68Ga-cyc-DX600 PET/CT in ACE2-targeted tumor imaging.

PURPOSE: For the tumor-specific ACE2 expression, this research aimed to establish and verify ACE2-targeted PET imaging in differentiating tumors with distinct ACE2 expression. METHODS: 68Ga-cyc-DX600 was synthesized as tracer of ACE2 PET. NOD-SCID mice were used to prepare the subcutaneous tumor models with HEK-293 or HEK-293T/hACE2 cells to verify ACE2 specificity, with other kinds of tumor cells to evaluate the diagnostic efficiency for ACE2 expression, additionally, immunohistochemical analysis and western blot were used to certify the findings on ACE2 PET, which was then performed on four cancer patients and compared with FDG PET. RESULTS: The metabolic clearance of 68Ga-cyc-DX600 was initially completed in 60 min, realizing an ACE2-dependent and organ-specific background of ACE2 PET; meanwhile, tracer uptake of subcutaneous tumor models was of a definite dependence on ACE2 expression (r = 0.903, p < 0.05), and the latter served as the primary factor when ACE2 PET was used for the differential diagnosis of ACE2-related tumors. In pre-clinical practice, a comparable tumor-to-background ratio was acquired in ACE2 PET of a lung cancer patient at 50 and 80 min post injection; the quantitative values of ACE2 PET and FDG PET were negatively correlated (r = - 0.971 for SUVmax, p = 0.006; r = - 0.994 for SUVmean, p = 0.001) in an esophageal cancer patient, no matter the primary lesion or metastasis. CONCLUSIONS: 68Ga-cyc-DX600 PET was an ACE2-specific imaging for the differential diagnosis of tumors and added complementary value to conventional nuclear medicine diagnosis, such as FDG PET on glycometabolism.

FDG PET/CT and CT Findings of Renal Cell Carcinoma With Sarcomatoid Differentiation.

OBJECTIVE. The purpose of this article is to investigate the value of 18F-FDG PET/CT and enhanced CT in the diagnosis of renal cell carcinoma (RCC) with sarcomatoid differentiation and the differential diagnosis of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS. Among patients with renal tumors confirmed by pathologic examination from September 2010 to August 2019, 29 patients with RCC with sarcomatoid differentiation and 82 patients with ccRCC who underwent FDG PET/CT, renal contrast-enhanced CT examination, or both, before surgery were studied. Features of the two groups on CT and PET/CT were retrospectively reviewed. RESULTS. The tumor size of RCC with sarcomatoid differentiation was larger than that of ccRCC (p = 0.0086). Cystic necrosis, peritumoral neovascularity, and metastasis were more common in RCC with sarcomatoid differentiation (p = 0.0052, p = 0.0008, p < 0.0001, respectively). The ratio of necrotic area to tumor diameter of RCC with sarcomatoid differentiation was statistically significantly larger than that of ccRCC (p = 0.0032). Three cases of RCC with sarcomatoid differentiation showed a large central necrotic area and dense intratu-moral neovascularity in the surrounding parenchyma, defined as the ring-of-fire sign, which was not found in ccRCC. The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and peak standardized uptake value (SUVpeak) of RCC with sarcomatoid differentiation were statistically significantly higher than those for ccRCC (all p < 0.0001), and the SUVmax, SUVmean, and SUVpeak cutoff values of 5.4, 4.2, and 5.0, respectively, were helpful for discrimination. CONCLUSION. Imaging features including higher SUVmax, SUVmean, and SUVpeak; a larger ratio of necrotic area to tumor diameter; the presence of peritumoral neovascularity; and metastasis are more commonly associated with RCC with sarcomatoid differentiation than with ccRCC. The ring-of-fire sign and SUVmax, SUVmean, SUVpeak cutoff values of 5.4, 4.2, 5.0, respectively, may be helpful to indicate RCC with sarcomatoid differentiation.

Intermittent hypoxia promotes melanoma lung metastasis via oxidative stress and inflammation responses in a mouse model of obstructive sleep apnea.

BACKGROUND: Recently, increased tumor incidence and cancer-related mortality have been reported among patients with obstructive sleep apnea (OSA). Intermittent hypoxia (IH), the hallmark feature of OSA, contributes to the metastasis of tumors. However, the molecular mechanisms by which tumor metastasis is accelerated by OSA-like IH remain to be elucidated. METHODS: C57BL/6 J male mice were subjected to intravenous injection of B16F10 melanoma cells before receiving IH treatment. Then, the animals were randomly distributed into three groups (n = 8 each): normoxia (N) group, IH group, and antioxidant tempol group (IHT, exposed to IH after treatment with tempol). After the mice were sacrificed, the number and weight of lung metastatic colonies were assessed. The lung tissues with tumor metastasis were analyzed for markers of oxidative stress and inflammation and for HIF-1α using western blotting and real-time PCR (qRT-PCR). The level of reactive oxygen species (ROS) in B16F10 cell was also assessed after N, IH and IH with tempol treatments. RESULTS: Compared with normoxia, IH significantly increased the number and weight of mouse lung metastatic colonies. Treatment of B16F10 cells with IH significantly enhanced ROS generation. Lung tissues with tumor metastasis provided evidence of increased oxidative stress, as assessed by p22phox and SOD mRNA levels and the NRF2 protein level, as well as increased inflammation, as assessed by TNF-α and IL-6 mRNA levels and the NF-κB P65 protein level. HIF-1α protein levels were increased in response to IH treatment. Tempol, an important antioxidant, ameliorated IH-induced melanoma lung metastasis in mice and reduced oxidative stress and inflammation responses. CONCLUSIONS: These results support the hypothesis that oxidative stress and inflammation responses play an important role in the pathogenesis of OSA-like IH-induced melanoma lung metastasis in mice. Antioxidant intervention provides a novel strategy for the prevention and treatment of cancer in OSA populations.

Privacy-Preserving Data Aggregation against False Data Injection Attacks in Fog Computing.

As an extension of cloud computing, fog computing has received more attention in recent years. It can solve problems such as high latency, lack of support for mobility and location awareness in cloud computing. In the Internet of Things (IoT), a series of IoT devices can be connected to the fog nodes that assist a cloud service center to store and process a part of data in advance. Not only can it reduce the pressure of processing data, but also improve the real-time and service quality. However, data processing at fog nodes suffers from many challenging issues, such as false data injection attacks, data modification attacks, and IoT devices' privacy violation. In this paper, based on the Paillier homomorphic encryption scheme, we use blinding factors to design a privacy-preserving data aggregation scheme in fog computing. No matter whether the fog node and the cloud control center are honest or not, the proposed scheme ensures that the injection data is from legal IoT devices and is not modified and leaked. The proposed scheme also has fault tolerance, which means that the collection of data from other devices will not be affected even if certain fog devices fail to work. In addition, security analysis and performance evaluation indicate the proposed scheme is secure and efficient.

Pancreatic retention cyst: multi-modality imaging findings and review of the literature.

PURPOSE: To investigate the multi-modality imaging presentation of the pancreatic retention cyst (PRC) with pathologic correlation. METHODS: Imaging data including CT, MRI, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration (EUS-FNA), and endoscopic retrograde cholangiopancreatography (ERCP) in fifteen patients (five males and ten females; mean age, 44.5 years) with pathologically proven PRC were analyzed retrospectively, and imaging features were correlated with pathological findings. RESULTS: Sixteen PRCs of 15 patients were included in this study. The mean size of PRCs was 4.4 × 4.6 cm (range 0.5 × 0.6-8.1 × 10.1 cm). PRC were round (n = 11), oval (n = 2), or lobular (n = 3). Punctiform calcification of the wall on CT (n = 2), thin septa (n = 4), thin wall (n = 3), and dilation of upstream pancreatic duct (n = 6; mean diameter, 4.3 mm) were detected. Dilation of upstream pancreatic duct was smooth in five PRCs and irregular in one PRC with pancreatic duct with punctiform calcification. Communication of PRCs with pancreatic duct was seen in two patients (one on CT, one on ERCP). Pancreatic inflammation and neoplasm were detected in four and two patients, respectively. CONCLUSIONS: PRC typically presents as a well-defined, round cystic lesion, and different associated pathologic conditions including pancreatic inflammation and neoplasm may be detected in some patients on the multi-modality imaging examinations. Smooth dilation of upstream pancreatic duct with uncommon communication to the cyst may be helpful for the differentiation. Combination of a variety of imaging modalities could contribute to improve the diagnosis.

Multi-modality imaging findings of splenic hamartoma: a report of nine cases and review of the literature.

PURPOSE: To investigate the presentation of splenic hamartomas (SHs) on ultrasonography (US), CT and MRI. METHODS: Nine patients (5 males and 4 females, mean age, 52.8 years) with pathologically proven SHs were included in this study. US, CT and MRI images were analyzed retrospectively, and imaging features were correlated with pathological findings. RESULTS: SHs appeared solitary lesion (n = 8) and multiple lesions (n = 1) in the present study. (1) In 8 cases of solitary lesion, the lesions appeared as solid nodules or masses with well-defined margins and varying echogenicity (hyperecho = 5, hypoecho = 2, strong echo = 1) on ultrasound. The lesions showed iso-attenuation (n = 3) or slightly hypo-attenuation (n = 4) on unenhanced CT, and calcification were revealed in 3 lesions. MRI showed isointensity (n = 3) or hypointensity (n = 2) on the T1-weighted image, and heterogeneous hypointensity (n = 2), slightly hyperintensity (n = 2) and hyperintensity (n = 1) on the T2-weighted image. The enhanced patterns of SHs showed mild diffuse heterogeneous enhancement (n = 6) and prominent enhancement (n = 1) during arterial phase and above 7 lesions were demonstrated progressive enhancement at delayed phase on enhanced CT. One lesion without any enhancement was revealed in another patient. (2) One case of multiple lesions included 1 cystic lesion with irregular calcification and 7 solid lesions with progressive enhancement on CT images. CONCLUSIONS: Combination of a variety of imaging modalities could more fully reflect the pathological characteristics and contribute to the diagnosis of SH.

Improving the anti-tumor effect of genistein with a biocompatible superparamagnetic drug delivery system.

The practical application of genistein as a low toxicity chemotherapeutic drug is hindered by many of its in vivo properties. To overcome these obstacles, a new multifunctional drug delivery system is developed, which is based on covalently attaching genistein onto Fe3O4 nanoparticles coated by cross-linked carboxymethylated chitosan (CMCH). The structure of the Fe3O4-CMCH-genistein nano-conjugate was confirmed by transmission electron micrographs (TEM), X-ray diffraction (XRD) and Fourier-transfer infrared (FT-IR) spectroscopy. The nano-conjugate shows good water solubility and superparamagnetic properties with a saturation magnetization of 55.1 emu/g. The effects of free genistein and FeO4-CMCH-genistein nano-conjugate on the proliferation and apoptosis of gastric cancer cell line SGC-7901 were investigated by MTT assay and flow cytometry (FACS). MTT results indicate that the Fe3O4-CMCH-genistein nano-conjugate exhibits a significantly enhanced inhibition effect to the SGC-7901 cancer cells than the free genistein. FACS data suggests that the inhibition on cell proliferation of the nano-conjugate is related with an induced apoptosis process. This drug delivery system is promising for future multifunctional chemotherapeutic application that combines drug release and magnetic hyperthermia therapy.

18F-FDG PET/CT feature of pancreatic adenosquamous carcinoma with pathological correlation.

PURPOSE: To investigate 18F-FDG PET/CT feature of pancreatic adenosquamous carcinoma (PASC) in contrast with conventional pancreatic ductal adenocarcinoma (PDAC), and its correlation with pathological findings. PATIENTS AND METHODS: Patients with PASC or PDAC confirmed by surgical pathology, who underwent FDG PET/CT scanning before surgical resection, were retrospectively studied. PASC group and conventional PDAC group included 13 and 104 patients, respectively. Delayed phase of PET/CT scanning was performed in 12 patients with PASC and 99 with PDAC. Maximum standardized value (SUVmax) was measured, and the mean retention index (RI) was calculated by ([PET120min SUVmax]-[PET 60min SUVmax]) ÷ PET 60min SUVmax × 100%. RESULTS: On PET/CT, all lesions of PASC group showed intense FDG uptake, and the SUVmax were significantly higher than the lesions of conventional PDAC group both on the early [10.43 ± 5.10 (4.37-24.00) vs. 7.31 ± 3.86 (1.93-21.08), P = 0.011] and delayed phase [13.29 ± 6.04 (5.72-28.16) vs. 8.84 ± 5.14 (1.92-27.58), P = 0.005]. On the delayed phase, all lesions of PASC group had increased SUVmax with positive RI value (27.04% ± 8.87%, 7.14-39.27%). For conventional PDAC group, 81 lesions had increased SUVmax with positive RI value (27.25% ± 19.10%, 1.09-104.49%), while eighteen (18.18%) lesions of PDAC group had slightly decreased SUVmax, and their RI value were negative (- 11.35% ± 13.50%, - 43.17 to - 0.14%). The proliferative index (Ki-67) of lesions of PASC group was positively correlated with both the early (P = 0.034, r = 0.671) and delayed SUVmax (P = 0.019, r = 0.721). The RI value of lesions with adjacent organ invasion in PASC group was significantly higher than those without invasion (33.25% ± 4.92% vs. 20.83% ± 7.49%, P = 0.007). CONCLUSION: PASC has more intense FDG uptake than conventional PDAC both on early and delayed phase. RI value of PASC was positive. Negative RI value may be helpful for differentiating PDAC from PASC. SUVmax and RI value may be helpful for prediction of its malignancy and invasion.

Clinical and imaging features in 16 infants exposed to food contaminated with melamine and cyanuric acid.

OBJECTIVE: The objective of our study was to describe the clinical and imaging features of infants exposed to milk formula contaminated with melamine and cyanuric acid. CONCLUSION: The imaging feature of patients exposed to food contaminated with melamine and cyanuric acid was multiple calculi of the urinary tract that varied greatly in size and shape. Most patients presented with symptoms of urinary obstruction.

Diagnostic value of multislice spiral computed tomography (CT) combined with CT angiography for intra-abdominal undescended testis secondary seminomas.

OBJECTIVE: To discuss the diagnostic value of multislice spiral tomography (CT) combined with CT angiography (CTA) technology in intra-abdominal undescended testis secondary seminoma cases. METHODS: We retrospectively analyzed the CT and CTA imaging features of CT and CTA findings of nine patients with an intra-abdominal undescended testis secondary seminoma. RESULTS: The tumors in all nine patients were mainly solid, and the average CT value was 38.4 ± 3.4 HU. Low-density areas of various sizes were visible in the tumors, and calcifications were detected in two patients. The tumors in eight patients had a complete capsule, which pressed on the surrounding structures. In one patient, the tumor had an incomplete capsule, which invaded the surrounding structures. Some of the solid tumors showed progressive and slight enhancement on the CT-enhanced scans. The values in the arterial phase, venous phase, and delayed phase were 46.3 ± 5.1 (40-55 HU), 57.3 ± 7.3HU (48-68 HU), and 65.1 ± 7.2HU (56-77 HU), respectively, with an average increase rate of 27.0 ± 7.2 HU. No enhancement was found in low-density areas on the CTA scans, and the supply arteries of the tumors in the nine patients all originated from the abdominal aortic wall 2-3 cm below the renal ostia. These arteries became thickened and tortuous when near the tumors, and there were no branching vessels. In eight patients, the supply arteries of the tumors originated from the posterior tumor and ended inside the tumor, and they originated from anterior of the tumor in one patient. Testicular venous drainage was detected in three patients, and lymph node metastasis in the abdominal aorta detected in two cases. CONCLUSION: An intra-abdominal undescended testis secondary seminoma exhibits a characteristic appearance on CT. CTA shows a three-dimensional testicular vascular pedicle sign of a seminoma. A combination of CT and CTA can improve the diagnostic accuracy of an intra-abdominal undescended testis secondary seminoma.

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.

AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS: CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors, multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle. RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors, respectively. Among the 8 tumors sizing up to 5 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases. In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later. CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.

Comparison of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening: a meta-analysis.

BACKGROUND: As a common and essential contrast medium at present, gadobenate dimeglumine has shown better performance than some other agents when applied to Breast Magnetic Resonance Imaging Screening (Breast MRI Screening). Nevertheless, reports on the diagnostic performance of these two mediums (gadobenate dimeglumine and gadopentetate dimeglumine) are not completely consistent. OBJECTIVE: To assess the diagnostic value of gadobenate dimeglumine and gadopentetate dimeglumine for Breast MRI Screening in patients suffering from breast cancer and to provide more convinced evidence to guide clinical practice in terms of appropriate contrast agents. DATA SOURCES AND REVIEW METHODS: Original articles in English and Chinese published before January 2013 were selected from available databases (The Cochrane Library, PUBMED, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, Chinese Journal Full-text). The criteria for inclusion and exclusion were based on the standard for diagnosis tests. Meta-Disc software (Version 1.4) was used for data analysis. Then, the area under curve (AUC) of SROC and the spearman rank correlation of sensitivity against (1-specificity) were calculated. RESULTS: Total of 17 researches involving 1934 patients were included. The pooled sensitivity of gadobenate dimeglumine and gadopentetate dimeglumine were 0.99 (0.97, 1.00) and 0.93 (0.88, 1.00) respectively. The pooled specificity for these two contrast agents were 0.924 (0.902, 0.943) and 0.838 (0.817, 0.858) respectively, and the AUC of SROC curve were 0.9781 and 0.9215 respectively. CONCLUSIONS: Gadobenate dimeglumine can be regarded as a more effective and feasible contrast medium for Breast MRI Screening. At least 5% differences in diagnostic performance are usually considered as clinically relevant.

CT features of colloid carcinomas of the pancreas.

BACKGROUND: Colloid carcinomas of the pancreas have better prognosis than ordinary ductal adenocarcinoma, and preoperative distinction of colloid carcinoma from other pancreatic tumors is valuable for patient therapeutic planning and prognosis assessment. However, data about CT features of colloid carcinoma are very limited. This study aimed to investigate the CT features of this tumor. METHODS: Institutional review board approval was obtained for this study. Seven patients with pathologically proven colloid carcinoma of the pancreas were included. Unenhanced and dynamic enhanced CT was performed in all the patients. CT features were analyzed retrospectively and correlations with pathological findings were evaluated. RESULTS: Mean age of the patients was 59.8 years (41 - 76 years). Five tumors were located in the pancreatic head, and the other two in body and tail respectively. The maximum mean diameter of the tumors on axial scanning was 3.9 cm (3.0 - 6.7 cm). Tumors were round (n = 5) and lobular (n = 2). Tumors appeared slight hyp-attenuation on unenhanced CT, and peripheral and internal meshlike progressive delayed enhancement with great percent of cystic areas on enhanced CT. Calcification and gas in the tumor was seen in one patient whose duodenum was invaded by the tumor. CONCLUSIONS: Colloid carcinomas of the pancreas appear as round or labular masses with great percent of cystic areas and slight hyp-attenuation on unenhanced CT and peripheral and internal meshlike progressive delayed enhancement on enhanced CT.

[The clinical study of multi-slice helical CT three-dimensional reconstruction in the sphenopalatine foramen].

OBJECTIVE: Used multi-slice helical CT to observe the reconstruction of the surface structure of nasal lateral wall "sphenopalatine foramen" and compared with anatomical specimens to verify the dependability of 3D data. METHOD: The position, shape, size and their correlational data of sphenopalatine foramen of 5 cadaver heads (10 sides) in adults fixed with formalin were dissected and measured. RESULT: Multi-slice helical CT has more rapid speed of 3D reconstruction and clearer imaging. The technique of Shade surface display and Volume rendering can give very clear structure of nasal lateral wall "sphenopalatine foramen". The 3D data makes no statistic difference with anatomical measurement. The 3D data can instruct the clinic directly. CONCLUSION: Multi-slice helical CT three-dimensional reconstruction can be used to orientation of surgery.

Computerized tomography guided percutaneous ethanol injection for the treatment of hyperfunctioning pheochromocytoma.

PURPOSE: We validated the therapeutic efficacy of computerized tomography (CT) guided percutaneous ethanol injection (PEI) for hyperfunctioning pheochromocytoma. MATERIALS AND METHODS: Pheochromocytoma was treated with CT guided PEI in 41 patients, including 19 men and 22 women with a mean age of 42 years (range 31 to 59). Of the 41 patients 40 had a solitary adrenal benign pheochromocytoma (18 on the left and 22 on the right side), which was diagnosed by biopsy in 36 and by typical clinical manifestations, laboratory and CT findings in 4. The remaining patient with malignant pheochromocytoma, who underwent surgical resection 2 years ago, had 2 recurrent lesions along the right sympathetic chain. RESULTS: CT or magnetic resonance imaging followup 7 to 20 days after treatment showed that adrenal benign pheochromocytoma disappeared in 27 patients and became completely necrotic or shrank in 13. The 2 malignant recurrent lesions also disappeared completely. During the followup of 23 to 54 months the foci disappeared completely in 31 patients, and shrank and completely necrotized in 10. All patients showed normal blood pressure without intermittent vertigo, complexion pallor or numbness of the 4 extremities. Blood and urine catecholamine was also within the normal range. CONCLUSIONS: The therapeutic efficacy of CT guided PEI for hyperfunctioning pheochromocytoma is definite and worth widespread application because the procedure is safe, microtraumatic and less costly, and has low morbidity.

CT-guided percutaneous ethanol injection of the thymus for treatment of myasthenia gravis.

OBJECTIVE: This study was designed to validate the therapeutic effectiveness of CT-guided percutaneous ethanol injection of the thymus for the treatment of myasthenia gravis. SUBJECTS AND METHODS: The subjects were 45 patients with myasthenia gravis. The diagnosis was determined by the patients' histories, physical findings, neostigmine tests, and morphologic changes. According to the Osserman classification, the 45 patients with myasthenia gravis were classified as stage I (n = 26), stage III (n = 13), and stage IV (n = 6). A 21- or 22-gauge needle was inserted into the thymus under CT guidance, and then ethanol was injected step by step until it was distributed throughout the whole thymoma, the hyperplasia of the thymus, or the normal thymus. The amount of ethanol injected ranged from 2 to 13 mL, with a mean of 7 mL. RESULTS: CT follow-up at 3-4 weeks showed that the thymus or thymoma was completely or mostly necrotized. CT follow-up at 3 months showed that the vertical, transverse, and anteroposterior dimensions of the thymus in all 45 myasthenia gravis patients decreased by 59.2%, 68.6%, and 73.2%, respectively, compared with those before percutaneous ethanol injection treatment. The therapeutic effect was observable clinically 2 days after treatment in 44 patients, including 36 patients who were able to open their eyes after treatment. A 5-year follow-up study showed that the condition markedly improved in 35 patients, improved in nine patients, and failed to improve in one patient who did not respond to the treatment. After treatment, 37 patients presented with low-grade fever (range, 37.3-37.7 degrees C; mean, 37.5 degrees C), which resolved 3 days later without treatment; all 45 patients complained of mild retrosternal pain after ethanol injection. CONCLUSION: The therapeutic effect of CT-guided percutaneous ethanol injection into the thymus of patients with myasthenia gravis is definite. This procedure is safe and has low morbidity. CT-guided percutaneous ethanol injection is a minimally invasive alternative treatment for myasthenia gravis.