Sonographic features of Lemmel's syndrome: Differential diagnosis from stones in the lower portion of the common bile duct.

BACKGROUND AND STUDY AIMS: Periampullary diverticula (PAD), a location-specific type of duodenal diverticula, can cause serious complications. PAD is difficult to differentially diagnose, mainly due to its nonspecific symptoms. This study aimed to identify sonographic features of PAD and to evaluate their value in the differential diagnosis of PAD from stones in the lower common bile duct (CBD). PATIENTS AND METHODS: A total of 30 patients with PAD and 60 patients with lower CBD stones were retrospectively enrolled, and sonographic features were analyzed. Measurements of sonographic features included echo shaped, posterior echo changes, location and relation to surrounding organs, and status of intrahepatic and extrahepatic bile duct dilation, and their diagnostic performance was assessed. RESULTS: Characteristic sonographic features of PAD were identified, including strong echoes (28/30, 93.3 %), strip shape (28/30, 93.3 %), multiple reflections in the posterior echo (27/30, 90.0 %), and location outside the CBD or near the biliary wall in connection with the duodenum (27/30, 90.0 %). Inter-observer agreement was good (Kappa values = 0.69-0.82). Comparative analysis of sonographic features revealed significant differences in echo shape, posterior echo changes (multiple reflections and acoustic shadowing), location and relation to surrounding organs, and intrahepatic and extrahepatic bile duct dilatation status between the dilatation status of the two groups. In particular, these characteristics achieved a sensitivity of 100 % and a specificity of 98 % for the differential diagnosis of PAD and lower CBD stones. CONCLUSIONS: This study identified characteristic sonographic features of PAD, which could be used as potential diagnostic indicators to distinguish PAD from lower CBD stones.

Anatomical thermal ablation as an alternative to surgical resection for subcapsular hepatocellular carcinoma.

PURPOSE: To simulate the advantages of anatomical resection, a new strategy of anatomical thermal ablation was proposed. The objective of this study was to evaluate the clinical value of anatomical thermal ablation (ATA) to treat subcapsular hepatocellular carcinoma by comparing it with anatomical resection (AR) and non-anatomical resection (NAR). METHODS: This retrospective cohort study enrolled hepatocellular carcinoma patients with subcapsular tumor diameter ≤ 50 mm treated by ATA or surgical resection at our center from October 2015 to December 2018. ATA features ablation of the Glisson capsule, ablation of the liver parenchyma between the tumor and hepatic veins or inferior vena cava and then puncture from the surrounding part to the central part of the tumor. Outcome parameters were compared. RESULTS: Seventy-six patients were grouped into ATA group, 95 patients into AR group and 41 patients into NAR group. The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, 0.0% for ATA group, 0.0%, 1.4%, 1.4% for the AR group and 0.0%, 0.0%, and 0.0% for the NAR group, respectively (P = 0.449). The 1-, 2-, and 3-year progression-free survival rates were 90.6%, 80.9%, and 74.6% for ATA group, 91.5%, 80.2%, and 80.2% for the AR group and 82.9%, 73.8%, and 73.8% for the NAR group, respectively (P = 0.608). The 1-, 2-, and 3-year overall survival rates were 100.0%, 95.2%, and 95.2% for the ATA group, 96.8%, 95.6%, and 95.6% for the AR group and 97.6%, 95.0%, and 95.0% for the NAR group, respectively (P = 0.970). No difference was found in major complication rate among these groups (P = 0.091). CONCLUSION: For subcapsular hepatocellular carcinoma, ATA could be an alternative to surgical resection with its comparable treatment effect and safety.

Thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma with clinically significant portal hypertension: propensity score matching study.

Purpose: The objectives were to investigate the safety and efficacy of thermal ablation as an alternative to liver transplantation for hepatocellular carcinoma patients with clinically significant portal hypertension (CSPH). Materials and Methods: From July 2016 to September 2019, hepatocellular carcinoma patients with CSPH treated by liver transplantation (N=37) or thermal ablation (N=114) were enrolled. Cumulative intrahepatic recurrence, overall survival and major complications were compared by propensity score matching. Results: In the two matched groups, the 1-, 2-, and 3-year intrahepatic recurrence rates for the ablation group (22.3%, 50.0%, and 50.0%, respectively) were significantly higher than those for the transplantation group (4.5%, 4.5%, and 4.5%, respectively) (P=0.016). The 1-, 2-, and 3-year overall survival rates were comparable between the two groups [96.1%, 88.7%, and 88.7%, respectively (ablation group) vs. 84.6%, 76.2%, and 76.2%, respectively (transplantation group)] (P=0.07). The major complication rate for the ablation group [4.8% (3/62)] was significantly lower than that for the transplantation group [36.0% (9/25)] (P<0.001). Conclusions: Thermal ablation is a safe and effective alternative for hepatocellular carcinoma patients with CSPH.

Radiofrequency Ablation of Hepatocellular Carcinomas Adjacent to the Gallbladder Without Isolation Under Contrast-Enhanced Ultrasound Monitoring: A Comparative Study with Long Term Follow-Up.

Objective: This study intends to compare the efficacy and safety between patients undergoing invasive isolation or monitoring measures and patients undergoing intra-operative contrast-enhanced ultrasound (CEUS) monitoring who underwent radiofrequency ablation (RFA) of hepatocellular carcinomas (HCC) adjacent to the gallbladder (GB). Methods: We retrospectively assessed patients with HCC adjacent to the GB who underwent ultrasound-guided RFA. They were divided into two groups: group A was monitored under intra-operative CEUS, while group B was assisted by invasive auxiliary means. The efficacy, complications and survival were followed up and compared. Results: Thirty-eight patients with 39 HCCs were enrolled into group A and 31 patients with 35 HCCs were enrolled into group B. The technique efficacy rates were both 100% in the two groups. There were no significant differences of the cumulative 1-, 3-, and 5-year local tumor progression, tumor-free survival and overall survival between the two groups (P = 0.851, 0.081 and 0.700, respectively). There were no significant differences of major and minor complications rates between the two groups (P = 1.000, 0.994, respectively). More importantly, no GB related complications occurred in group A. Conclusion: Intra-operative CEUS monitoring without protective isolation of the GB might be also a potentially safe and effective method for the RFA of HCC adjacent to the GB, when compared with those assisted with invasive auxiliary means.

FI-CEUS: a solution to improve the diagnostic accuracy in MRI LI-RADS-indeterminate (LR-3/4) FLLs at risk for HCC.

Objective: To evaluate the diagnostic accuracy of fusion imaging contrast-enhanced ultrasound (FI-CEUS) of magnetic resonance imaging (MRI) LI-RADS-indeterminate (LR-3/4) and conventional ultrasound undetected focal liver lesions (FLLs) in patients at risk for hepatocellular carcinoma (HCC). Methods: Between February 2020 and July 2021, 71 FLLs in 63 patients were registered for diagnostic performance evaluation respectively for ultrasound-guided thermal ablation evaluation in this retrospective study. Diagnostic performance regarding FLLs was compared between FI-CEUS and contrast-enhanced MRI (CE-MRI). Results: For diagnostic performance evaluation, among 71 lesions in 63 patients, the diagnostic efficacy of FI-CEUS with LI-RADS was significantly higher than that of CE-MRI (P < 0.05) in both overall and hierarchical comparison (except for the group with lesion diameter ≥2 cm). For malignant lesions, the proportion of arterial phase hyperenhancement (APHE) and washout on FI-CEUS was higher than that on CE-MRI (P < 0.05). Conclusion: FI-CEUS has a high value in the precise qualitative diagnosis of small FLLs (<2 cm) of MRI LI-RADS-indeterminate diagnosis (LR-3/4) that are undetected by conventional ultrasound in patients at risk for HCC and can be a good supplementary CE-MRI diagnostic method for thermal ablation evaluation.

The frequency and risk factors of major complications after thermal ablation of liver tumours in 2,084 ablation sessions.

Background: To assess the frequency of major complications after thermal ablation of liver tumours and to determine risk factors for adverse events. Methods: A retrospective study was conducted between January 2015 and January 2021. A total of 2,084 thermal ablation sessions in 1,592 patients with primary and metastatic liver tumours were evaluated. The frequency of major complications was evaluated according to the Society of Interventional Radiology Standards, and putative predictors of adverse events were analysed using simple and multivariate logistic regression. Results: Thermal ablation-related mortality was 0.1% (2/2,084), with an overall major complication rate of 5.6% (117/2,084). The most frequent major complication was symptomatic pleural effusion (2.9%, 60/2,084). Multivariate logistic regression analysis revealed that a total maximum diameter of lesions >3 cm, microwave ablation (MWA) and MWA combined with radiofrequency ablation, intrahepatic cholangiocarcinoma and postoperative systemic inflammatory response syndrome were independent prognostic factors for major complications. Conclusions: Thermal ablation of liver tumours is a safe procedure with an acceptable incidence of major complications. The risk factors identified in this study will help to stratify high-risk patients.

Prevention of major biliary complications by fusion imaging for thermal ablation of malignant liver tumors adjacent to the bile ducts: a preliminary comparative study.

PURPOSE: Ultrasound (US)-guided thermal ablation (TA) may cause major biliary complications, particularly in patients with malignant liver tumors (MLTs) adjacent to the bile ducts. Fusion imaging (FI), is postulated to reduce complication rate; however, there is a lack of clinical data to support this theory. Thus, the aim of our study was to evaluate the safety and efficacy of FI for TA of MLTs proximal to the bile ducts. METHODS: A retrospective single-center review was conducted on a total of 289 patients with 316 MLTs adjacent to the bile ducts. The patients were divided into two groups based on whether FI was used in the ablation procedures. The choice of the FI-assisted procedure always depends on different operation periods and whether registrations will succeed. The baseline demographics and outcomes of these patients were compared. The efficacy was determined at the 1-month follow-up using contrast-enhanced computed tomography/magnetic resonance. Biliary complications and local tumor progression were subsequently followed-up every 3-6 months. The last follow-up visit was before August 30, 2019. RESULTS: Among the included tumors, the incidence rate of major biliary complications after ablation in the FI group was 1.6%, which was significantly lower than that in the non-FI group (7.9%, p = 0.005). There was no significant difference in the efficacy rates of the techniques [99.5% (185/186) versus 98.4% (123/125), p = 0.56] or local progression rates [3.8% (7/185) versus 5.7% (7/123), p = 0.61] between the FI and non-FI groups. CONCLUSION: FI for US-guided TA could be a noninvasive means to decrease major biliary complications. Trial registration number and date of registration: retrospectively registered.

Comparison of anatomical thermal ablation and routine thermal ablation for hepatocellular carcinoma≤50 mm: A propensity score matching.

AIM: The present study was to evaluated the clinical value of anatomical thermal ablation to treat hepatocellular carcinoma compared with routine thermal ablation. METHODS: Hepatocellular carcinoma patients with tumor diameter ≤50 mm treated by thermal ablation at our center were retrospectively enrolled from October 2015 to December 2018. Enrolled patients were grouped into the anatomical ablation group and routine ablation group, respectively. To minimize the effects of potential confounders from selection bias, a propensity score matching was carried out. Technical efficacy, recurrence and survivals rates were compared. RESULTS: Altogether 101 patients (119 lesions) were grouped into the anatomical ablation group and 101 patients (131 lesions) into the routine ablation group. The ablation zone volume of the anatomical ablation group was 36.8 (2.5-176.9) ml, significantly larger than that of the routine ablation group (28.5 [28.5 (2.8-184.3) ml] (p = 0.005)). Adjusted with propensity score matching, The 1-, 2-, and 3-year local recurrence rates were 0.0%, 0.0%, and 0.0% for the anatomical ablation group and 6.9%, 10.1%, and 10.1% for the routine ablation group, respectively (p = 0.013). The cumulative 1-, 2-, and 3-year progression-free survival rates were 93.4%, 82.7%, and 79.0% for the anatomical ablation group, 74.2%, 56.9%, and 51.6% for the routine ablation group (p = 0.001). CONCLUSIONS: Anatomical ablation could be a favorable ablation strategy to improve therapeutic effect of thermal ablation for HCC with visible feeding vessels and reserved liver function.

An Optimal Ablative Margin of Small Single Hepatocellular Carcinoma Treated with Image-Guided Percutaneous Thermal Ablation and Local Recurrence Prediction Base on the Ablative Margin: A Multicenter Study.

OBJECTIVE: To explore the best ablative margin (AM) for single hepatocellular carcinoma (HCC) patients with image-guided percutaneous thermal ablation (IPTA) based on MRI-MRI fusion imaging, and to develop and validate a local tumor progression (LTP) predictive model based on the recommended AM. METHODS: Between March 2014 and August 2019, 444 treatment-naïve patients with single HCC (diameter ≤3 cm) who underwent IPTA as first-line treatment from three hospitals were included, which were randomly divided into training (n= 296) and validation (n = 148) cohorts. We measured the ablative margin (AM) by MRI-MRI fusion imaging based on pre-ablation and post-ablation images. Then, we followed up their LPT and verified the optimal AM. Risk factors related to LTP were explored through Cox regression models, the nomogram was developed to predict the LTP risk base on the risk factors, and subsequently validated. The predictive performance and discrimination were assessed and compared with conventional indices. RESULTS: The median follow-up was 19.9 months (95% CI 18.0-21.8) for the entire cohort. The results revealed that the tumor size (HR: 2.16; 95% CI 1.25-3.72; P = 0.003) and AM (HR: 0.72; 95% CI, 0.61-0.85; P < 0.001) were independent prognostic factors for LTP. The AM had a pronounced nonlinear impact on LTP, and a cut-off value of 5-mm was optimal. We developed and validated an LTP predictive model based on the linear tumor size and nonlinear AM. The model showed good predictive accuracy and discrimination (training set, concordance index [C-index] of 0.751; validation set, C-index of 0.756) and outperformed other conventional indices. CONCLUSION: The 5-mm AM is recommended for the best IPTA candidates with single HCC (diameter ≤3 cm). We provided an LTP predictive model that exhibited adequate performance for individualized prediction and risk stratification.

A novel prognostic nomogram for hepatocellular carcinoma after thermal ablation.

It remains impossible to accurately assess the prognosis after thermal ablation in patients with hepatocellular carcinoma (HCC). Our aim was to build a nomogram to predict the survival rate of HCC patients after thermal ablation. We developed and validated a nomogram using data of 959 HCC patients after thermal ablation from two centers. Harrell's concordance index (C-index), calibration plot and Decision curve analysis (DCA) were used to measure the performance of the nomogram, and we compared it with the Barcelona Clinic Liver Cancer (BCLC) staging system and a previous nomogram. Six variables including age, serum albumin, operation method, risk area, tumor number and early recurrence were selected to construct the nomogram. In the training cohort, internal validation cohort, and external validation cohort, the nomogram all had a higher C-index to predict survival rate than both the BCLC staging system and the previous nomogram (0.736, 0.558 and 0.698, respectively; 0.763, 0.621 and 0.740, respectively; and 0.825, 0.551 and 0.737, respectively). Calibration plots showed a high degree of consistency between prediction and actual observation. Decision curve analysis (DCA) presented that compared with BCLC system and the previous nomogram, our nomogram had the highest net benefit. In all three cohorts, the nomogram could accurately divide patients into three subgroups according to predicted survival risk. A nomogram was developed and validated to predict survival of HCC patients who underwent thermal ablation, which is helpful for prognostic prediction and individual surveillance in clinical practice.

Case Report: Ultrasound-Guided Percutaneous Microwave Ablation of Focal Nodular Hyperplasia in a 9-Year-Old Girl.

Focal nodular hyperplasia (FNH) is a rare benign tumor-like space-occupying lesion of the liver that is especially rare in children. Since there have been no reports of malignant progression of this disease and these lesions remain unchanged for a long period of time or even disappear in some cases, it remains controversial whether clinical treatment is needed. However, if the diagnosis is unclear, the patient has symptoms or the lesion becomes enlarged during follow-up, clinical treatment should be considered. Here, we report the first case of FNH near the gallbladder treated by ultrasound-guided percutaneous microwave ablation (MWA) in a 9-year-old girl.

Utility of Fusion Imaging for Percutaneous Thermal Ablation of Hepatocellular Carcinoma in the Caudate Lobe.

The treatment outcomes of ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma in the caudate lobe with and without fusion imaging (FI) assistance were evaluated and compared. Twenty-six patients with 28 tumors in the FI group and 8 patients with 8 tumors in the non-FI group were included. Although a higher number of tumors measured >20 mm in the FI group, the technique efficacy and local tumor progression were similar between the 2 groups (P > .99 and P = .45, respectively). FI aided in the detection, guidance, and treatment monitoring of thermal ablation for caudate lobe hepatocellular carcinomas, especially for tumors measuring >20 mm.

Thermal ablation of medium-sized hepatocellular carcinomas using intraoperative ultrasound fusion imaging: A propensity score-matched analysis.

OBJECTIVE: To explore the value of ultrasound fusion imaging for the thermal ablation of medium-sized hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: From December 2010 to June 2018, patients with medium-sized (3.1-5.0cm) HCCs who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) with the assistance of ultrasound fusion imaging were enrolled in this retrospective study. Technical efficacy, local tumor progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS), tumor-free survival (TFS) and major complications were evaluated during the follow-up period. The therapeutic outcomes were compared between the RFA/MWA combined with trans-arterial chemoembolization (TACE) group and the RFA/MWA alone group with propensity-score matching (PSM) analysis. RESULTS: A total of 112 patients with 115 medium-sized HCCs were finally enrolled in this study. The median duration of follow-up was 33 months (range, 2-104 months). The technique efficacy was 100% (115/115). The 1-, 3-, 5-year OS rates and TFS rates were 95.5%, 76.7%, 71.5% and 74.1%, 48.7%, 41.8%, respectively. The corresponding LTP rates and IDR rates were 5.4%, 7.3%, 7.3% and 21.8%, 46.9%, 50.3%, respectively. The incidence of major complications was 5.4% (6/112). After PSM analysis (19 patients in each group), the therapeutic outcomes, including the OS, TFS, and LTP rates, were comparable in the two groups (P > 0.05). CONCLUSIONS: With the assistance of ultrasound fusion imaging, thermal ablation of medium-sized HCC could achieve a satisfactory local control rate and long-term survival. The outcomes were comparable in the stratified analysis between the RFA/MWA alone group and the RFA/MWA+TACE group after PSM analysis.

Improving Ablation Safety for Hepatocellular Carcinoma Proximal to the Hilar Bile Ducts by Ultrasound-MR Fusion Imaging: A Preliminary Comparative Study.

AIM: To explore whether ablation safety could be improved by ultrasound (US)-magnetic resonance (MR) fusion imaging for hepatocellular carcinoma (HCC) proximal to the hilar bile ducts (HBDs) through a preliminary comparative study. METHODS: Between January 2014 and June 2019, 18 HCC nodules proximal to the HBDs were included in a US-MR fusion imaging-assisted radiofrequency ablation (RFA) group (study group), while 13 HCC nodules in a similar location were included as a control group. For the study group, the tumor and adjacent bile ducts were outlined on preprocedural MR images. Procedural ablation planning was conducted to assess the feasibility of ablating the tumors while avoiding biliary injury. Such tumors were then ablated under US-MR fusion imaging guidance. The control group nodules were ablated under conventional ultrasound guidance. Baseline characteristics and outcomes were compared between the groups. RESULTS: After preprocedural assessment, 14 of 18 patients with tumors that were feasible to ablate underwent US-MR fusion imaging-assisted RFA. No biliary complications were observed in these 14 patients; the complication rate was significantly lower in the study group than in the control group (30.8%, 4/13) (P = 0.041). There was no significant difference in the technique efficacy rates [92.9% (13/14) versus 100% (13/13), P = 1] or local progression rates [7.1% (1/14) versus 7.7% (1/13), P = 1] between the study and control groups. CONCLUSIONS: US-MR fusion imaging may be a non-invasive means for assisting RFA of HCC nodules proximal to the HBDs and ensuring ablation safety.

Dynamic Contrast-Enhanced Ultrasound Radiomics for Hepatocellular Carcinoma Recurrence Prediction After Thermal Ablation.

PURPOSE: To develop a radiomics model based on dynamic contrast-enhanced ultrasound (CEUS) to predict early and late recurrence in patients with a single HCC lesion ≤ 5 cm in diameter after thermal ablation. PROCEDURES: We enrolled patients who underwent thermal ablation for HCC in our hospital from April 2004 to April 2017. Radiomics based on two branch convolution recurrent network was utilized to analyze preoperative dynamic CEUS image of HCC lesions to establish CEUS model, in comparison to the conventional ultrasound (US), clinical, and combined models. Clinical follow-up of HCC recurrence after ablation were taken as reference standard to evaluate the predicted performance of CEUS model and other models. RESULTS: We finally analyzed 318 patients (training cohort: test cohort = 255:63). The combined model showed better performance for early recurrence than CUES (in training cohort, AUC, 0.89 vs. 0.84, P < 0.001; in test cohort, AUC, 0.84 vs. 0.83, P = 0.272), US (P < 0.001), or clinical model (P < 0.001). For late recurrence prediction, the combined model showed the best performance than the CEUS (C-index, in training cohort, 0.77 vs. 0.76, P = 0.009; in test cohort, 0.77 vs. 0.68, P < 0.001), US (P < 0.001), or clinical model (P < 0.001). CONCLUSIONS: The CEUS model based on dynamic CEUS radiomics performed well in predicting early HCC recurrence after ablation. The combined model combining CEUS, US radiomics, and clinical factors could stratify the high risk of late recurrence.

Feasibility of 3D US/CEUS-US/CEUS fusion imaging-based ablation planning in liver tumors: a retrospective study.

PURPOSE: To assess the feasibility of ablation planning based on fusion imaging of three-dimensional ultrasound/contrast-enhanced ultrasound (3D US/CEUS) with real-time US/CEUS for liver tumor thermal ablation. MATERIALS AND METHODS: Between January 2017 and December 2018, 85 hepatic tumors from 82 patients who underwent percutaneous ablation were included. First, intraprocedural 3D US/CEUS imaging was performed for ablation planning. Then, fusion imaging of 3D US/CEUS with real-time US/CEUS was used to guide the implementation of the plan, immediately evaluate the technical success and indicate the need for supplemental ablation. In addition, contrast-enhanced CT/MR imaging was performed 1 month after the procedure to evaluate the presence of residual tumors, and follow-up scans were repeated every 3 months. RESULTS: The average liver tumor diameter was 28 ± 9 mm (range, 10-55 mm). 3D US/CEUS-based planning was successfully conducted in all 85 tumors with a 100% technical success rate of planning. The immediate evaluation by 3D CEUS/US-CEUS fusion imaging showed a 100% technical success rate of ablation. The 1-month CT/MR scans found a residual tumor in one intrahepatic cholangiocarcinoma patient; the technique efficacy rate was 98.8%. The median follow-up period was 21.5 months (IQR: 4-36 months). During the follow-up period, the local tumor progression rate was 5.9% (5/84), and no major procedure-related complications occurred. CONCLUSIONS: Ablation planning based on 3D US/CEUS-US/CEUS fusion imaging is feasible for liver tumors.

Intra-Procedural CT/MR-Ultrasound Fusion Imaging Helps to Improve Outcomes of Thermal Ablation for Hepatocellular Carcinoma: Results in 502 Nodules.

PURPOSE: The aim was to assess the value of intra-procedural CT/MR-ultrasound (CT/MR-US) fusion imaging in the management of thermal ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board. From May 2010 to October 2016, 543 HCC nodules in 440 patients (387 men and 53 women; age range: 25-84 years) that met the Milan Criteria were treated by percutaneous thermal ablation using intra-procedural CT/MR-US fusion imaging. The HCC nodules were divided into subgroups and compared (≤ 3 cm and > 3 cm, or high-risk and low-risk location, or inconspicuous and conspicuous, respectively). Technique efficacy and major complication were calculated. Cumulative local tumor progression (LTP), tumor-free and overall survival rates were estimated with the Kaplan-Meier method. RESULTS: CT/MR-US fusion imaging was successfully registered in 419 patients with 502 nodules. The technique efficacy rate of thermal ablation was 99.4 %. The major complication rate was 1.9 %. The cumulative LTP rates were 3.2 %, 5.6 % and 7.2 % at 1, 3, and 5 years, respectively. There were no significant differences for the comparisons of cumulative LTP rates between different subgroups (P = 0.541, 0.314, 0.329). The cumulative tumor-free survival rates were 74.8 %, 54.0 % and 37.5 % at 1, 3, and 5 years, respectively. The cumulative overall survival rates were 97.8 %, 87.1 % and 81.7 % at 1, 3, and 5 years, respectively. CONCLUSION: Intra-procedural CT/MR-ultrasound fusion imaging is a useful technique for percutaneous liver thermal ablation. It could help to achieve satisfying survival outcomes for HCC patients who meet the Milan Criteria.

Transcholecystic Contrast-Enhanced Ultrasound-Guided Percutaneous Transhepatic Biliary Drainage for Central Bile Duct Protection During Thermal Tumor Ablation.

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.

Intra-procedural real-time ultrasound fusion imaging improves the therapeutic effect and safety of liver tumor ablation in difficult cases.

In certain difficult cases involving tumors unclear in B-mode ultrasound or tumors in a high-risk location, image-guided liver tumor thermal ablation was previously contraindicated. The aim of this retrospective study was to investigate the value of intra-procedural ultrasound fusion imaging in improving the therapeutic effect and safety of liver tumor ablation in difficult cases. A total of 502 patients (441 males and 61 females, aged 52 ± 11 years) with 805 liver tumors (16 ± 6 mm; range, 4-29 mm) who underwent thermal ablation with intra-procedural fusion imaging from October 2010 to June 2018 in our hospital were enrolled. Fusion imaging was employed for targeting, puncture guidance and immediate evaluation of the therapeutic response. Contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) was performed one month after ablation and every 3~6 months in the follow-up period. 511 and 294 liver tumors were in classified in the difficult case group and the non-difficult case group, respectively. The technical efficacy rate was 99.4% (800/805), and no difference was found between the two groups (P=0.658). No significant difference in the local tumor progression rate was found between the difficult case group (1 year: 3.2%; 3 years: 7.6%; 5 years: 7.6%) and non-difficult case group (1 year: 2.1%; 3 years: 5.5%; 5 years: 11.6%) (P=0.874). The major complication rate was 1.8% (11/608). Injury to adjacent organs occurred in only 1 patient who sustained a bile duct injury. We conclude that intra-procedural fusion imaging can improve the therapeutic efficacy and safety of thermal ablation in difficult cases and may expand the indications for thermal ablation.

Value of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery.

BACKGROUND: To evaluate the feasibility and effectiveness of artificial ascites to assist thermal ablation of liver cancer adjacent to the gastrointestinal tract in patients with previous abdominal surgery. METHODS: Thirty-nine patients with a total of 40 liver malignant tumors were enrolled between January 2016 and June 2019. All had histories of hepatectomy, splenectomy, cholecystectomy, and intestinal surgery. The distance between the tumor and the gastrointestinal tract was < 5 mm. Normal saline was used as artificial ascites to protect the gastrointestinal tract during thermal ablation. The success rate of the procedure, incidence of major complications, and the technical efficacy of ablation were recorded. Patients were followed for local tumor progression (LTP), and overall survival (OS). RESULTS: The use of artificial ascites was successful in 38 of the 40 procedures (95%). Major complications occurred in two of the 39 patients (5.1%) following the procedure. One was an intestinal fistula that occurred in a failed case and was associated with an infection. The other was a liver abscess that occurred in a successful case. The technical efficacy of ablation was 100% (40/40 procedures). The median follow-up was 16 months. The 1-, 2-, and 3-year LTP rates were 2.9, 5.7 and 5.7%. The 1-, 2-, and 3-year OS rates were 97.1, 86.8 and 69.5%. CONCLUSION: In patients with previous abdominal surgery, artificial ascites is feasible and effective for assisting thermal ablation of liver cancer adjacent to the gastrointestinal tract.