Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

Comparison of percutaneous radiofrequency ablation and CyberKnife®for initial solitary hepatocellular carcinoma:A pilot study

AIM To compare therapeutic outcomes and adverseevents in initial solitary hepatocellular carcinoma（HCC） treated with radiofrequency ablation （RFA） andCyberKnife？.METHODS： Seventy three consecutive patients withinitial solitary HCC treated with RFA （38 patients;RFA group） and CyberKnife （35 patients; CK group）were enrolled in this study. Background factorswere compared between the two groups. Local andintrahepatic distant recurrence control, and cumulativesurvival rates were compared between the two groups.These were determined using the Kaplan-Meier method,and the significance of differences was analyzed by log-rank test. The presence of more grade 3 on CTCAE ver.4.0 early and late adverse events was investigated.RESULTS： In background factors, age was significantlyhigher （P = 0.005） and the tumor diameter wassignificantly larger （P = 0.001） in the CK group. The1-year local recurrence control rates were 97.4%and 97.1% in the RFA and CK groups, respectively （P= 0.71）; the 1-year intrahepatic distant recurrencecontrol rates were 85.6% and 86.1%, respectively （P= 0.91）; and the 1-year cumulative survival rates were100% and 95.2%, respectively （P = 0.075）, showingno significant difference in any rate between the twogroups. There were no late adverse event in the RFAgroup, but 11.4% in the CK group had late adverseevents. In the CK group, the Child-Pugh score at 12 moafter treatment was significantly higher than that in theRFA group （P = 0.003） and significantly higher than thescore before treatment （P = 0.034）.CONCLUSION： The occurrence of adverse events is aconcern, but CyberKnife treatment is likely to becomean important option for local treatment of early HCC.

Acute pancreatitis secondary to intramural duodenal hematoma:Case report and literature review

Nontraumatic intramural duodenal hematoma(IDH) is rare disease and it is generally related to coagulation abnormalities.Reports of nontraumatic IDH associated with pancreatic disease are relatively rare,and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH.However,the association between IDH and acute pancreatitis remains unknown.We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain.He had no medical history,but was a heavy drinker.The diagnosis of IDH was established by computed tomography,ultrasonography and endoscopy,and it was complicated by acute pancreatitis.The lesions resolved with conservative management.We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis.In our patient,acute pancreatitis occurred concurrently with hematoma,probably due to obstruction of the duodenal papilla,or compression of the pancreas caused by the hematoma.The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.

Evaluation of sorafenib for hepatocellular carcinoma by contrast-enhanced ultrasonography:A pilot study

AIM:To determine the usefulness of arrival time parametric imaging(AtPI) using contrast-enhanced ultrasonography(CEUS) with Sonazoid in evaluating early response to sorafenib for hepatocellular carcinoma(HCC).METHODS:Fourteen advanced HCC patients who received sorafenib 400/800 mg/d for at least 4 wk and were followed up by CEUS were enrolled in this study.CEUS was performed before treatment and 2 and 4 wk after treatment,and images of the target lesion in the arterial phase were recorded for each patient.The images were analyzed by AtPI.Color mapping(CM) images obtained by AtPI were compared before and after the treatment.In these CM images,the mean arrival time of the contrast agent in the region of interest from the starting point [mean time(MT)] was calculated.In each patient,differences between MT before and MT 2 and 4 wk after the treatment were compared with responses evaluated 4-8 wk after the treatment by dynamic computed tomography(CT),and statistical analysis was performed.Modified response evaluation criteria in solid tumors was used for the response evaluation.RESULTS:In CM images both 2 and 4 wk after the treatment,delays in the arrival time of the contrast agent were noted in 8 of the 14 patients.In the other 6 patients,no color changes were observed in the tumor,or red and/or yellow increase,suggesting a decrease in blood flow velocity between images 2 and 4 wk after the treatment and those before the treatment.Dynamic CT could be performed 4-8 wk after the treatment in 13 of the 14 patients.Median differences in the MT were 1.13 s and 1.015 s,2 and 4 wk after the treatment,respectively,in the 8 patients who showed stable disease(SD)/partial response(PR) on dynamic CT.Median differences in the MT were-0.39 s and-0.95 s,2 and 4 wk after the treatment,respectively,in the 5 patients who showed progressive disease(PD).Differences in the median MT between SD/PR and PD groups were significant 2 and 4 wk after the treatment with P = 0.019 and P = 0.028,respectively.CONCLUSION:AtPI by CEUS using Sonazoid is suggested to be useful for evaluating early responses to sorafenib.

在为胆汁管癌症的内视镜的胆汁的 stenting 以后的肝的动脉 pseudoaneurysm

We report a case of a pseudoaneurysm of the right hepatic artery observed 9 mo after the endoscopic placement of a Wallstent,for bile duct stenosis,which was treated with transcatheter arterial embolization.The patient presented with obstructive jaundice and was diagnosed with inoperable common bile duct cancer.A plastic stent was inserted endoscopically to drain the bile,and chemotherapy was initiated.Abdominal pain and jaundice appeared approximately 6 mo after the beginning of chemotherapy.A diagnosis of stent occlusion and cholangitis was made,and the plastic stent was removed and substituted with a self-expandable metallic stent(SEMS) endoscopically.Nine months after SEMS insertion,contrast-enhanced computed tomography showed a pseudoaneurysm of the right hepatic artery protruding into the common bile duct lumen and in contact with the SEMS.The shape and size of the pseudoaneurysm and diameter of its neck was determined by contrast-enhanced ultrasonography using Sonazoid.A micro-catheter was led into the pseudoaneurysm in the right hepatic artery,GDC Detachable Coils were placed,and IDC Detachable Coils were then placed in the right hepatic artery on the distal and proximal sides of the pseudoaneurysm using the isolation method.There have been a few reports on pseudoaneurysm associated with stent placement in the biliary tract employing percutaneous transhepatic procedures,however,reports of pseudoaneurysms associated with endoscopic SEMS placement are very rare.