chemoembolization was performed before resection. They were followed up after resection, and the time of recurrence was recorded. They were divided into 2 groups: group A (15 cases): tumor recurrence within 1 year after tumor resection, and group B (15 cases): with or without tumor recurrence 2 years after tumor resection. Pathological slices were made with tumor wax-sample. Immunohistochemistry staining was performed with c-myc, Ki-67, MMP-2 and VEGF monoclonal antibodies. Staining intensity was quantitatively analysed with a pathological diagram-writing analyzing system. The expressing intensity differences of stained molecules in cancer tissue and para-cancer were analysed. RESULTS: c-myc, Ki-67, MMP-2 and VEGF expressing intensities in cancer tissue in group A were higher than those in group B (P values were 0.010, 0.030, 0.022 and 0.004, respectively), but they were not significantly different in para-cancer tissue in groups A and B (P values were 0.334, 0.343, 0.334 and 0.334, respectively). CONCLUSION: The expression of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue is related to the recurrence of HCC after tumor resection.

Significance of changes in local immunity in patients with hepatocellular carcinoma after percutaneous microwave coagulation therapy.

OBJECTIVE: To assess the local immune response in patients with hepatocellular carcinoma after percutaneous microwave coagulation therapy (PMCT). METHODS: Seventy-eight patients with hepatocellular carcinoma underwent PMCT. Both cancerous and adjacent liver tissue were taken before, and 3, 17 and 30 days after PMCT using ultrasound-guided liver biopsy. Specimens were stained by immunohistochemical techniques for detecting CD3, CD45RO, CD56, CD68, and CD20 positive cells. RESULTS: A few CD3, CD45RO, CD56, CD68 and CD20 positive cells were observed in the cancer stroma and surrounding sinusoids in liver tissue pre-PMCT. The number of immunocytes, except for CD20 positive cells, was significantly increased both within the cancer and the adjacent liver tissue, with a larger increase in tumor tissue at day 3 post-PMCT compared with pre-PMCT. These immunocytes were enlarged in size. The number of CD3, CD45RO and CD56 positive cells peaked at day 17 and CD68 positive cells peaked at days 3 post-PMCT. At day 30 post-PMCT, this increase still existed. These infiltrating immunocytes distributed in the parenchyma of the tumor, and within the lumen of small blood vessels after PMCT. In addition, more infiltrated immune cells were seen in cancer cell spaces. CONCLUSIONS: A change in immunocyte infiltration takes place in number, configuration and location after patients with HCC are treated with percutaneous microwave coagulation, suggesting that local immune function is enhanced post-PMCT.

[Ultrasonography in the diagnosis of hepatic malignant cystic tumors].

OBJECTIVE: To evaluate the clinical application of gray scale and color Doppler sonography in the diagnosis of hepatic malignant cystic tumors. METHODS: Characteristics of gray scale and color Doppler sonography were studied in 16 cases of malignant hepatic tumors confirmed by pathology. Tumor size, shape, number of lesion, thickness of cystic wall and echogenecity of the lesion were observed with gray scale sonography. Blood supply of the tumor and its velocity were observed with Color Doppler sonography. RESULTS: One single lesion was common in primary malignancy while multiple lesions signified metastasis. Sonographic findings revealed that the shape of the tumor was spheroid in 8 cases, irregular in 5 and leaf-shaped in 3, with the diameter varying from 1.9 cm to 13.6 cm. Sonography showed malignant cystic tumor with irregular thick wall in 15 cases, multiple septa in 7 cases and papillary projections in 6 on gray scale. Color Doppler flow signal was detected in the irregular thick wall, multiple septa or papillary projections in 14 cases, of which the arterial blood flow signals were demonstrated in 13. CONCLUSION: Color Doppler is able to clearly detect the blood flow signals in the irregular thick wall, multiple septa or papillary projections, providing an important sign for the diagnosis of hepatic malignant cystic tumors.