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Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

World Journal of Gastroenterology 2009年第21期15卷 2638-2643页

作者： yi-bin hou min-hua chen kun yan jin-yu wu wei yang Ultrasound Department Peking University School of Oncology Cancer Hospital & Institute No. 52 Fucheng Road Haidian District Beijing 100142 China

AIM:To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation(RFA) of the feeding artery of hepatocellular carcinoma(HCC) in reducing the blood-flow-induced heat-sink effect of ***:A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two ***-one patients with 75 HCCs(average tumor size,4.3 ± 1.1 cm) were included in group A,in which the feeding artery of HCC was identified by color Doppler flow imaging,and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery(PAA)] before routine RFA treatment of the ***-three patients with 102 HCC(average tumor size,4.1 ± 1.0 cm) were included in group B,in which the tumors were treated routinely with ***-enhanced computed tomography was used as post-RFA imaging,when patients were followed-up for 1,3 and 6 ***:In group A,feeding arteries were blocked in 66(88%) HCC lesions,and the size of arteries decreased in nine(12%).The average number of punctures per HCC was 2.76 ± 1.12 in group A,and 3.36 ± 1.60 in group B(P = 0.01).The tumor necrosis rate at 1 mo post-RFA was 90.67%(68/75 lesions) in group A and 90.20%(92/102 lesions) in group *** recur-rence rate at 6 mo post-RFA was 17.33%(13/75) in group A and 31.37%(32/102) in group B(P = 0.04).CONCLUSION:PAA blocked effectively the feeding artery of *** of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC.

关键词： Hepatocellular carcinoma Feeding artery Radiofrequency ablation Recurrence Color Dopplerflow imaging

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Radiofrequency Ablation for Postoperative Recurrences of Intrahepatic Cholangiocarcinoma

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Chinese Journal of Cancer Research 2011年第4期23卷 295-300页

作者： ying Fu wei yang wei wu kun yan Bao-cai Xing min-hua chen Key Laboratory of Carcinogenesis and Translational Research (ministry of Education) 1Department of Ultrasound Department of Surgery Peking University School of Oncology Beijing Cancer Hospital & Institute Beijing 100142 China

Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients’ survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. Methods: A total of 12 patients with 19 RICCs after radical resection were included in this study. The tumors were 1.9–6.8 cm at the maximum diameter (median, 3.2±1.6 cm). All patients were treated with ultrasound guided RFA. There were two RFA approaches including percutaneous and open. Results: A total of 18 RFA treatment sessions were performed. Ablation was successful (evaluated by 1-month CT after the initial RFA procedure) in 18 (94.7%) of 19 tumors. By a median follow-up period of 29.9 months after RFA, 5 patients received repeated RFA because of intrahepatic lesion recurrence. The median local recurrence-free survival period and median event-free survival period after RFA were 21.0 months and 13.0 months, respectively. The median overall survival was 30 months, and the 1- and 3-year survival rates were 87.5% and 37.5%, respectively. The complication rate was 5.6% (1/18 sessions). The only one major complication was pleural effusion requiring thoracentesis. Conclusion: This study showed RFA may effectively and safely manage RICC with 3-year survival of 37.5%. It provides a treatment option for these RICC patients who lost chance for surgery.

关键词： Intrahepatic cholangiocarcinoma Hepatectomy Recurrence Radiofrequency ablation Survival

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Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

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World Journal of Gastroenterology 2020年第9期26卷 960-972页

作者： Xiao-Feng wu Xiu-Mei Bai wei yang yu Sun Hong Wang wei wu, min-hua chen kun yan Key Laboratory of Carcinogenesis and Translational Research(ministry of Education/Beijing) Department of UltrasoundPeking University Cancer Hospital&InstituteBeijing 100142China Key laboratory of Carcinogenesis and Translational Research(ministry of Education/Beijing) Department of PathologyPeking University Cancer Hospital&InstituteBeijing 100142China

BACKGROUND In clinical practice,the diagnosis is sometimes difficult with contrast-enhanced ultrasound(CEUS)when the case has an atypical perfusion *** parametric imaging(CPI)is an analysis software for CEUS with better detection of temporal differences in CEUS imaging using arbitrary *** measures the differences in arrival time of the contrast agent in lesions so that the perfusion features of atypical hemangioma and colorectal cancer(CRC)liver metastasis can be *** To evaluate the role of a novel type of CPI of CEUS in the differential diagnosis of atypical hemangioma from liver metastases in patients with a history of *** From January 2016 to July 2018,42 patients including 20 cases of atypical hemangioma and 22 cases of liver metastases from CRC were *** patients had a mean age of 60.5±9.3 years(range:39-75 years).All patients received ultrasound,CEUS and CPI *** and staff radiologists independently and retrospectively reviewed CEUS and CPI *** sets of criteria were assigned:(1)Routine CEUS alone;and(2)CEUS and *** diagnostic sensitivity,specificity,accuracy and receiver operating characteristic(ROC)curve of resident and staff radiologists were *** The following CPI features were significantly different between liver hemangioma and liver metastases analyzed by staff and resident radiologists:Peripheral nodular enhancement(65%-70.0%vs 4.5%-13.6%,P<0.001,P=0.001),mosaic/chaotic enhancement(5%-10%vs 68.2%-63.6%,P<0.001,P<0.001)and feeding artery(20%vs 59.1%-54.5%,P=0.010,P=0.021).CPI imaging offered significant improvements in detection rates compared with routine CEUS in both resident and staff *** resident radiologists,the specificity and accuracy of CEUS+CPI were significantly increased compared with that of CEUS(77.3%vs 45.5%,P=0.030;78.6%vs 50.0%,P=0.006).In addition,the area under the curve(AUC)of CEUS+CPI was significantly higher than that of CEUS(0.803 vs 0.757,

关键词： Color parametric imaging Contrast enhanced ultrasound Liver hemangioma Liver metastases

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Radiofrequency ablation of hepatocellular carcinoma in difficult locations:Strategies and long-term outcomes

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World Journal of Gastroenterology 2015年第5期21卷 1554-1566页

作者： wei yang kun yan Gong-Xiong wu wei wu ying Fu Jung-Chieh Lee Zhong-yi Zhang Song Wang min-hua chen Department of Ultrasound Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and Institute Research Division Joslin Diabetes CenterHarvard Medical SchoolBostonMA 02215United States Department of Cardiovascular The Second Hospital Affiliated to Guangzhou Medical UniversityGuangzhou Institute of Cardiovascular Disease

AIM:To investigate the treatment strategies and longterm outcomes of radiofrequency ablation(RFA) of hepatocellular carcinoma(HCC) in difficult locations and to compare the results with non-difficult ***:From 2004 to 2012,a total of 470 HCC patients underwent ultrasound-guided percutaneous *** these HCC patients,382 with tumors located ≤ 5 mm from a major vessel/bile duct(n = 87),from peripheral important structures(n = 232) or from the liver capsule(n = 63) were regarded as difficult *** were 331 male patients and 51 female patients,with an average age of 55.3 ± 10.1 years old.A total of 235 and 147 patients had ChildPugh class A and class B liver function,*** average tumor size was 3.4 ± 1.2 *** treatment strategies were developed to treat these difficult *** the same period,88 HCC patients with tumors that were not in difficult locations served as the control *** the control group,74 patients were male,and 14 patients were female,with an average age of 57.4 ± 11.8 years *** these,62 patients and 26 patients had Child-Pugh class A and class B liver function,*** follow-up after RFA was performed to assess treatment *** results were generated from Kaplan-Meier estimates,and multivariate analysis was performed using the Cox regression ***:Early tumor necrosis rate in the difficult group was similar to that in the control group(97.6% vs 94.3%,P = 0.080).The complication rate in the difficult group was significantly higher than that in thecontrol group(4.9% vs 0.8%,P = 0.041).The followup period ranged from 6 to 116 mo,with an average of 28 ± 22.4 *** progression rate in the difficult group was significantly higher than that in the control group(12.7% vs 7.1%,P = 0.046).However,the 1-,3-,5-,and 7-year overall survival rates in the difficult group were not significantly different from those in the control group(84.3%,54.4%,41.2%,and 29.9% vs 92.5%,60.3%,43.2%,and

关键词： Radiofrequency ablation Ultrasound guidance Hepato

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Ten-year survival of hepatocellular carcinoma patients undergoing radiofrequency ablation as a first-line treatment

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World Journal of Gastroenterology 2016年第10期22卷 2993-3005页

作者： wei yang kun yan S Nahum Goldberg Muneeb Ahmed Jung-Chieh Lee wei wu Zhong-yi Zhang Song Wang min-hua chen Key Laboratory of Carcinogenesis and Translational Research (ministry of Education) Department of UltrasoundPeking University Cancer Hospital and Institute Division of Image-guided Therapy Department of RadiologyHadassah Hebrew University Medical Center Laboratory for minimally Invasive Tumor Therapies Department of RadiologyBeth Israel Deaconess Medical Center/Harvard Medical School

AIM: To investigate the long-term survival and prognostic factors in hepatocellular carcinoma (HCC) patients undergoing radiofrequency ablation (RFA) as a first-line ***: From 2000 to 2013, 316 consecutive patients with 404 HCC (1.0-5.0 cm; mean: 3.2 ± 1.1 cm) underwent ultrasonography-guided percutaneous RFA as a first-line treatment. There were 250 males and 66 females with an average age of 60.1 ± 10.8 years (24-87 years). Patients were followed for 1 year to > 10 years after RFA (234, 181, 136, and 71 for 3, 5, 7, and 10 years, respectively). Overall local response rates and long-term survival rates were assessed. Survival results were generated using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression ***: In total, 548 RFA sessions were performed and major complications occurred in 10 sessions (1.8%). Local tumor progression and/or new tumor development were observed in 43.3% (132/305) of the patients during the follow-up period. Overall 5- and 10-year survival rates were 49.7% and 28.4%, respectively. Based on multivariate analysis, three factors were identified as independent prognostic factors for overall survival: Child-Pugh classification (HR = 4.054, P hout portal vein hypertension.

关键词： Radiofrequency ablation Hepatocellular carcinoma Percutaneous Ultrasonography-guided Long term survival

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Intrahepatic biliary injuries associated with radiofrequency ablation of hepatic malignancies

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Chinese Medical Journal 2011年第13期124卷 1957-1963页

作者： FU ying yang wei wu jin-yu yan kun wu wei XING Bao-cai chen min-hua Department of Ultrasound Key Laboratory of Carcinogenesis and Translational Research (Ministryof Education) Peking University Cancer Hospital & InstituteBeijing 100142 China Department of Oncology Surgery Key Laboratory of Carcinogenesis and Translational Research (Ministryof Education) Peking University Cancer Hospital & InstituteBeijing 100142 China

Background Biliary injury after radiofrequency ablation can cause serious consequences including death. However, there are limited data regarding bile duct changes with or without complications associated with radiofrequency ablation of hepatic malignancies. This study aimed to assess the incidence, prognosis and risk factors of intrahepatic biliary injury associated with radiofrequency ablation. Methods Between June 2001 and January 2009, 638 patients with hepatic malignancies （405 with hepatocellular carcinoma, and 233 with liver metastasis） who had 955 treatment sessions were enrolled in this study. Imaging and laboratory data, the course of treatment, and patient outcomes were reviewed retrospectively. The risk factors of biliary injury and the impact on overall survival of patients were analyzed. The chi-square test, Fisher＇s exact test, Kaplan-Meier curves and stepwise Logistic regression model were used for statistical analysis where appropriate. Results Biliary injury was observed in 17 patients after 17 ablation sessions based on imaging findings. The overall incidence of biliary injury was 1.8% （17/955） with an average onset time of 12 weeks （2-36 weeks）. Mild, moderate and severe complications of biliary injury were identified in 9, 6 and 2 cases, respectively. The median survival time after detection of biliary injury was 40 months. There seemed no notable difference in overall survival between patients with and those without biliary injuries. By multivariate analysis, vessel infiltration （P=-0.034） and treatment session 〉4 times （P=0.025） were independent risk factors for biliary injury of hepatocellular carcinoma; while tumor located centrally was the only independent risk factor in the metastasis group （P=0.043）. Conclusions The incidence of biliary injury was not frequent （1.8%）. Through appropriate treatment, intrahepatic bile duct injuries seemed not affect the patients＇ long-term survival. Additionally, risk factors may be helpful for selecting ra

关键词： hepatic malignancy radiofrequency ablation biliary tract injury complications

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Role of Contrast Enhanced Ultrasound in Radiofrequency Ablation of Metastatic Liver Carcinoma

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Chinese Journal of Cancer Research 2012年第1期24卷 44-51页

作者： jin-yu wu min-hua chen wei yang Shu-zhi Lin wei wu Shan-shan yin HuiZhang kun yan Department of Ultrasound Harbin First HospitalHarbin 150010China Key Laboratory of Carcinogenesis and Translational Research(ministry of Education) Department of UltrasoundPeking University School of OncologyBeijing Cancer Hospital&InstituteBeijing 100142China

Objective： To investigate the application of contrast enhanced ultrasound （CEUS） in planning and guiding for radiofrequency ablation （RFA） for metastatic liver carcinoma （MLC）. Methods： One hundred and thirty-five patients with clinically and pathologically diagnosed MLC （from gastrointestinal tumors） were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 204 patients, 21 （20.1%） were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA （group A）. During the same period, other 32 patients with 202 lesions serving as control group were treated based on findings of conventional ultrasound without contrast （group B）. The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 2st month. Results： In group A, 72 of 147 MLC lesions （48.9%） showed increased sizes on CEUS. Among them, 48 lesions （66.6%） appeared enlarged in arterial phase, and 24 （33.3%） showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients （42.2%）（ranged from 8 to 15 mm） compared with conventional ultrasound （US）, and 42 （68.8%） of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% （196/208）. In this group, local recurrence was found in 26 lesions （7.7%） during 3-42 months＇ following up, and new metastases were seen in 30 cases （36.2%）. For group B, the tumor necrosis rate was 86.3% （88/202）, local recurrence in 27 lesions （16.7%）, and new metastases in 13 cases （41.9%）. Tumor early necrosis and recurrence rates were significantly different between th

关键词： Contrast enhanced ultrasound (CEUS) Liver metastasis Radiofrequency ablation (RFA)

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Efficacy and feasibility of radiofrequency ablation for decompensated cirrhotic patients with hepatocellular carcinoma

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Chinese Medical Journal 2010年第15期123卷 1967-1972页

作者： wu jin-yu yang wei CUI ming yiN Shan-shan GAO Wen wu wei yan kun chen min-hua Ultrasound Department Harbin First Hospital HarbinHeilongjiang 150010 China Ultrasound Department Peking University School of Oncology Beijing Cancer Hospital & Institute Beijing 100142 China Oncology Surgery Department Peking University School of Oncology Beijing Cancer Hospital & Institute Beijing 100142 China

Background Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） patients with poor liver function （Child-Pugh class C）, who are not suitable for surgery or hepatic artery *** Thirteen HCC patients （the number of tumors was 17） with liver function of Child-Pugh C （scores： 10.2±0.4）were included in the study. Among the patients, 8 were male and 5 were female with the average age of （61.6±10.9）years old. The average size of HCC was （3.8±1.0） cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors （2-3 tumors）. All the patients were treated with *** There were 22 RFA sessions （1-4 sessions per patient） in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients （69.2%）, in 7 of them, the liver enzyme returned to pre-RFA level in 1-3 months. One month after RFA, the Child-Pugh grading was 10.3±0.8 （Child-Pugh C）, while that of pre-RFA was 10.2±0.4 （Child-Pugh C）, with no significant difference. Computer tomography （CT） one month after RFA showed that the tumor necrosis rate was 88.2% （15/17）. Five patients had 2-4 repeated RFA due to HCC *** the follow-up of 2-69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% （3/22 sessions）, including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function *** minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to t

关键词： Child-Pugh classification liver function decompensation hepatoceUular carcinoma radiofrequency ablation ultrasound guidance

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Contrast-enhanced ultrasound of hepatocarcinogenesis in liver cirrhosis

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Chinese Medical Journal 2012年第17期125卷 3104-3109页

作者： wu wei chen min-hua SUN Maryellen yan kun yang wei LI Ji-you Key laboratory of Carcinogenesis and Translational Research (ministry of Education) Department of Ultrasound Peking University Cancer Hospital & Institute Beijing 100142 China Abdominal Imaging Department of Radiology Beth Israel Deaconess Medical Center Boston 02215 USA Key laboratory of Carcinogenesis and Translational Research (ministry of Education) Department of Pathology Peking University Cancer Hospital & Institute Beijing 100142 China

Backoround Hepatocellular carcinoma （HCC） often occurs in association with liver cirrhosis. A stepwise carcinogenesis for HCC has been proposed. The purpose of this study was to observe the enhancement pattern of hepatocellular nodules in cirrhotic patients using contrast-enhanced ultrasound （CEUS） and to correlate patterns of enhancement at CEUS with the diagnosis of hepatocellular nodules using pathologic correlation as the gold standard. Methods Ninety-three cirrhotic patients with indeterminate hepatocellular nodules at ultrasound, underwent biopsy of each indeterminate nodule. Patients with nodules found to have pathologic diagnoses of regenerative nodules （RNs）, dysplastic nodules （DNs）, or DNs with focus of HCC （DN-HCC）, were enrolled in this study. Enhancement patterns of all nodules were examined throughout the various vascular phases of CEUS and classified into five enhancement patterns： type I, isoenhancement to hepatic parenchyma at all phases; type II, hypoenhancement in the arterial phase, and isoenhancement in the portal venous phase and late phase; type III, iso-to-hypoenhancement in arterial and portal venous phase, and hypoenhancement in the late phase （washout）; type IV, slight hyperenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）; and type V, partial hyperenhancement in the arterial phase and hypoenhancement in the late phase; and another partial iso-to-hypoenhancement in the arterial and portal venous phase and hypoenhancement in the late phase （washout）. The correlation between the contrast enhancement patterns and the pathological diagnoses was analyzed by the chi-squared test. Results Totally 132 lesions were examined with CEUS in 93 patients. Pathologic diagnoses included 45 DN, 68 RN, and 19 DN-HCC. The enhancement patterns observed were as follows： type I, 49 （37.1%）; type II, 27 （20.5%）; type III, 28 （21.2%）; type IV, 9 （6.8%）; type V, 19 （14.4%）. Nodules with type I enhancement showed dy

关键词： ultrasonography contrast agent cirrhosis hepatocellular carcinoma

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Intraperitoneal hemorrhage during and after percutaneous radiofrequency ablation of hepatic tumors: reasons and management

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Chinese Medical Journal 2005年第20期118卷 1682-1687页

作者： chen min-hua DAI ying yan kun yang wei GAO Wen wu wei LIAO Sheng-ri HAO Chun-yi Department of Ultrasound School of Oncology Peking UniversityBeijing 100036 China Department of Surgery School of Oncology Peking UniversityBeijing 100036 China

Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency （RF） ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.Methods Three hundred and flfty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients （0. 8% ）. The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.Results Two patients with liver metastasis and one hepatocellular carcinoma （HCC） patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four （80%） of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date.Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablat

关键词： liver neoplasm radio frequency ablation complication intraperitoneal hemorrhage ultrasound

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