Viable hepatocellular carcinoma around retained iodized oil after transarterial chemoembolization: radiofrequency ablation of viable tumor plus retained iodized oil versus viable tumor alone.

OBJECTIVE: The objective of our study was to compare the effectiveness of radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) including areas of retained oil after transarterial chemoembolization (TACE) versus RFA treatment of viable HCC alone for ablation coverage. MATERIALS AND METHODS: Eighty-five patients with 88 viable HCCs underwent RFA of residual viable HCCs around retained iodized oil after TACE. RFA of both viable HCC and retained iodized oil was performed on 47 viable tumors (group A), and RFA of viable HCC only was used to treat the remaining 41 viable tumors (group B). RESULTS: After initial RFA, the endpoint of ablation was successfully achieved for 45 of 47 tumors in group A and for all 41 tumors in group B. Two residual viable tumors in group A were successfully treated by additional RFA. Major complications occurred after initial RFA treatment of one tumor each in group A (pleural effusion) and group B (collateral damage). During follow-up (mean, 37.1 months; range, 5-116.5 months), local tumor progression of treated lesions was found in 28% in group A and 59% in group B. The respective 1-, 3-, 5-, and 7-year local tumor progression rates were significantly lower in group A (15%, 32%, 32%, and 32%) than in group B (43%, 71%, 81%, and 81%) (p = 0.001). CONCLUSION: In treatment of viable tumors after TACE in patients with HCC, RFA of both viable tumor and retained iodized oil may reduce rates of local tumor progression compared with RFA of viable tumor only.

Sorafenib alone versus sorafenib combined with transarterial chemoembolization for advanced-stage hepatocellular carcinoma: results of propensity score analyses.

PURPOSE: To compare the time to progression (TTP) and overall survival (OS) in patients with advanced-stage hepatocellular carcinoma (HCC) who are undergoing sorafenib treatment combined with transarterial chemoembolization (TACE) versus sorafenib monotherapy. MATERIALS AND METHODS: The retrospective analysis of the data was approved by the institutional review board, and the requirement to obtain informed consent was waived. Of 355 patients with advanced-stage HCC (Barcelona Clinic Liver Cancer stage C) who were undergoing sorafenib therapy for at least 5 weeks between April 2007 and July 2011, 164 (46.2%) underwent repeat TACE (or chemolipiodolization if indicated) along with sorafenib therapy (combined group); the remaining 191 patients (53.8%) received sorafenib alone (monotherapy group). The median patient age was 53 years (range, 22-84 years). The median age was 53 years (range, 26-84 years) for men and 56 years (range, 22-75 years) for women. Propensity score-based methods were used to minimize bias when evaluating TTP on the basis of modified Response Evaluation Criteria in Solid Tumors and OS. Statistical analysis was performed with the Kaplan-Meier method by using the log-rank test and Cox regression models. RESULTS: In the combined and monotherapy groups, respectively, 64.6% and 49.2% of patients had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. During follow-up (median duration, 5.5 months), the median TTP and OS in the combined group were longer than those in the monotherapy group (TTP: 2.5 months vs 2.1 months, respectively, P = .008; OS: 8.9 months vs 5.9 months, P = .009). At univariate and subsequent multivariate analyses, additional TACE was an independent predictor of favorable TTP and OS (adjusted hazard ratio: 0.74 and 0.57, respectively; P < .05 for both), consistent with the outcomes of inverse probability of treatment weighting. In the propensity score-matched cohort (96 pairs), the median TTP in the combined group was significantly longer than that in the monotherapy group (2.7 months vs 2.1 months, respectively; P = .011), but median OS was not (9.1 months vs 6.7 months, P = .21). CONCLUSION: In this retrospective study, TACE plus sorafenib was superior to sorafenib alone with respect to TTP in patients with advanced-stage HCC, although it may or may not improve OS. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13130150/-/DC1.

Optimal measurement modality and method for evaluation of responses to transarterial chemoembolization of hepatocellular carcinoma based on enhancement criteria.

PURPOSE: To determine the usefulness of enhancement by iodized oil deposits on computed tomography (CT) following transarterial chemoembolization for hepatocellular carcinoma (HCC), and to compare the reliability of such CT imaging with that of magnetic resonance (MR) imaging. MATERIALS AND METHODS: Fifty-one patients for whom resected or explanted livers containing chemoembolized HCC lesions of at least 1 cm were available. Imaging responses were determined based on modified Response Evaluation Criteria In Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) criteria for 59 target tumors on CT and MR scans before surgery. CT-based evaluation was performed per mRECIST and EASL criteria, considering iodized oil retention as indicating necrosis and, alternatively, as enhancing viable tissue ("mRECIST-Lipiodol" and "EASL-Lipiodol"). Pathologic necrosis was graded as 100%, 50%-99%, or less than 50%. RESULTS: Goodman-Kruskal γ-values for radiologic-pathologic correlation were greater than 0.95 for mRECIST and EASL criteria on CT or MR imaging. However, mRECIST-Lipiodol and EASL-Lipiodol measurements showed weaker correlation with pathologic findings, with γ-values of 0.797 and 0.846, respectively. With respect to intermethod agreement, weighted γ-values for mRECIST by CT and MR, and for EASL criteria by CT and MR, both exceeded 0.80, whereas mRECIST-Lipiodol and EASL-Lipiodol showed only moderate levels of agreement with mRECIST/EASL criteria by CT or MR imaging, with γ-values of 0.522-0.631. CONCLUSIONS: Response estimation based on measurement of iodized oil deposits as necrosis on CT when applying enhancement criteria after chemoembolization for HCC correlated well with actual pathologic class, and agreed with MR-based evaluation.

Evaluation of metabolic characteristics and viability of lipiodolized hepatocellular carcinomas using 18F-FDG PET/CT.

UNLABELLED: This study aimed to evaluate the metabolic characteristics of lipiodolized hepatocellular carcinomas (HCCs) and the diagnostic accuracy of (18)F-FDG PET/CT in assessing the viability of lipiodolized HCCs. METHODS: Thirty-six patients (age range, 32-73 y) with 38 lipiodolized HCCs who had undergone transcatheter arterial chemoembolization (TACE) with lipiodol before (18)F-FDG PET/CT (2-434 d) and 55 patients (age range, 36-77 y) with 57 treatment-naïve HCCs who had not been treated with TACE were retrospectively studied. All patients underwent hepatic lobectomy or transplantation within 1 mo after PET/CT and multiphasic contrast-enhanced CT. (18)F-FDG uptake by lipiodolized and naïve HCCs was compared and correlated with tumor size, pathologic grade, serum α-fetoprotein (AFP) concentration, and time interval between TACE and PET/CT. The diagnostic accuracy of PET/CT and contrast-enhanced CT in evaluating the viability of lipiodolized HCC was compared. RESULTS: Histologic examination showed 30 viable and 8 nonviable lipiodolized HCCs. Of the 30 viable tumors, 19 showed increased, 10 similar, and 1 decreased (18)F-FDG uptake. Of the 8 nonviable HCCs, 3 showed increased and 5 decreased (18)F-FDG uptake. Uptake by viable lipiodolized HCCs was correlated with tumor size (P < 0.05) but not correlated with pathologic grade, AFP concentration, or interval between TACE and PET/CT. In contrast, (18)F-FDG uptake by naïve HCCs was significantly correlated with tumor size and pathologic grade (P < 0.05 for each comparison). When lipiodolized HCCs with (18)F-FDG uptake that was greater than or similar to that in the surrounding normal liver were considered viable, the diagnostic sensitivity of PET/CT and contrast-enhanced CT in the early postembolic period (<3 mo) was 100% and 94%, respectively, and that in the late postembolic period was 93% and 79%, respectively. The specificity of (18)F-FDG PET/CT and contrast-enhanced CT was 63% and 100%, respectively, in the acute period. Three viable lipiodolized HCCs with high AFP concentration were true-positives on PET/CT but false-negatives on contrast-enhanced CT images. CONCLUSION: After TACE, (18)F-FDG uptake in lipiodolized HCCs was not correlated with pathologic grade, in contrast to uptake in treatment-naïve HCCs. (18)F-FDG PET/CT showed a high diagnostic sensitivity in assessing the viability of lipiodolized HCCs, with moderate specificity. This method may be useful in determining the viability of lipiodolized HCCs in patients with increased serum AFP concentration or normal results on contrast-enhanced CT images.

The Relationship between Parathyroid Hormone Gene BstBI Polymorphism, Bone Mineral Density and Bone Responsiveness to Hormone Replacement Therapy in Postmenopausal Korean Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between parathyroid hormone (PTH) gene BstBI polymorphism, bone mineral density (BMD) and bone responsiveness to hormone replacement therapy (HRT). METHODS: PTH BstBI polymorphism was determined by restriction fragment length polymorphism (RFLP) in 444 postmenopausal Korean women. Among these women, 309 women received sequential HRT for 1 year. Serum bone alkaline phosphatase, CrossLaps, osteocalcin, calcitonin, and parathyroid hormone levels were measured by immunoassay and serum calcium and phosphorus levels by atomic absorptiometry. BMD at the lumbar spine and proximal femur was determined by dual energy X-ray absorptiometry before and after HRT of 1 year. RESULTS: PTH genotype frequencies were 81.1% for BB, 18.0% for Bb, and 1.2% for bb (uppercase letters signifying the absence and lowercase letters the presence of the restriction site). BMD at the femoral neck in women with the bb genotype was higher than that in women with the Bb or BB genotype respectively. Similar trend was found in BMD of lumbar spine and Ward's triangle. The PTH genotypes were not distributed differently between HRT-responders and HRT-nonresponders (women who lose more than 3% of bone mass per year) and were not related with annual percent change of BMD after HRT. There were no significant differences in levels of PTH, calcitonin, calcium, phophorus and bone turnover markers or their 6 month percentage changes after HRT among PTH genotypes. CONCLUSION: PTH BstBI polymorphism is not associated with bone responsiveness to HRT but BMD in Korean women.

The relationship between calcium sensing receptor gene (CA) polymorphism, bone mineral density and bone responsiveness to hormone replacement therapy in postmenopausal Korean women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between the calcium sensing receptor (Casr) gene cytosine adenine (CA) polymorphism, bone mineral density (BMD) and bone responsiveness to hormone replacement therapy (HRT). METHODS: Casr (CA) polymorphism was analyzed by polyacrylamide-urea gel electrophoretic patterns, genescan and direct DNA sequencing in 502 postmenopausal Korean women. Among these women, 352 women received sequential HRT for 1 year. Serum bone alkaline phosphatase, CrossLaps, osteocalcin, calcitonin, and parathyroid hormone levels were measured by immunoassay and Serum calcium and phosphorus levels by atomic absorptiometry. BMD at the lumbar spine and proximal femur was determined by dual energy X-ray absorptiometry before and after HRT of 1 year. RESULTS: Nine Casr alleles were observed with product sizes ranging between 176-196 bp, and their distribution was as follows: 188 bp 26.2%, 194 bp 19.8%, 186 bp 18.2%, 190 bp 15.5%. 192 bp 14.3% etc. BMD at the Ward's triangle was significantly lower in women carrying at least one copy of 216 bp Casr (CA) allele than in women who did not this allele, but no significant differences in annual percentage changes of BMD were noted among Casr (CA) genotypes. There were no significant differences in after HRT levels of biochemical bone markers and their 6 month percentage changes after HRT among Casr (CA) genotypes. The Casr (CA) genotypes were not distributed differently between HRT-responders and HRT-nonresponders (women who lose more than 3% of bone mass per year) or between women with normal BMD and women with low bone mass. CONCLUSION: The Casr (CA) polymorphism is not associated with bone responsiveness to HRT but BMD of Ward's triangle in Korean women.

Effects of Reactive Oxygen Species on Sperm Function, Lipid Peroxidation and DNA Fragmentation in Bovine Spermatozoa / 대한불임학회지

OBJECTIVE: To evaluate the effects of the reactive oxygen species (ROS) generated with a xanthine(X) and xanthine oxidase (XO) system on sperm function, the change of sperm characteristics, lipid peroxidation, and DNA fragmentation in bovine spermatozoa. MATERIALS AND METHODS: ROS were produced using a combination of 100 micrometer X and 50 mU/ml XO. The ROS scavengers: superoxide dismutase (SOD)(200mu/ml) and catalase (500mu/ml) were also tested. Spermatozoa were incubated for 2 hours in BWW medium with a combination of X-XO supplemented with or without ROS scavengers at 37degrees C under 5% CO2 incubator. Sperm movement characteristics by CASA (computer-aided sperm analysis), HOST (hypoosmotic swelling test), Ca-ionophore induced acrosome reaction, malondialdehyde formation for the analysis of lipid peroxidation, the percentage of DNA fragmentation using the method of TdT-mediated nick end labelling (TUNEL) by flow cytometry were determined after 2 hours incubation. RESULTS: The action of ROS on bovine spermatozoa resulted in a decreased in capacity for sperm motility, Ca-ionophore induced acrosome reaction and membrane integrity, an increased in malondialdehyde formation and the percentage of sperm with DNA fragmentation. In the effects of antioxidant, catalase completely alleviated the toxic effects induced by the ROS in terms of sperm function and characteristics, however SOD exhibited no capacity to reduce the toxic effects. CONCLUSION: The ROS can induce significant damages to sperm functions and characteristics. The useful ROS scavengers can minimized the defects of sperm function and various damages of spermatozoa.

A study on risk factors for postmenopausal osteoporosis / 대한산부인과학회잡지

OBJECTIVE: To evaluate the risk factors for postmenopausal osteoporosis. METHODS: Bone mineral density (BMD) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Questions about life styles, demographic parameters, medical history and social habits etc. were asked on 80 women with normal bone mineral density, and 187 women with osteopenia or osteoporosis. RESULTS: Age of >50 years, low body mass index (BMI; 10 years) or breast feeding (>3 years), frequent drinking, and previous history of fracture were associated with increased prevalence of osteopenia or osteoporosis. Women without outside activity or job also showed a higher frequency of low bone mass but risk for osteopenia or osteoporosis was low in high socioeconomic status. Positivity of familial history was higher in women with low bone mass than in women with normal BMD, but this trend was not significant. The prevalence of low bone mass appeared to be independent of the following parameters: smoking, exercise, previous use of oral contraceptive, coffee and milk intake, and degree of sunlight exposure. CONCLUSIONS: Age, BMI, duration of menopause or breast feeding, drinking, and degree of outside activity, etc were the risk factors for postmenopausal osteoporosis.