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CT diagnosis of recurrence after pancreatic cancer:Is there a pattern?

World Journal of Gastroenterology 2011年第9期17卷 1126-1134页

作者： Tobias Heye Nicola Zausig Miriam Klauss Reinhard Singer Jens Werner Gtz Martin Richter Hans-Ulrich Kauczor Lars Grenacher department of Diagnostic and interventional Radiology University Hospital department of Surgery University Hospital department of Diagnostic and interventional Radiology Katharinen Hospital

AIM:To investigate predilection sites of recurrence of pancreatic cancer by computed tomography(CT)in follow-up after surgery. METHODS:Seventy seven patients with recurrence after pancreatic cancer surgery were retrospectively *** operative technique,R-status,T-stage and development of tumor markers were evaluated. Two radiologists analyzed CT scans with consensus *** of local recurrence,lymph node recurrence and organ metastases were *** and progression of findings on follow-up CT were con-sidered as reference standard. RESULTS:The mean follow-up interval was 3.9± 1.8 mo,with a mean relapse-free interval of 12.9± 10.4 *** predominant site of recurrence was local (65%),followed by lymph node(17%),liver metastasis (11%)and peritoneal carcinosis(7%).Local recurrence emerged at the superior mesenteric artery(n=28),the hepatic artery(n=8),in an area defined by the surrounding vessels:celiac trunk,portal vein,inferior vena cava(n=22),and in a space limited by the mesenteric artery,portal vein and inferior vena cava(n=17). Lymph node recurrence occurred in the mesenteric root and left lateral to the *** was confirmed by surgery(n=22)and follow-up CT(n=55).Tumor markers[carbohydrate antigen 19-9(CA19-9),carcinoembryonic antigen(CEA)]increased in accordance with signs of recurrence in most cases(86%CA19-9;79.2% CEA). CONCLUSION:Specific changes of local and lymph node recurrence can be found in the course of the cardinal peripancreatic *** superior mesenteric artery is the leading structure for recurrence.

关键词： Pancreatic cancer Recurrence Computed tomography Follow-up Tumor marker

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Role of endovascular embolisation for curative treatment of intracranial non- Galenic pial arteriovenous fistula

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Stroke & Vascular Neurology 2021年第2期6卷 260-266页

作者： Hengwei Jin Xiangyu Meng Jiale Quan Yi Lu Youxiang Li department of interventional Neuroradiology Beijing Tiantan HospitalBeijingChina interventional Neuroradiology department Beijing Neurosurgical InstituteBeijingChina Pediatric department Dongming People’s HospitalBeijingChina department of interventional Neuroradiology Beijing Neurosurgical InstituteBeijingChina

Background and purpose The safety and effectiveness of endovascular treatment for non-Galenic pial arteriovenous fistula(NGPAVF)is inadequately *** aim of this study is to explore the role of endovascular embolisation for curative treatment of *** and methods Patients with NGPAVF underwent endovascular treatment from January 2011 to November 2019 in our institution were retrospectively ***,clinical information,treatment details and clinical outcomes were *** associated with clinical outcomes were statistically *** Twenty patients were included,with a total of 22(2 patients have 2 fistulas)lesions.A total of 25 procedures were performed and 5 patients underwent 2 ***-up ranged from 3 to 84 months(mean=34.5 months).Thirteen(59.1%)lesions in 12(60.0%)patients acquired immediate occlusion after initial treatment(immediately occluded group)and follow-up confirmed the complete obliteration.A total of 17(77.3%)lesions in 15(75.0%)patients were cured at last *** maximal diameter of feeding arteries(p=0.04)and the maximal diameter of the varix(p=0.01)in immediately occluded group was smaller than non-immediately occluded *** number of feeding artery(p=0.004)and the maximal diameter of the varix(p<0.001)were much smaller in curative group than non-curative *** patients suffered procedure-related *** patients had an increased Modified Rankin Scale(mRS)and all patients had favourable clinical outcome(mRS≥2)at last *** Endovascular therapy plays an important role in curative treatment of *** with less feeding arteries and small varix may be easier to be cured by endovascular embolisation.

关键词： curative fistula treatment

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Portal vein thrombosis and arterioportal shunts:Effects on tumor response after chemoembolization of hepatocellular carcinoma

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World Journal of Gastroenterology 2011年第10期17卷 1267-1275页

作者： Thomas J Vogl Nour-Eldin Nour-Eldin Sally Emad-Eldin Nagy NN Naguib Joerg Trojan Hans Ackermann Omar Abdelaziz Institute for Diagnostic and interventional Radiology Johan Wolfgang Goethe University Hospital Diagnostic and interventional Radiology department Cairo University Hospital

AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology,Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS.

关键词： Hepatocellular carcinoma Transarterialchemoembolization Portal Shunt Thrombosis

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Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

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World Journal of Gastroenterology 2016年第27期22卷 6145-6172页

作者： Omar Abdelaziz Hussein Attia department of Diagnostic and interventional Radiology Cairo University Hospitals department of Diagnostic and interventional Radiology National Cancer Institute Cairo University

Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intraoperative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.

关键词： Doppler Ultrasound Living donor Liver transplantation Intraoperative Postoperative Vascular Complications

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Transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for large solitary hepatocellular carcinomas

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World Journal of Gastroenterology 2013年第26期19卷 4192-4199页

作者： Zhi-Jun Wang Mao-Qiang Wang Feng Duan Peng Song Feng-Yong Liu Zhong-Fei Chang Yan Wang Jie-Yu Yan Kai Li department of interventional Radiology PLA General Hospital

AIM: To assess the technical safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA) for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm). METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5 cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA between January 2010 and June 2012. All of the patients had previously undergone one to four cycles of TACE treatment. Regular imaging and laboratory tests were performed to evaluate the rate of technical success, technique-related complications, local-regional tumor responses, recurrence-free survival time and survival rate after ***: Technical success was achieved for all 18 visible HCCs. Complete response (CR) was observed in 17 cases, and partial response was observed in 1 case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly characterized by coagulative necrosis. During follow-up (2-29 mo), the mean recurrencefree survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated overall survival rate at 6, 12, and 18 mo was 100%. No major complications were observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the blood of 17 patients transiently increased on the third day after treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was controlled with morphine and fentanyl. CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment for large solitary HCCs. Severe pain is a major side effect, but can be controlled by morphine.

关键词： Large hepatocellular carcinoma Transcatheter arterial chemoembolisation Radiofrequency ablation Combination therapy Synchronism

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Transjugular intrahepatic portosystemic shunt with covered stents for hepatocellular carcinoma with portal vein tumor thrombosis

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World Journal of Gastroenterology 2014年第6期20卷 1602-1607页

作者： Jian-Bo Zhao Chao Feng Qiao-Hua Zhu Xiao-Feng He Yan-Hao Li Yong Chen department of interventional Radiology Nanfang Hospital Southern Medical University department of interventional Radiology People’s Hospital Southern Medical University

AIM: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) with covered stents for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (PVTT).

关键词： Transjugular intrahepatic portosystemic shunt Covered stent Portal hypertension Main portal vein tumor thrombus Hepatocellular carcinoma

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Stents combined with iodine-125 implantation to treat main portal vein tumor thrombus

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World Journal of Gastrointestinal Oncology 2018年第12期10卷 496-504页

作者： Yi-Fan Wu Tao Wang Zhen-Dong Yue Hong-Wei Zhao Lei Wang Zhen-Hua Fan Fu-Liang He Fu-Quan Liu department of interventional Therapy Beijing Shijitan HospitalCapital Medical University department of interventional Therapy The Affiliated Yantai Yuhuangding Hospital of Qingdao University

AIM To evaluate the efficacy of main portal vein stents combined with iodine-125(^(125)Ⅰ) to treat main portal vein tumor *** From January 1, 2010 to January 1, 2015, 111 patients were diagnosed with liver cancer combined with main portal vein tumor thrombus. They were non-randomly assigned to undergo treatment with transarterial chemoembolization(TACE)/transarterial embolization(TAE) + portal vein stents combined with ^(125)Ⅰ implantation(Group A) and TACE/TAE + portal vein stents only(Group B). After the operation, scheduled follow-up was performed at 6, 12 and 24 mo. The recorded information included clinical manifestations, survival rate, and stent restenosis rate. Kaplan–Meier curves, log-rank test and Cox regression were used for data analyses. RESULTS From January 1, 2010 to January 1, 2015, 54 and 57 patients were allocated to Groups A and B, respectively. The survival rates at 6, 12 and 24 mo were 85.2%, 42.6% and 22.2% in Group A and 50.9%, 10.5% and 0% in Group B. The differences were significant [log rank P < 0.05, hazard ratio(HR): 0.37, 95%CI: 0.24-0.56]. The rates of stent restenosis were 18.5%, 55.6% and 83.3% in Group A and 43.9%, 82.5% and 96.5% in Group B. The differences were significant(log rank P < 0.05, HR: 0.42, 95%CI: 0.27-0.63). Cox regression identified that treatment was the only factor affecting survival rate in this *** Main portal vein stents combined with ^(125)Ⅰ can significantly improve survival rate and reduce the rate of stent restenosis.

关键词： Iodine-125 Liver cancer Stent Main portal vein tumor thrombus Transarterial chemoembolization/ transarterial embolization

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Transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed for hepatocellular carcinoma with major portal vein tumor thrombus

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World Journal of Gastroenterology 2018年第23期24卷 2501-2507页

作者： Lin-Zhong Zhu Song Xu Hai-Long Qian department of interventional Therapy Beijing Cancer Hospital department of Radiology Yunnan Second People’s Hospital interventional Therapy Baotou Cancer Hospital

AIM To determine the efficacy and safety of transarterial embolization and low-dose continuous hepatic arterial infusion chemotherapy with oxaliplatin and raltitrexed in hepatocellular carcinoma(HCC) with major portal vein tumor thrombus(MPVTT).METHODS eighty-six patients with MPVTT accepted routine embolization. The catheter was kept in the hepatic artery and oxaliplatin(50 mg in 250 m L of glucose) was infused by pump for 4 h,followed by raltitrexed(2 mg in 100 m L of 0.9% saline) infusion by pump for the next 1 h. The efficacy and safety were evaluated afterthe transarterial chemoembolization(TACe).RESULTS Full or partial embolization was achieved in 86 cases,where all the cases received low dose continuous hepatic arterial infusion chemotherapy. Complete responses(CRs),partial responses(PRs),stable disease(SD),and disease progression(PD) for intrahepatic disease were observed in 0,45,20,and 21 patients,respectively. The 1-,2-and 3-year overall survival rates of the 86 patients were 40.7%,22.1%,and 8.1% respectively,and the median survival time was 8.7 mo. Complication was limited. CONCLUSION TACE with low dose continuous hepatic arterial infusion of oxaliplatin and raltitrexed could be an option in MPVTT patient; it was shown to be effective in patients with advanced HCC with MPVTT with less toxicity.

关键词： Transarterial embolization Oxaliplatin Major portal vein tumor thrombus Raltitrexed Continuous hepatic arterial infusion chemotherapy

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Clinical value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal hypertension

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World Journal of Gastroenterology 2017年第45期23卷 8044-8052页

作者： Yan Zhang Da-Feng Mao Mei-Wu Zhang Xiao-Xiang Fan department of interventional Therapy Second Hospital of Ningbo Municipality

AIM To explore the relationship of liver and spleen shear wave velocity in patients with liver cirrhosis combined with portal hypertension,and assess the value of liver and spleen shear wave velocity in predicting the prognosis of patients with portal *** All 67 patients with liver cirrhosis diagnosed as portal hypertension by hepatic venous pressure gradient in our hospital from June 2014 to December 2014 were enrolled into this study. The baseline information of these patients was recorded. Furthermore,67 patients were followed-up at 20 mo after treatment,and liver and spleen shear wave velocity were measured by acoustic radiation force impulse at the 1^(st) week,3^(rd) month and 9^(th) month after treatment. Patients with favorable prognosis were assigned into the favorable prognosis group,while patients with unfavorable prognosis were assigned into the unfavorable prognosis group. The variation and difference in liver and spleen shear wave velocity in these two groups were analyzed by repeated measurement analysis of variance. Meanwhile,in order to evaluate the effect of liver and spleen shear wave velocity on the prognosis of patients with portal hypertension,Cox's proportional hazard regression model analysis was applied. The ability of those factors in predicting the prognosis of patients with portal hypertension was calculated through receiver operating characteristic(ROC) *** The liver and spleen shear wave velocity in the favorable prognosis group revealed a clear decline,while those in the unfavorable prognosis group revealed an increasing tendency at different time points. Furthermore,liver and spleen shear wave velocity was higher in the unfavorable prognosis group,compared with the favorable prognosis group; the differences were statistically significant(P < 0.05). The prognosis of patients with portal hypertension was significantly affected by spleen hardness at the 3^(rd) month after treatment [relative risk(RR) = 3.481].

关键词： Liver cirrhosis Portal hypertension Liver and spleen shear wave velocity Acoustic radiation force impulse

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Accuracy of combined PET/CT in image-guided interventions of liver lesions: An ex-vivo study

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World Journal of Gastroenterology 2006年第15期12卷 2388-2393页

作者： Patrick Veit Christiane Kuehle Thomas Beyer Hilmar Kuehl Andreas Bockisch Gerald Antoch department of Diagnostic and interventional Radiology and Neuroradiology department of Nuclear Medicine University Hospital Essen

AIM： Positioning of interventional devices in liver lesions is a challenging task if only CT is available. We investigated the potential benefit of combined PET/CT images for localization of interventional devices in interventional liver studies. METHODS： Thirty lesions each of hyperdense, isodense and hypodense attenuation compared to normal liver parenchyma were injected into 15 ex-vivo pig livers. All lesions were composed of the same amounts of gelatine containing 0.5 MBq of ^18F-FDG. Following lesion insertion, an interventional needle was placed in each lesion under CT-guidance solely. After that, a PET/CT study was performed. The localization of the needle within the lesion was assessed for CT alone and PET/CT and the root mean square （RMS） was calculated. Results were compared with macroscopic measurements after lesion dissection serving as the standard of reference. RESULTS： In hypo- and isodense lesions PET/CT proved more accurate in defining the position of the interventional device when compared with CT alone. The mean RMS for CT and PET/CT differed significantly in isodense and hypodense lesions. No significant difference was found for hyperdense lesions. CONCLUSION： Combined FDG-PET/CT imaging provides more accurate information than CT alone concerning the needle position in FDG-PET positive liver lesions. Therefore combined PET/CT might be potentially beneficial not only for localization of an interventional device, but may also be beneficial for guidance in interventional liver procedures.

关键词： Liver biopsy Radiofrequency ablation Combined PET/CT ex-vivo study Image guided interventions

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