Quantitative information from gadobenate dimeglumine-enhanced MRI can predict proliferative subtype of solitary hepatocellular carcinoma: a multicenter retrospective study.

OBJECTIVES: To investigate the value of quantitative parameters derived from gadobenate dimeglumine-enhanced magnetic resonance imaging (MRI) for predicting molecular subtype of hepatocellular carcinoma (HCC) and overall survival. METHODS: This multicenter retrospective study included 218 solitary HCC patients who underwent gadobenate dimeglumine-enhanced MRI. All HCC lesions were resected and pathologically confirmed. The lesion-to-liver contrast enhancement ratio (LLCER) and lesion-to-liver contrast (LLC) were measured in the hepatobiliary phase. Potential risk factors for proliferative HCC were assessed by logistic regression. The ability of LLCER and LLC to predict proliferative HCC was assessed by the receiver operating characteristic (ROC) curve. Prognostic factors were evaluated using the Cox proportional hazards regression model for survival outcomes. RESULTS: LLCER was an independent predictor of proliferative HCC (odds ratio, 0.015; 95% confidence interval [CI], 0.008-0.022; p < 0.001). The area under the ROC curve was 0.812 (95% CI, 0.748-0.877), higher than that of LLC, alpha-fetoprotein > 100 ng/ml, satellite nodules, and rim arterial phase hyperenhancement (all p ≤ 0.001). HCC patients with LLCER < -4.59% had a significantly higher incidence of proliferative HCC than those with the LLCER ≥ -4.59%. During the follow-up period, LLCER was an independent predictor of overall survival (hazard ratio, 0.070; 95% CI, 0.015-0.324; p = 0.001) in HCC patients. CONCLUSIONS: Gadobenate dimeglumine-enhanced quantitative parameter in the hepatobiliary phase can predict the proliferative subtype of solitary HCC with a moderately high accuracy. CLINICAL RELEVANCE STATEMENT: Quantitative information from gadobenate dimeglumine-enhanced MRI can provide crucial information on hepatocellular carcinoma subtypes. It might be valuable to design novel therapeutic strategies, such as targeted therapies or immunotherapy. KEY POINTS: • The lesion-to-liver contrast enhancement ratio (LLCER) is an independent predictor of proliferative hepatocellular carcinoma (HCC). • The ability of LLCER to predict proliferative HCC outperformed lesion-to-liver contrast, alpha-fetoprotein > 100 ng/ml, satellite nodules, and rim arterial phase hyperenhancement. • HCC patients with LLCER < -4.59% had a significantly higher incidence of proliferative HCC than those with the LLCER ≥ -4.59%.

Limbic Stimulation Drives Mania in STN-DBS in Parkinson Disease: A Prospective Study.

In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. ANN NEUROL 2022;92:411-417.

Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Tractography and Lesion Geometry study.

INTRODUCTION: A bilateral anterior capsulotomy effectively treats refractory obsessive-compulsive disorder (OCD). We investigated the geometry of lesions and disruption of white matter pathways within the anterior limb of the internal capsule (ALIC) in patients with different outcomes. METHODS: In this retrospective study, we analyzed data from 18 patients with refractory OCD who underwent capsulotomies. Patients were grouped into "responders" and "nonresponders" based on the percentage of decrease in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) after surgery. We investigated neurobehavioral adverse effects and analyzed the overlap between lesions and the ventromedial prefrontal (vmPFC) and dorsolateral prefrontal (dlPFC) pathways. Probabilistic maps were constructed to investigate the relationship between lesion location and clinical outcomes. RESULTS: Of the 18 patients who underwent capsulotomies, 12 were responders (>35% improvement in YBOCS), and six were nonresponders. The vmPFC pathway was more involved than the dlPFC pathway in responders (p = 0.01), but no significant difference was observed in nonresponders (p = 0.10). The probabilistic voxel-wise efficacy map showed a relationship between ventral voxels within the ALIC with symptom improvement. Weight gains occurred in 11/18 (61%) patients and could be associated with medial voxels within the ALIC. CONCLUSION: The optimal outcome after capsulotomy in refractory OCD is linked to vmPFC disruption in the ALIC. Medial voxels within the ALIC could be associated with weight gains following capsulotomy.

Chemical Constituents from Soft Coral Clavularia spp. Demonstrate Antiproliferative Effects on Oral Cancer Cells.

Five new eudensamane-type sesquiterpene lactones, clasamanes A-E (1-5), three new dolabellane-type diterpenes, clabellanes A-C (6-8), and fifteen known compounds (9-23) were isolated from the ethanolic extract of Taiwanese soft coral Clavularia spp. The structures of all undescribed components (1-8) were determined by analysis of IR, mass, NMR, and UV spectroscopic data. The absolute configuration of new compounds was determined by using circular dichroism and DP4+ calculations. The cytotoxic activities of all isolated marine natural products were evaluated. Compound 7 showed a significant cytotoxic effect against oral cancer cell line (Ca9-22) with an IC50 value of 7.26 ± 0.17 µg/mL.

The value of gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase for predicting post-hepatectomy liver failure in HCC patients.

OBJECTIVES: To determine the value of gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase for predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC). METHODS: Patients with HCC who underwent gadobenate dimeglumine-enhanced hepatobiliary magnetic resonance imaging prior to hepatectomy were collected in two centers. The relative enhancement ratio of the biliary system (REB) and the liver to muscle ratio (LMR) were measured at the hepatobiliary phase. Potential risk factors for PHLF were analyzed by logistic regression. The capacity of the REB and LMR to predict PHLF was analyzed via receiver operating characteristic curve. RESULTS: Of the 221 patients, post-hepatectomy liver failure occurred in 60 patients (27.1%). The REB was an independent risk factor for PHLF (odds ratio [OR] = 0.127 [0.047-0.348], p < 0.001). Although the LMR tended to be associated with PHLF (p = 0.063), it was not an independent risk factor in the multivariable analysis (OR = 0.624 [0.023-16.709], p = 0.779). Moreover, the area under the receiver operating characteristic curve of the REB and LMR was 0.87 and 0.60. The most appropriate cutoff value for the REB was 2.21. The HCC patients with the REB ≤ 2.21 had a higher incidence of post-hepatectomy liver failure than those with the REB > 2.21 (60.0% versus 8.5%, p < 0.001). CONCLUSIONS: Gadobenate dimeglumine-enhanced biliary imaging from the hepatobiliary phase was valuable in predicting post-hepatectomy liver failure in HCC patients. KEY POINTS: • The relative enhancement ratio of the biliary system (REB) was an independent risk factor for post-hepatectomy liver failure in HCC patients. • HCC patients with the REB ≤ 2.21 had significantly higher incidence of post-hepatectomy liver failure than those with the REB > 2.21 (60.0% versus 8.5%).

Design of Airborne Large Aperture Infrared Optical System Based on Monocentric Lens.

Conventional reconnaissance camera systems have been flown on manned aircraft, where the weight, size, and power requirements are not stringent. However, today, these parameters are important for unmanned aerial vehicles (UAVs). This article provides a solution to the design of airborne large aperture infrared optical systems, based on a monocentric lens that can meet the strict criteria of aerial reconnaissance UAVs for a wide field of view (FOV) and lightness of airborne electro-optical pod cameras. A monocentric lens has a curved image plane, consisting of an array of microsensors, which can provide an image with 368 megapixels over a 100° FOV. We obtained the initial structure of a five-glass (5GS) asymmetric monocentric lens with an air gap, using ray-tracing and global optimization algorithms. According to the design results, the ground sampling distance (GSD) of the system is 0.33 m at 3000 m altitude. The full-field modulation transfer function (MTF) value of the system is more than 0.4 at a Nyquist frequency of 70 lp/mm. We present a primary thermal control method, and the image quality was steady throughout the operating temperature range. This compactness and simple structure fulfill the needs of uncrewed airborne lenses. This work may facilitate the practical application of monocentric lens in UAVs.

Imaging features of microwave-ablated lesions of the VX2 tumors in rabbit lungs on computed tomography and magnetic resonance images and their correlations with pathological examination.

PURPOSE: This study aimed to explore the accuracy of different imaging methods for lesion volume estimation pre- and post-microwave ablation (MWA) as compared with that of pathological examination. METHODS: We used the VX2 cell line to establish the VX2 lung tumor model in rabbits, followed by MWA of the tumor. The imaging features of the VX2 tumors were documented. The volume of the tumors and the ablated lesions were measured and compared across imaging methods, using the pathological examination as reference. RESULTS: Tumors were successfully developed in 11 rabbits (age, 13.91 ± 1.38 weeks; weight, 2.15 ± 0.56 kg). The mean volume of the tumors was 2.05 ± 1.88 cm3. CT showed the strongest correlation with the pathologic examination results (r = 0.998, p<.001). MWA created three-layered structures that were delineated on MRI. The mean volume of the post-ablation lesion was 10.39 ± 8.93 cm3, and the measurement of the post-ablation volume on 3D-VIBE-T1WI showed the strongest correlation with the pathologic examination results (r = 0.991, p<.001). CONCLUSION: Both CT and MRI are capable of depicting lung tumors. In terms of post-ablation evaluation, MR images could provide more versatile information. The 3D-VIBE-T1WI sequence provides more precise lesion volume evaluation after ablation compared with other methods.

Magnetic resonance-guided thermal ablation for small liver malignant tumor located on segment II or IVa abutting the heart: a retrospective cohort study.

OBJECTIVE: This study aimed to evaluate the clinical safety and efficacy magnetic resonance (MR)-guided percutaneous thermal ablation for the treatment of small liver malignant tumors of segment II and IVa (≤3.0 cm) abutting the heart. METHOD: The enrollment of 24 patients with 25 malignant liver lesions located on the II or IVa segment abutting the heart who underwent MRI-guided thermal ablation between August 2010 and February 2020 were retrospectively analyzed. Follow-up MRI was performed to evaluate the curative effect. Local tumor progression-free survival and overall survival rates were also calculated. RESULTS: The procedures including radiofrequency ablation (RFA) for 15 patients and microwave ablation (MWA) for 9 patients were successfully accomplished (technical success rate of 100%) without major complications. The mean duration time was 78.4 ± 29.4 min (40-140 min), and mean follow-up time was 31.5 ± 22.2 months (6-92 months). The technical efficacy was 100% following one ablation session with MRI assessment after one month. Local tumor progression was observed in one patient with a metastatic lesion located in segment II at 18 months follow-up. The progression-free survival time was 20.1 ± 16.9 months (median: 15 months). The 1-, 3-, and 5-year local tumor progression-free survival rates of this patient were 100%, 94.7%, and 94.7%, respectively. With regards to all the patients, the 1-, 3-, and 5-year estimated overall survival rates were 91.7%, 80.6%, and 50.1%, respectively. CONCLUSION: MR-guided thermal ablation is safe and effective for the treatment of small liver malignant tumors located on the II or IVa segment abutting the heart.

Rescue Anterior Capsulotomy after Failure of Nucleus Accumbens Deep Brain Stimulation in Anorexia Nervosa: A Case Report.

Anorexia nervosa (AN) is a highly disabling mental disorder with high rates of morbidity and mortality. Few psychological treatments and pharmacotherapy are proven to be effective for adult AN. Two invasive stereotactic neurosurgical interventions, deep brain stimulation (DBS) and anterior capsulotomy, are now commonly used as investigational approaches for the treatment of AN. Here, we report the long-term safety and efficacy of rescue bilateral anterior capsulotomy after the failure of bilateral nucleus accumbens (NAcc)-DBS in an 18-year-old female patient with life-threatening and treatment-resistant restricting subtype AN. Improvements in the neuropsychiatric assessment were not documented 6 months after the NAcc-DBS. Rescue bilateral anterior capsulotomy was proposed and performed, resulting in a long-lasting restoration of body weight and a significant and sustained remission in AN core symptoms. The DBS pulse generator was exhausted 2 years after capsulotomy and removed 3 years postoperatively. No relapse was reported at the last follow-up (7 years after the first intervention). From this case, we suggest that capsulotomy could be a rescue treatment for patients with treatment-resistant AN after NAcc-DBS failure. Further well-controlled studies are warranted to validate our findings.

Utility of Deep Brain Stimulation Telemedicine for Patients With Movement Disorders During the COVID-19 Outbreak in China.

OBJECTIVE: To explore the utility of deep brain stimulation (DBS) telemedicine in the management of patients with movement disorders from January 2019 to March 2020, covering the main period of the COVID-19 outbreak in China. MATERIALS AND METHODS: We obtained data from 40 hospitals around China that employed DBS tele-programming for their outpatients with Parkinson's disease or dystonia from January 2019 to March 2020. Data were obtained on the number and nature of patients' DBS health care service requests, reasons for their requests, the number of DBS telemedicine sessions subsequently completed, safety issues, and the patients' satisfaction with the DBS tele-programing parameter adjustments made. RESULTS: There were 909 DBS tele-programming health service requests (from 196 patients) completed during the study period. The results showed: 1) the number of DBS telemedicine sessions requested and the number of patients examined increased during the COVID-19 outbreak in February and March 2020 when compared with the monthly numbers in 2019; 2) the most common reason for the patients' health service requests was poor symptom control; 3) the most common DBS tele-programming adjustment made was voltage change; 4) overall, most (89%) DBS tele-programming adjustment sessions were experienced by the patients as satisfactory; and 5) significant adverse events and unexpected treatment interruptions caused by connection failure or other hardware- or software-related problems did not occur. CONCLUSIONS: DBS telemedicine could have a unique role to play in maintaining the delivery of DBS treatment and medical care to outpatients with movement disorders during the COVID-19 pandemic.

Percutaneous radiofrequency ablation for small hepatocellular carcinoma in hepatic dome under MR-guidance: clinical safety and efficacy.

Purpose: To evaluate the clinical safety and efficacy of percutaneous radiofrequency ablation (RFA) using multitined expandable electrodes under magnetic resonance imaging (MRI) guidance in the treatment of small hepatocellular carcinomas (HCCs) in the hepatic dome.Materials and methods: The data of 49 patients with 50 HCC lesions in the hepatic dome who underwent MRI-guided RFA from April 2010 to January 2018 were retrospectively analyzed. Planning, targeting, and controlling were performed under MR-guidance during the procedure. The complications after RFA were observed. Follow-up MRI was performed to evaluate the curative effect. The local progression-free survival, recurrence-free survival, and overall survival rates were calculated using the Kaplan-Meier survival curve.Results: The procedures were successfully accomplished in all patients without major complications. The mean follow-up time was 36.9 ± 25.8 months (range, 3-99 months). Technical success was 100% after one RFA session with MRI assessment after 1 month. Local tumor progression was observed in one patient (2%) with the lesion located in the hepatic dome at 4 months on a subsequent follow-up MRI. The progression-free survival time was 25.0 ± 22.7 months (median, 17.0 months). The 1-,3-, and 5-year local tumor progression-free survival rates were all 98.0%. The 1-,3-, and 5-year recurrence-free survival rates were 68.1%, 39.9%, and 28.5%, respectively, and the estimated overall survival rates were 93.7%, 76.3%, and 54.3%, respectively.Conclusion: Planning, targeting, and controlling of RFA were well supported by MRI with acceptable time. MRI-guided RFA for small HCCs in the hepatic dome is safe and effective with fewer RF sessions.

Feasibility and efficacy study of microwave ablation of recurrent small HCC guided by enhanced liver-specific magnetic resonance imaging contrast agent.

OBJECTIVES: To investigate the feasibility and efficacy of liver-specific magnetic resonance imaging (MRI) with gadolinium-containing contrast agent guidance for microwave ablation (MWA) of recurrent small hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The Ethics Committee of the First Affiliated Hospital of Fujian Medical University approved this study. Eighteen patients presented with 30 recurrent small HCCs, at least one lesion per patient was undetectable on unenhanced MRI, but this was clearly demonstrated in the hepatobiliary phase after liver-specific MRI contrast agent administration. Gd-BOPTA (16 cases) or Gd-EOB-DTPA (2 cases) were injected half an hour before the procedure, and MWA was performed by percutaneous puncture of the target lesion with a magnetic resonance-compatible microwave antenna under 1.5 T MRI guidance. RESULTS: The technical success rate was 100%. The mean maximum diameter of the lesions was 9.7 ± 2.8 mm (5.0-15.4 mm). The mean follow-up time was 11.6 ± 4.7 months (range, 4-19 months), and no local recurrence was observed. CONCLUSIONS: MWA of small HCCs guided by enhanced liver-specific MRI contrast agent is a safe and effective technique.

Deep brain stimulation telemedicine programming during the COVID-19 pandemic: treatment of patients with psychiatric disorders.

OBJECTIVE: The ongoing coronavirus disease 2019 (COVID-19) pandemic has considerably affected the delivery of postoperative care to patients who have undergone deep brain stimulation (DBS) surgery. DBS teleprogramming technology was developed and deployed in China before the COVID-19 outbreak. In this report, the authors share their experiences with telemedical DBS treatment of patients with psychiatric disorders during the COVID-19 outbreak. METHODS: Four patients (2 with obsessive-compulsive disorder, 1 with major depressive disorder, and 1 with anorexia nervosa) underwent DBS surgery at Ruijin Hospital and received continuous postoperative DBS telemedicine case management from January 2020 to July 2020. DBS teleprogramming, individualized psychological support, and medical consultations were provided via the authors' DBS telemedicine platform, which also incorporated a synchronous real-time video communication system. RESULTS: Forty-five DBS telemedicine sessions were conducted; there was no unexpected loss of network connection during the sessions. Of these, 28 sessions involved DBS teleprogramming. Adjustments were made to the stimulation voltage, frequency, pulse width, and contact site in 21, 12, 9, and 9 sessions, respectively. Psychological support and troubleshooting were provided during the remaining telemedicine sessions. Modest to substantial clinical improvements after DBS surgery were observed in some but not all patients, whereas stimulation-related side effects were reported by 2 patients and included reversible sleep and mood problems, headache, and a sensation of heat. CONCLUSIONS: DBS telemedicine seems to offer a feasible, safe, and efficient strategy for maintaining the delivery of medical care to psychiatric patients during the COVID-19 outbreak. The authors propose that implementation of a comprehensive DBS telemedicine system, which combines DBS teleprogramming with psychological counseling, medical consultations, and medication prescriptions and delivery, could be an efficient and effective approach to manage the mental health and quality of life of patients with psychiatric disorders during future local or global public health crises.

Development of a prognostic score for recommended TACE candidates with hepatocellular carcinoma: A multicentre observational study.

BACKGROUND & AIMS: Previous prognostic scores for transarterial chemoembolization (TACE) were mainly derived from real-world settings, which are beyond guideline recommendations. A robust model for outcome prediction and risk stratification of recommended TACE candidates is lacking. We aimed to develop an easy-to-use tool specifically for these patients. METHODS: Between January 2010 and May 2016, 1,604 treatment-naïve patients with unresectable hepatocellular carcinoma (HCC), Child-Pugh A5-B7 and performance status 0 undergoing TACE were included from 24 tertiary centres. Patients were randomly divided into training (n = 807) and validation (n = 797) cohorts. A prognostic model was developed and subsequently validated. Predictive performance and discrimination were further evaluated and compared with other prognostic models. RESULTS: The final presentation of the model was "linear predictor = largest tumour diameter (cm) + tumour number", which consistently outperformed other currently available models in both training and validation datasets as well as in different subgroups. The thirtieth percentile and the third quartile of the linear predictor, namely 6 and 12, were further selected as cut-off values, leading to the "six-and-twelve" score which could divide patients into 3 strata with the sum of tumour size and number ≤6, >6 but ≤12, and >12 presenting significantly different median survival of 49.1 (95% CI 43.7-59.4) months, 32.0 (95% CI 29.9-37.5) months, and 15.8 (95% CI 14.1-17.7) months, respectively. CONCLUSIONS: The six-and-twelve score may prove an easy-to-use tool to stratify recommended TACE candidates (Barcelona Clinic Liver Cancer stage-A/B) and predict individual survival with favourable performance and discrimination. Moreover, the score could stratify these patients in clinical practice as well as help design clinical trials with comparable criteria involving these patients. Further external validation of the score is required. LAY SUMMARY: There is currently no prognostic model specifically developed for recommended or ideal transarterial chemoembolization (TACE) candidates with hepatocellular carcinoma, despite these patients being frequently identified as the best target population in pivotal randomized controlled trials. The six-and-twelve score provides patient survival prediction, especially in ideal candidates of TACE, outperforming other currently available models in both training and validation sets, as well as different subgroups. With cut-off values of 6 and 12, the score can stratify ideal TACE candidates into 3 strata with significantly different outcomes and may shed light on risk stratification of these patients in clinical practice as well as in clinical trials.

Evaluation of the MR and pathology characteristics immediately following percutaneous MR-guided microwave ablation in a rabbit kidney VX2 tumor implantation model.

Purpose: This study aimed to evaluate the immediate efficacy of magnetic resonance (MR)-guided microwave ablation (MWA) in rabbit kidneys implanted with VX2 tumors.Materials and methods: MR-guided MWA was performed in eight VX2 tumor-bearing rabbits. MR images after ablation were obtained and analyzed. The differences between the tissue specimens and MR images obtained after ablation were compared.Results: On the three-dimensional volumetric interpolated breath-hold T1-weighted (3D-VIBE-T1WI) sequence, a low signal intensity indicated the primary tumor at the center of the ablation area, which was surrounded by a peripheral high-signal area. The signal for the primary tumor in the fast spin-turbo spin-echo T2-weighted (FS-TSE-T2WI) sequence was lower than before, and the ablation zone showed a low signal that completely covered the primary tumor. There was no significant difference in volume among the low-signal areas of the primary tumor on FS-TSE-T2WI before MWA, the central low-signal area on 3D-VIBE-T1WI after MWA, and the tumor coagulation necrosis area on the tissue specimens (p > 0.05). No significant difference was found in the volume of ablation zones among the tissue specimens, the high-signal area around the lesion on the 3D-VIBE-T1WI sequence, and the low-signal area covering the lesion on the FS-TSE-T2WI sequence (p > 0.05).Conclusion: Magnetic resonance imaging (MRI) is an effective method for immediate efficacy evaluation of rabbit renal VX2 tumors after MWA and can serve as a valuable reference for the clinical assessment of post-ablative renal tumors.

Microwave ablation of hepatic malignant tumors using 1.5T MRI guidance and monitoring: feasibility and preliminary clinical experience.

Purpose: To evaluate the feasibility and therapeutic efficacy of 1.5-T MRI-guided and monitored microwave ablation in patients with hepatic malignant tumors.Materials and Methods: This retrospective study was approved by the ethics committee of the First Affiliated Hospital of Fujian Medical University. Thirty-five patients (32 men, three women) with 48 lesions (maximum diameter < 3 cm) underwent microwave ablation under the guidance and monitoring of a 1.5-T MRI. The MRI-compatible microwave generator was appended with a magnetic shield case, and the cable was combined with a choke coil for shielding the Larmor processing frequency. The average age of the patients was 56.51 ± 11.36 years (31-77 years). Twenty-eight patients (37 lesions) displayed hepatocellular carcinoma and seven patients (11 lesions) had metastatic liver carcinoma. The mean maximum tumor diameter was 12.31 ± 4.72 mm (range 5.0-25.7 mm).Results: MRI scans were performed simultaneously without electromagnetic interference during ablation. The average maximum diameter of the hypointense zone of the last monitored T2WI sequence, hypointense zone of post-procedure T2WI sequence, and hyperintense zone of post-procedure T1WI were 28.82 ± 7.58 mm, 29.79 ± 7.91 mm, and 28.28 ± 8.37 mm, respectively, with no observed statistical difference (F = 0.434, p = .649). The technical success rate was 100%. The average follow-up duration was 11.43 ± 5.29 (4-33) months. The technique efficacy rate was 100%.Conclusion: MRI-guided and monitored microwave ablation of hepatic malignant tumors is feasible and potentially safe and effective.Key pointsMRI-guided microwave ablation of hepatic malignant tumors is feasible.The MRI monitoring scan could accurately reflect the scope of ablation lesion.On T1WI, the ablation lesions of liver showed the 'target sign'.

Local curative effect of MRI-guided radiofrequency ablation on small hepatocellular carcinoma.

Radiofrequency ablation (RFA) is one of the treatment modes for liver cancer. The trauma caused by RFA is small, and its local curative effect is reliable. Computed tomography (CT) can only be used for axial scans, and parts of the lesion are unclear on plain scans. The aim of this study is to compare the local curative effect of RFA percutaneously guided by MRI and ultrasound for small hepatocellular carcinoma (HCC). This study is a retrospective study. In this study, we examined 60 cases of 88 liver lesions and 50 cases of 52 lesions, in which RFA was guided by MRI and ultrasound, respectively. All cases were clinically diagnosed. The therapeutic effect of ablation lesions was examined by postoperative imaging follow-up. The results indicated that there were 5 (5/88) recurrences of liver lesions with MRI-guided RFA and 14 (14/52) recurrences of liver lesions with ultrasound-guided RFA. The median time to recurrence in the case of recurrent lesions was 7 months. Postoperative ablation lesions showed a low-intensity signal surrounded by a thin high-intensity signal ring on T2WI images. On T1WI images, the ablation lesion showed a concentric pattern and the central area of the original lesion continued to show a low-intensity signal with a clear ring of high-intensity signal that had a clear boundary. In conclusion, the local curative effect of MRI-guided RFA for small HCC is superior to that of ultrasound-guided RFA.

Motor improvement of remote programming in patients with Parkinson's disease after deep brain stimulation: a 1-year follow-up.

Background: Remote programming (RP) is an emerging technology that enables the adjustment of implantable pulse generators (IPGs) via the Internet for people with Parkinson's disease (PwPD) who have undergone deep brain stimulation (DBS). Previous studies have not comprehensively explored the effectiveness of RP in managing motor symptoms, often omitting assessments such as the rigidity and retropulsion tests during the follow-up. This study evaluates the comprehensive improvements in motor performance and the potential cost benefits of RP for PwPD with DBS. Methods: A retrospective analysis was conducted on two groups of patients-those who received RP and those who received standard programming (SP). Clinical outcomes including motor improvement, quality of life, and daily levodopa dosage were compared between the groups during a 12 (± 3)-month in-clinic follow-up. Results: A total of 44 patients were included in the study, with 18 in the RP group and 26 in the SP group. No significant differences were observed in the frequency of programming sessions or clinical outcomes between the groups (p > 0.05). However, the RP group experienced significantly lower costs per programming session than the SP group (p < 0.05), despite patients in the former group living further from our center (p < 0.05). Conclusions: Our findings suggest that RP could significantly reduce the costs of programming for PwPD with DBS, especially without compromising the effectiveness of treatment across all motor symptoms in the short term.

Telemedicine in patients with obsessive-compulsive disorder after deep brain stimulation: a case series.

Background: Patients suffering from refractory obsessive-compulsive disorder (OCD) who have undergone deep brain stimulation (DBS) surgery require repeated in-person programming visits. These sessions could be labor-intensive and may not always be feasible, particularly when in-person hospital visits are restricted. Telemedicine is emerging as a potential supplementary tool for post-operative care. However, its reliability and feasibility still require further validation due to the unconventional methods of interaction. Methods: A study was conducted on three patients with refractory OCD who had undergone DBS. Most of their programming sessions were completed via a remote programming system. These patients were recruited and monitored for a year. Changes in their clinical symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II), the Hamilton Anxiety Scale-14 (HAMA), the Hamilton Depression Scale-17 (HAMD), and the Short Form 36 Health Survey Questionnaire (SF-36). The scores from these assessments were reported. Results: At the last follow-up, two out of three patients were identified as responders, with their Y-BOCS-II scores improving by more than 35% (P1: 51%, P3: 42%). These patients also experienced some mood benefits. All patients observed a decrease in travel expenses during the study period. No severe adverse events were reported throughout the study. Conclusion: The group of patients showed improvement in their OCD symptoms within a 1-year follow-up period after DBS surgery, without compromising safety or benefits. This suggests that telemedicine could be a valuable supplementary tool when in-person visits are limited.

Optimizing Deep Brain Stimulation in Essential Tremor: A Randomized Controlled Trial for Target Consideration.

BACKGROUND AND OBJECTIVES: The thalamic ventral intermediate nucleus (VIM) is a well-established target for deep brain stimulation (DBS) in the treatment of essential tremor (ET). Increasing data indicate that the posterior subthalamic area (PSA) may be superior, but high-level evidence is limited. We aimed at further comparing the intraindividual efficacy and side effect profile of PSA vs VIM DBS in ET. METHODS: In this randomized, double-blind, crossover trial, 4-contact DBS leads were bilaterally implanted with single-trajectory covering the VIM and PSA. Patients were randomized postsurgery to 2 groups, receiving VIM stimulation (4-7 months) and then PSA stimulation (8-11 months) or vice versa. The primary end point was the difference in improvement from baseline to the end of the VIM vs PSA DBS period in the total score of the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). RESULTS: Ten patients with medically refractory ET were enrolled, and 9 completed the study. The difference between reduction of FTM-TRS total score in the PSA vs VIM DBS period was -7.4 (95% CI: -28.5 to 13.7, P = .328). Clinical benefit was achieved at significantly lower stimulation intensity under PSA DBS. Furthermore, PSA DBS provided greater improvement in head tremor subscore of FTM-TRS (PSA vs VIM: -2.2, P = .020) and disease-specific quality of life (PSA vs VIM: -13.8, P = .046) and induced fewer speech (Dysphonia Severity Index score: P = .043; diadochokinetic rate: P = .007; VDI score: P = .005) and gait disturbances compared with VIM DBS. Seven patients remained with PSA DBS after the crossover phase. CONCLUSION: Our study confirms that PSA-DBS is comparable with VIM-DBS in suppressing tremors, superior in improving disease-specific quality of life, and possibly more effective in reducing head tremor.