Interpretable artificial intelligence-based app assists inexperienced radiologists in diagnosing biliary atresia from sonographic gallbladder images.

BACKGROUND: A previously trained deep learning-based smartphone app provides an artificial intelligence solution to help diagnose biliary atresia from sonographic gallbladder images, but it might be impractical to launch it in real clinical settings. This study aimed to redevelop a new model using original sonographic images and their derived smartphone photos and then test the new model's performance in assisting radiologists with different experiences to detect biliary atresia in real-world mimic settings. METHODS: A new model was first trained retrospectively using 3659 original sonographic gallbladder images and their derived 51,226 smartphone photos and tested on 11,410 external validation smartphone photos. Afterward, the new model was tested in 333 prospectively collected sonographic gallbladder videos from 207 infants by 14 inexperienced radiologists (9 juniors and 5 seniors) and 4 experienced pediatric radiologists in real-world mimic settings. Diagnostic performance was expressed as the area under the receiver operating characteristic curve (AUC). RESULTS: The new model outperformed the previously published model in diagnosing BA on the external validation set (AUC 0.924 vs 0.908, P = 0.004) with higher consistency (kappa value 0.708 vs 0.609). When tested in real-world mimic settings using 333 sonographic gallbladder videos, the new model performed comparable to experienced pediatric radiologists (average AUC 0.860 vs 0.876) and outperformed junior radiologists (average AUC 0.838 vs 0.773) and senior radiologists (average AUC 0.829 vs 0.749). Furthermore, the new model could aid both junior and senior radiologists to improve their diagnostic performances, with the average AUC increasing from 0.773 to 0.835 for junior radiologists and from 0.749 to 0.805 for senior radiologists. CONCLUSIONS: The interpretable app-based model showed robust and satisfactory performance in diagnosing biliary atresia, and it could aid radiologists with limited experiences to improve their diagnostic performances in real-world mimic settings.

Three-dimensional ultrasound fusion imaging in precise needle placement for thermal ablation of hepatocellular carcinoma.

PURPOSE: To investigate the value of three-dimensional ultrasound fusion imaging (3DUS FI) technique for guiding needle placement in hepatocellular carcinoma (HCC) thermal ablation. METHODS: A total of 57 patients with 60 HCCs with 3DUS FI-guided thermal ablation were retrospectively included in the study. 3DUS volume data of liver were acquired preoperatively by freehand scanning with the tumor and predetermined 5 mm ablative margin automatically segmented. Plan of needle placement was made through a predetermined simulated ablation zone to ensure a 5 mm ablative margin with the coverage rate toward tumor and ablative margin. With real-time ultrasound and 3DUS fusion imaging, ablation needles were placed according to the plan. After ablation, the ablative margin was immediately evaluated by contrast-enhanced ultrasound and 3DUS fusion imaging. The rate of adequate ablative margin, complete response (CR), local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) was evaluated. RESULTS: According to postoperative contrast-enhanced CT or MR imaging, the complete response rate was 100% (60/60), and 83% of tumors (30/36) achieved adequate ablative margin (>5 mm) three-dimensionally. During the follow-up period of 6.0-42.6 months, LTP occurred in 5 lesions, with 1- and 2-year LTP rates being 7.0% and 9.4%. The 1- and 2-year DFS rates were 76.1% and 65.6%, and 1- and 2-year OS rates were 98.1% and 94.0%. No major complications or ablation-related deaths were observed in any patients. CONCLUSIONS: Three-dimensional ultrasound fusion imaging technique may improve the needle placement of thermal ablation for HCC and reduce the rate of LTP.

Comparison of non-radiomics imaging features and radiomics models based on contrast-enhanced ultrasound and Gd-EOB-DTPA-enhanced MRI for predicting microvascular invasion in hepatocellular carcinoma within 5 cm.

OBJECTIVES: The purpose of this study is to establish microvascular invasion (MVI) prediction models based on preoperative contrast-enhanced ultrasound (CEUS) and ethoxybenzyl-enhanced magnetic resonance imaging (EOB-MRI) in patients with a single hepatocellular carcinoma (HCC) ≤ 5 cm. METHODS: Patients with a single HCC ≤ 5 cm and accepting CEUS and EOB-MRI before surgery were enrolled in this study. Totally, 85 patients were randomly divided into the training and validation cohorts in a ratio of 7:3. Non-radiomics imaging features, the CEUS and EOB-MRI radiomics scores were extracted from the arterial phase, portal phase and delayed phase images of CEUS and the hepatobiliary phase images of EOB-MRI. Different MVI predicting models based on CEUS and EOB-MRI were constructed and their predictive values were evaluated. RESULTS: Since univariate analysis revealed that arterial peritumoral enhancement on the CEUS image, CEUS radiomics score, and EOB-MRI radiomics score were significantly associated with MVI, three prediction models, namely the CEUS model, the EOB-MRI model, and the CEUS-EOB model, were developed. In the validation cohort, the areas under the receiver operating characteristic curve of the CEUS model, the EOB-MRI model, and the CEUS-EOB model were 0.73, 0.79, and 0.86, respectively. CONCLUSIONS: Radiomics scores based on CEUS and EOB-MRI, combined with arterial peritumoral enhancement on CEUS, show a satisfying performance of MVI predicting. There was no significant difference in the efficacy of MVI risk evaluation between radiomics models based on CEUS and EOB-MRI in patients with a single HCC ≤ 5 cm. CLINICAL RELEVANCE STATEMENT: Radiomics models based on CEUS and EOB-MRI are effective for MVI predicting and conducive to pretreatment decision-making in patients with a single HCC within 5 cm. KEY POINTS: • Radiomics scores based on CEUS and EOB-MRI, combined with arterial peritumoral enhancement on CEUS, show a satisfying performance of MVI predicting. • There was no significant difference in the efficacy of MVI risk evaluation between radiomics models based on CEUS and EOB-MRI in patients with a single HCC ≤ 5 cm.

Treatment outcomes after radiofrequency ablation in patients with non-B non-C hepatocellular carcinoma within Milan criteria: comparison with HBV-related hepatocellular carcinoma.

PURPOSE: This study aims to evaluate the treatment outcomes of radiofrequency ablation (RFA) for patients with non-B non-C hepatocellular carcinoma (HCC) (NBNC-HCC) within Milan criteria, as well as to compare them with those of patients with hepatitis B virus (HBV)-related HCC (HBV-HCC). METHODS: From January 2007 to February 2020, 303 patients with primary HCC who underwent RFA were retrospectively reviewed, including 259 patients with HBV-HCC (HBV-HCC group) and 44 patients with NBNC-HCC (NBNC-HCC group). The clinical characteristics and treatment survivals were evaluated and compared. Moreover, the propensity score matching was used to reduce selection bias. RESULTS: A significantly lower proportion of cirrhosis was observed in the NBNC-HCC group (p = .048). Before propensity score matching, local tumor progression, disease-free survival, and overall survival after RFA showed no significant differences between the two groups (all p > .05). After matching, the overall survival rates in the NBNC-HCC group were significantly better than those in the HBV-HCC group (p = .042). Moreover, for patients with NBNC-HCC, tumor size (hazard ratio = 8.749, 95% confidence interval, 1.599-47.849; p = .012) was the only independent predictor of local tumor progression. CONCLUSIONS: Patients with NBNC-HCC within the Milan criteria after RFA had better long-term survival than patients with HBV-HCC, although larger, prospective and multicenter trials are required to validate these results.

Radiofrequency ablation for pediatric recurrent hepatocellular carcinoma: a single-center experience.

PURPOSE: To summarize our single-center experience with percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for pediatric recurrent hepatocellular carcinoma (RHCC). METHODS: From September 2007 to September 2021, patients under 18 who underwent percutaneous US-guided RFA for RHCC were retrospectively enrolled in this study. Local effectiveness, complications, local tumor progression (LTP), progression free survival (PFS), and overall survival (OS) were evaluated. RESULTS: A total of 10 patients (9 male and 1 female; mean age, 11.7 ± 4 years ; age range, 6-17 years) with 15 intrahepatic RHCC lesions were enrolled in this study. Complete ablation (CA) was achieved in 14 out of 15 lesions (93.3%) after the first RFA. During the follow-up (mean, 63.1 ± 18 months; range, 5.3-123.3 months), LTP did not occur. Five patients died including three with tumor progression and one with liver failure. The accumulative one- and three-year PFS rates were 30% and 10%, respectively. The accumulative one- and three-year OS rates were 77.8% and 44.4%, respectively. CONCLUSIONS: Our single-center experience suggests the safety and feasibility of percutaneous US-guided RFA for pediatric RHCC.

Intercomparison of equivalent black carbon (eBC) and elemental carbon (EC) concentrations with three-year continuous measurement in Beijing, China.

Due to the lack of black carbon (BC) measurement data in some cases, elemental carbon (EC) is often used as a surrogate of BC, with a simple assumption that they are interchangeable. Such assumption will inevitably lead to uncertainties in radiative forcing estimation and health impact assessment. In order to quantitatively and systematically evaluate the relationship between BC and EC as well as factors responsible for their difference, 3-year collocated equivalent BC (eBC) and EC measurements with 1-h resolution were performed in Beijing, China continuously from 2016 to 2019. EBC concentration was measured by the multi-wavelength aethalometer (AE-33) based on optical analysis, while EC concentration was determined by semi-continuous OC/EC analyzer with thermal-optical method. The results showed that around 90% of eBC concentration was higher than that of EC, with average difference between eBC and EC as 1.21 µg m-3 (accounting for 33% of average eBC in Beijing). EBC and EC concentrations exhibited strong correlation (r = 0.90) during the whole study period, but the slopes (or eBC/EC ratio) and correlation coefficients varied across seasons (spring: 1.67 and 0.94; summer: 0.91 and 0.65; fall: 1.15 and 0.88; winter: 1.09 and 0.91, respectively). Based on the information from shell/core ratios by Single Particle Soot Photometer (SP2), source apportionment results by positive matrix factorization model, and chemical composition of PM2.5, the differences between eBC and EC concentrations were found to be primarily related to BC aging process and secondary components as evidenced by strong positive correlation with secondary species (e.g., secondary organic carbon and nitrate). This study provided seasonal specific conversion factors of eBC and EC in Beijing and helpful reference for other areas, which will contribute new knowledge of carbonaceous aerosol and reduce uncertainty in assessing future climate change and health studies of BC.

Ultrasound-guided percutaneous radiofrequency ablation in treatment of neuroendocrine tumor liver metastases：a single-center experience.

PURPOSE: To investigate the local tumor control of ultrasound-guided percutaneous radiofrequency ablation (RFA) in treating neuroendocrine tumor liver metastases (NETLM). MATERIALS AND METHODS: From March 2011 to December 2020, 23 patients with 39 NETLM treated with percutaneous RFA were studied. The study assessed the therapeutic outcomes after RFA, including the rates of technical success, technical efficacy, major complications, local tumor progression (LTP) and overall survival. Cumulative LTP rates were estimated with the Kaplan-Meier method. RESULTS: The technical efficacy rate was 91.3% (21/23) at one month after RFA. No major complication occurred in the treatment. LTP occurred in 50% (11/22) of patients who had complete ablation, with a median progression-free survival time of 15 months (1-61 months). Patients with Ki-67 < 5% had a longer progression-free survival than those with Ki-67 ≥ 5% (22.0 vs. 3.5 months, p<.001). Four patients, who had sporadic recurrent liver metastases, received 1-6 times of additional RFA after the initial treatment. Twenty patients were alive at the end of this study, except three patients withdrawn. The overall survival was at a median of 48 months (9-182 months). CONCLUSION: RFA provides effective local tumor control with low morbidity and it can be applied repeatedly over years to control recurrence of NETLM. Patients with Ki-67 < 5% have better local tumor control with percutaneous RFA of NETLM.

Drivers of improved PM2.5 air quality in China from 2013 to 2017.

From 2013 to 2017, with the implementation of the toughest-ever clean air policy in China, significant declines in fine particle (PM2.5) concentrations occurred nationwide. Here we estimate the drivers of the improved PM2.5 air quality and the associated health benefits in China from 2013 to 2017 based on a measure-specific integrated evaluation approach, which combines a bottom-up emission inventory, a chemical transport model, and epidemiological exposure-response functions. The estimated national population-weighted annual mean PM2.5 concentrations decreased from 61.8 (95%CI: 53.3-70.0) to 42.0 µg/m3 (95% CI: 35.7-48.6) in 5 y, with dominant contributions from anthropogenic emission abatements. Although interannual meteorological variations could significantly alter PM2.5 concentrations, the corresponding effects on the 5-y trends were relatively small. The measure-by-measure evaluation indicated that strengthening industrial emission standards (power plants and emission-intensive industrial sectors), upgrades on industrial boilers, phasing out outdated industrial capacities, and promoting clean fuels in the residential sector were major effective measures in reducing PM2.5 pollution and health burdens. These measures were estimated to contribute to 6.6- (95% CI: 5.9-7.1), 4.4- (95% CI: 3.8-4.9), 2.8- (95% CI: 2.5-3.0), and 2.2- (95% CI: 2.0-2.5) µg/m3 declines in the national PM2.5 concentration in 2017, respectively, and further reduced PM2.5-attributable excess deaths by 0.37 million (95% CI: 0.35-0.39), or 92% of the total avoided deaths. Our study confirms the effectiveness of China's recent clean air actions, and the measure-by-measure evaluation provides insights into future clean air policy making in China and in other developing and polluting countries.

Spatial Distribution and Assessment of the Human Health Risks of Heavy Metals in a Retired Pharmaceutical Industrial Area, Southwest China.

Heavy metals pollution in pharmaceutical industries received increasing attention. A total of 94 soil samples were collected in this study. Results showed the mean contents of Hg, Cd, As, Pb, Ni and Cu were 0.21, 0.26, 9.59, 55.06, 51.52 and 50.81 mg·kg-1, respectively. The spatial distribution of metals in topsoil largely attributed to the pharmaceutical production process. The distribution of Hg and As were related to the production of medical absorbent cotton. While Ni was related to the fuel supply of Ni-rich coal. Cr, Cu and Pb mainly distributed in the process which they were used as catalysts. The vertical migration of metals was complex in soil. To a great extent, it was related to the texture of the soil and the properties of metals in this filed. The total non-cancer and cancer human health risk were within the limits of USEPA (10-6 a-1). This demonstrated the health risks of individual's exposure to heavy metals in this factory was acceptable.

Annual nonmethane hydrocarbon trends in Beijing from 2000 to 2019.

High loads of ground-level ozone have occurred with the implementation of the Air Pollution Prevention and Control Action Plan. However, the long temporal variation in precursor nonmethane hydrocarbons (NMHCs) has rarely been studied. In this study, we examined the evolution of NMHCs in Beijing based on ambient measurements from 2000 to 2019. The results indicated that the annual variation of ambient NMHCs during 2000 and 2019 could be divided into two stages. The mixing ratios of NMHCs rapidly rose during 2000 and 2009 (1.76 ppbv/year) but exhibited a downward trend from 2009 to 2019 at rate of 0.80 ppbv/yr. Moreover, the notable decrease in alkenes and aromatics after 2009 led to a sharp decrease in the propylene-equivalent concentration (PEC) (-0.80 ppbv/year). Implementation of emission reduction measures in Beijing have effectively reduced the contribution of vehicle-related sources, but the contribution of solvent usage and fuel consumption increased, which will become the focus of VOC control in Beijing in the future.

Impacts of COVID-19 on Black Carbon in Two Representative Regions in China: Insights Based on Online Measurement in Beijing and Tibet.

Under the influence of Coronavirus Disease 2019 (COVID-19), China conducted a nationwide lockdown (LD) which significantly reduced anthropogenic emissions. To analyze the different impacts of COVID-19 on black carbon (BC) in the two representative regions in China, one-year continuous online measurements of BC were conducted simultaneously in Beijing and Tibet. The average concentration in the LD period was 20% higher than that in the pre-LD period in Beijing, which could be attributed to the increase of transport from southwestern neighboring areas and enhanced aged BC. In contrast to megacity, the average concentration of BC in Tibet decreased over 70% in the LD period, suggesting high sensitivity of plateau background areas to the anthropogenic emission reduction in South Asia. Our study clearly showed that BC responded very differently in megacity and background areas to the change of anthropogenic emission under the lockdown intervention.

Characteristics of PM2.5 pollution in Beijing after the improvement of air quality.

Following the implementation of the strictest clean air policies to date in Beijing, the physicochemical characteristics and sources of PM2.5 have changed over the past few years. To improve pollution reduction policies and subsequent air quality further, it is necessary to explore the changes in PM2.5 over time. In this study, over one year (2017-2018) field study based on filter sampling (TH-150C; Wuhan Tianhong, China) was conducted in Fengtai District, Beijing, revealed that the annual average PM2.5 concentration (64.8 ± 43.1 µg/m3) was significantly lower than in previous years and the highest PM2.5 concentration occurred in spring (84.4 ± 59.9 µg/m3). Secondary nitrate was the largest source and accounted for 25.7% of the measured PM2.5. Vehicular emission, the second largest source (17.6%), deserves more attention when considering the increase in the number of motor vehicles and its contribution to gaseous pollutants. In addition, the contribution from coal combustion to PM2.5 decreased significantly. During weekends, the contribution from EC and NO3- increased whereas the contributions from SO42-, OM, and trace elements decreased, compared with weekdays. During the period of residential heating, PM2.5 mass decreased by 23.1%, compared with non-heating period, while the contributions from coal combustion and vehicular emission, and related species increased. With the aggravation of pollution, the contribution of vehicular emission and secondary sulfate increased and then decreased, while the contribution of NO3- and secondary nitrate continued to increase, and accounted for 34.0% and 57.5% of the PM2.5 during the heavily polluted days, respectively.

Preoperative prediction of tumour deposits in rectal cancer by an artificial neural network-based US radiomics model.

OBJECTIVE: To develop a machine learning-based ultrasound (US) radiomics model for predicting tumour deposits (TDs) preoperatively. METHODS: From December 2015 to December 2017, 127 patients with rectal cancer were prospectively enrolled and divided into training and validation sets. Endorectal ultrasound (ERUS) and shear-wave elastography (SWE) examinations were conducted for each patient. A total of 4176 US radiomics features were extracted for each patient. After the reduction and selection of US radiomics features , a predictive model using an artificial neural network (ANN) was constructed in the training set. Furthermore, two models (one incorporating clinical information and one based on MRI radiomics) were developed. These models were validated by assessing their diagnostic performance and comparing the areas under the curve (AUCs) in the validation set. RESULTS: The training and validation sets included 29 (33.3%) and 11 (27.5%) patients with TDs, respectively. A US radiomics ANN model was constructed. The model for predicting TDs showed an accuracy of 75.0% in the validation cohort. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and AUC were 72.7%, 75.9%, 53.3%, 88.0% and 0.743, respectively. For the model incorporating clinical information, the AUC improved to 0.795. Although the AUC of the US radiomics model was improved compared with that of the MRI radiomics model (0.916 vs. 0.872) in the 90 patients with both ultrasound and MRI data (which included both the training and validation sets), the difference was nonsignificant (p = 0.384). CONCLUSIONS: US radiomics may be a potential model to accurately predict TDs before therapy. KEY POINTS: • We prospectively developed an artificial neural network model for predicting tumour deposits based on US radiomics that had an accuracy of 75.0%. • The area under the curve of the US radiomics model was improved than that of the MRI radiomics model (0.916 vs. 0.872), but the difference was not significant (p = 0.384). • The US radiomics-based model may potentially predict TDs accurately before therapy, but this model needs further validation with larger samples.

Different HONO Sources for Three Layers at the Urban Area of Beijing.

Gaseous nitrous acid (HONO) is a crucial precursor of the hydroxyl (OH) radical, which is a "detergent" in the atmosphere. Nowadays, HONO formation mechanisms at polluted urban areas are controversial, which restricts the understanding of atmospheric oxidative capacity and radical cycling. Herein, multiday vertical observation of HONO and NOx was simultaneously performed at three heights at the urban area of Beijing for the first time. The vertical distribution of HONO was often unexpected, and it had the highest HONO concentration at 120 m, followed by those at 8 and 240 m. 0D box model simulations suggest that ground and aerosol surfaces might play similar roles in NO2 conversion at 8 m during the whole measurement. NO2 conversion on aerosol surfaces was the most important HONO source aloft during haze days. At daytime, a strong missing HONO source unexpectedly existed in the urban aloft, and it was relevant to solar radiation and consumed OH.

Efficacy and safety of US-guided thermal ablation for primary hyperparathyroidism: a systematic review and meta-analysis.

Purpose: To summarize the published literature on thermal ablation for primary hyperparathyroidism (PHPT) and to evaluate the effectiveness and safety of thermal ablation as a novel treatment strategy.Materials and methods: Two authors carried out the literature search using four databases independently, including PubMed, Embase, Cochrane, and Web of Science. The meta-analysis included prospective and retrospective data that compared post-ablative outcomes to pre-ablative values. The primary outcomes were parathyroid hormone (PTH), serum calcium and volume of the parathyroid gland (VPG).Results: From the 184 original articles, five studies (4 retrospective studies and 1 prospective study) examining 84 patients met the inclusion criteria. The meta-analysis showed significant reduction of PTH at 3 (standardized mean difference (SMD) = -1.09, 95% confidence index (CI) = -1.42 to -0.76, p < 0.001) and 6 months (SMD = -1.13, 95% CI = -1.46 to -0.80, p < 0.001) after thermal ablation. Serum calcium level was significantly reduced at 3 (mean difference (MD) = -0.31, 95% CI = -0.50 to -0.12, p = 0.001) and 6 months (MD = -0.31, 95% CI = -0.46 to -0.17, p < 0.001) after thermal ablation. There was no significant difference between pre-ablative VPG and that of 6 months after ablation (MD = -0.30, 95% CI = -0.70 to 0.09, p = 0.13). The most common complications were transient dysphonia and subcutaneous edema. No major complications or death occurred.Conclusion: Thermal ablation is effective and safe for treatment of PHPT. PTH and calcium levels were reduced significantly at 3 and 6 months after thermal ablation.

Feasibility and outcomes of percutaneous radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma after liver transplantation: a single-center experience.

PURPOSE: To evaluate the feasibility, effectiveness, and treatment outcomes of percutaneous radiofrequency ablation (RFA) in the application of intrahepatic recurrent hepatocellular carcinoma (r-HCC) after liver transplantation (LT). METHODS: From April 2008 to December 2019, a total of 37 patients (34 male and 3 female, mean age: 48.7 ± 10.5 years) with 61 r-HCCs after LT treated by RFA as a first-line option were enrolled. The technical success, recurrence-free survival (RFS), overall survival (OS) and complications were evaluated. RESULTS: After the first session of RFA, three patients were detected with residual foci. All of them received additional session of RFA and two tumors were successfully ablated. Therefore, the technical success was 97.3% (36/37). During the follow-up period, a total of 7 tumors developed local tumor progression (LTP) after 2.2-10.8 months. The LTP rate was 11.7% for r-HCC in the transplanted liver. The median RFS was 4.8 months (95% confidence interval [CI]: 2.2-7.3 months). The 1-, 3-, and 5-year cumulative OS rates were 68.5%, 40.3%, and 40.3%, respectively. Multivariate analyses revealed that tumor size was the only independent predictor for RFS (hazard ratio [HR] = 2.557, 95% CI, 1.015-6.444; p = .046) and limited extrahepatic metastasis was the only independent prognostic factors of OS after RFA for post-LT r-HCC (HR = 4.031, 95%CI, 1.218-13.339; p = .022). Major complications after RFA occurred in two patients (2/37, 5.4%). CONCLUSION: Percutaneous RFA is safe and effective for intrahepatic r-HCC after LT, especially for those without limited extrahepatic metastasis.

Predictive factors of treatment outcomes after percutaneous ablation of hepatocellular carcinoma in the caudate lobe: a retrospective study.

BACKGROUND: Hepatocellular carcinomas (HCC) arising in the caudate lobe is rare and the treatment is difficult. The aim of this study is to summarize the experience of ultrasound-guided percutaneous ablation therapy for HCC located in the caudate lobe and to investigate the predictive factors of the treatment outcomes. METHODS: From August 2006 to June 2017, 73 patients (63 males and 10 females; mean age, 54.9 ± 11.6 years; age range, 25-79 years) with 73 caudate lobe HCCs (mean size, 2.6 ± 1.1 cm; size range, 1.0-5.0 cm) were treated with percutaneous ablation, including 33 patients with radiofrequency ablation (RFA), 23 patients with ethanol ablation (EA), and 17 patients with combination of RFA and EA. The treatment outcome and survival after ablation for caudate lobe HCC were assessed and the predictive factors were calculated by univariate and multivariate analyses. RESULTS: A total of 72 patients achieved complete ablation after the first or second session of ablation. The treatment effectiveness was 98.6% (72/73). During the follow-up, 16 tumors developed local tumor progression (LTP) and a total of 61 patients (61/73, 83.6%) were detected distant recurrence (DR). According to univariate and multivariate analyses, tumor size > 2 cm (hazard ratio[HR] = 3.667; 95% confidence interval[CI], 1.043-12.889; P = 0.043) was a significant prognostic factor of LTP after ablation for HCC in the caudate lobe, while tumor number (HR = 2.245; 95%CI, 1.168-4.317; P = 0.015) was a significant prognostic factor of DR. The mean overall survival time after ablation was 28.7 ± 2.8 months, without independent predictive factors detected. Four patients (4/73, 5.5%) were detected treatment-related major complications, without independent predictive factor detected. CONCLUSION: Ultrasound-guided percutaneous ablation is a feasible treatment for a selected case with HCC in the caudate lobe. Tumor size > 2 cm increases the risk of LTP and intrahepatic tumor number is associated with DR after ablation.

Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging.

PURPOSE: To analyse the precise ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and the correlation between AM and local tumour progression (LTP) with a three-dimension (3D) reconstruction technique. METHODS: From March 2011 to May 2013, 134 patients who underwent RFA for 159 primary or recurrent HCCs within Milan criteria were enrolled. Contrast-enhanced computed tomography (CECT) scans were performed 1 week before and 1 month after treatment. The AM was measured in various directions using a 3D reconstruction technique that shows the index tumour and ablated zone on the same image. The average of all obtained AMs (average AM) and the smallest AM (min-AM) were calculated. RESULTS: The min-AM after RFA ranged from 1 to 9.3 mm (median ± standard deviation, 4.8 ± 1.8 mm). LTP was observed in 19 tumours from 19 patients. The median min-AM was 3.1 ± 1.6 mm for patients with LTP, while the median min-AM of patients without LTP was 5.1 ± 1.8 mm (p = 0.023). After RFA, the 1-, 2- and 3-year LTP rates were 10.9, 25.9 and 35.1%, respectively, for patients with min-AM <5 mm, and 4.1, 4.1 and 4.1%, respectively, for patients with min-AM ≥5 mm (p = 0.016). Multivariate analysis showed that only min-AM <5 mm was an independent risk factor for LTP after RFA (p = 0.044, hazard ratio =4.587, 95% confidence interval, 1.045-22.296). CONCLUSIONS: The 3D reconstruction technique is a precise method for evaluating the post-ablation margin. Patients with min-AM less than 5 mm had a higher probability of developing LTP.

Multipronged ethanol ablation combined with TACE for intermediate hepatocellular carcinoma.

PURPOSE: To retrospectively investigate the efficacy of multipronged ethanol ablation with or without transarterial chemoembolization (TACE) in the treatment of intermediate hepatocellular carcinoma (HCC) (3.1-5.0 cm in diameter) at high-risk locations . MATERIAL AND METHODS: From March 2009 to April 2014, 25 consecutive patients with intermediate HCC who underwent multipronged ethanol ablation combined with TACE were included in the combination treatment group, while 50 patients who underwent multipronged ethanol ablation alone were included in the control group. RESULTS: Primary technique effectiveness was achieved in 70 patients (25/25, 100% in the combination treatment group; 45/50, 90% in the control group; p = .162). The local tumor progression (LTP) rates at 1, 3, 5, and 7 years were 8.0%, 24.0%, 24.0%, and 24.0% in the combination treatment group, respectively, which were significantly lower than those in the control group (24.4%, 44.1%, 66.5% and 66.5%, respectively; p = .043). However, no significant differences of overall survival and disease-free survival were found between the two groups (p = .996 and .974, respectively). CONCLUSION: Multipronged ethanol ablation combined with TACE could improve local tumor control for patients with intermediate HCC at high-risk locations when compared with multipronged ethanol ablation alone, although the survival outcomes were comparable.

Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a comparative study with grey-scale US.

OBJECTIVES: To prospectively assess the diagnostic performance of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) among infants with conjugated hyperbilirubinaemia by comparing this approach with grey-scale ultrasonography (US). METHODS: Forty infants were analysed as the control group to determine normal liver stiffness values. The use of SSWE values for identifying BA was investigated in 172 infants suspected of having BA, and results were compared with the results obtained by grey-scale US. The Mann-Whitney U test, unpaired t-test, Spearman correlation and linear regression were also performed. RESULTS: The success rates of SSWE measurements in the control and study group were 100% (40/40) and 96.4% (244/253), respectively. Age, direct bilirubin, and indirect bilirubin all significantly correlated with SSWE in the liver (all P < 0.001). Linear regression showed that age had a greater effect on SSWE values than direct or indirect bilirubin. The diagnostic performance of liver stiffness values in identifying BA was lower than that of grey-scale US (area under the receiver operating characteristic curve [AUC], 0.790 vs 0.893, P < 0.001). CONCLUSIONS: SSWE is feasible and valuable in differentiating BA from non-BA. However, its diagnostic performance does not exceed that of grey-scale US. KEY POINTS: • SSWE could be successfully performed in an infant population. • For infants, the liver stiffness will increase as age increases. • SSWE is potentially useful in assessing infants suspected of biliary atresia. • SSWE is inferior to grey-scale US in identifying biliary atresia.