Chinese expert consensus of image-guided irreversible electroporation for pancreatic cancer.

Pancreatic cancer (PC) is a lethal disease with extremely high mortality. Although surgical resection is the optimal therapeutic approach for PC, about 30%-40% of those patients are not candidates for surgical resection when diagnosed. Chemotherapy and radiotherapy also could not claim a desirable effect on PC. The application of interventional radiology approaches is limited by unavoidable damage to the surrounding vessels or organs. By the superiority of mechanism and technology, IRE could ablate the tumor by creating irreversible pores on the membrane of PC cells with other tissues like vessels and pancreatic ducts untouched. This consensus gathers the theoretical basis and clinical experience from multiple Chinese medical centers, to provide the application principles and experience from Chinese experts in the IRE field.

CT-guided conformal cryoablation for peripheral NSCLC: initial experience.

PURPOSE: To study the feasibility of CT-guided and monitored percutaneous conformal cryoablation of Non-Small Cell Lung Cancer for patients who are not suitable for surgical resection. MATERIALS AND METHOD: CT-guided percutaneous conformal cryoablation was performed on 46 patients with peripheral Non-Small Cell Lung Cancer. Patients with tumor sizes less than 3 cm in diameter were treated with double-needle clamping cryoablation, while the patients with 3-5 cm tumor sizes were treated with multiple-needle conformal cryoablation. CT was used to monitor the extent of cryoablation during the procedures. At month 1, 3, 6, 12, and 24 post-procedure, enhanced CT scans and/or PET-CT scans were performed to evaluate the impact of the therapy. RESULTS: The average tumor CT values were 32±10 HU and -21±8 HU before and after cryoablation, respectively. The largest diameters of the lesions at month 1, 3, 6, 12, and 24 post-procedure were 2.63±0.56 cm, 1.93±0.51 cm, 1.55±0.39 cm, 1.43±0.40 cm, and 1.38±0.38 cm, respectively, in patients with tumor diameter less than 3 cm, and 3.63±0.39 cm, 2.98±0.31 cm, 2.62±0.32 cm, 2.54±0.34 cm, and 2.56±0.37 cm respectively in patients with the tumor diameters between 3 and 5 cm. At the 24th month, there were 36 cases of complete response (83.7%), 7 cases of partial response (16.3%), and no cases of stable disease or progressive disease. 3 patients died due to multiple metastases. CONCLUSION: CT-guided percutaneous conformal cryoablation is a safe, effective, and minimally invasive therapeutic method for peripheral lung cancer.

CT-guided percutaneous chemical ablation of adrenal neoplasms.

OBJECTIVE: The objective of our study was to evaluate the feasibility and effectiveness of percutaneous chemical ablation of primary and metastatic adrenal neoplasms under CT guidance. MATERIALS AND METHODS: Thirty-seven patients with 46 adrenal tumors underwent CT-guided percutaneous chemical ablation. The average (+/- SD) tumor diameter was 4.2 +/- 2.0 cm. Acetic acid was injected in lesions with a diameter of more than 3 cm, and ethanol was injected in lesions with a diameter of less than 3 cm. Eleven adrenal lesions were nonfunctional adenomas, six lesions were corticosteroid adenomas (bilateral lesions in one patient), nine lesions were aldosteronomas (bilateral lesions in two patients), and 20 were metastases (bilateral metastases in six patients). RESULTS: Tumor volume decreased gradually during the first 2 years after the procedure. For primary tumors, a complete response (CR) rate of 92.3% (24/26) and a partial response (PR) rate of 7.7% (2/26) were obtained, but for metastasis, a CR rate of 30% (6/20) and PR rate of 70% (14/20) were obtained 24 months after therapy. The level of corticosteroid in five patients (six tumors) with Cushing's syndrome was in the normal range 3 months after the procedure. Seven patients (nine tumors) with Conn's syndrome began receiving oral antihypertensive medications during the first month after the procedure to maintain normal blood pressure and the dose was gradually decreased after 1 month. No severe complications were encountered. CONCLUSION: CT-guided percutaneous chemical ablation of adrenal tumors is an effective, minimally invasive, and easily performed procedure.

Hepatic perfusion disorders: etiopathogenesis and related diseases.

In this article, we have reviewed the hepatic perfusion disorder (HPD), etiopathogenesis of HPD and corresponding diseases. Review of the literature was based on computer searches (PubMed, Index Medicus) and personal experiences. We considered HPD reflects perfusion differences due to redistribution of arterial blood flow among segments, subsegments and lobes of the liver. The plain CT scan findings of HPD manifests as triangular or wedge-shaped areas of low attenuation. On contrast-enhanced CT scan, HPD manifests multiple (or single) transient wedge-shaped, rotundloid or irregular appearance, homogeneous hyperattenuation (in less cases, hypoattenuation) during the hepatic arterial phase (HAP) and isoattenuated or slightly hyperattenuated areas during the portal arterial phase. Dynamic enhanced magnetic resonance (MR) features are similar to enhanced CT scan. Angiographic findings include non-opacification of portal vein on portograms or wedge-shaped segmental staining in arterial and parenchymal phases on hepatic angiograms. The causes of HPD are arterioportal shunts (APS), intrahepatic vascular compressions and portal vein occlusion, steal phenomenon by hypervascular tumors, vascular variations and any other unknown reasons. It is very important for radiologists to be familiar with the various appearances of HPD to avoid false-positive diagnosis of pseudolesions and not to overestimate the extent of the disease.