与 transarterial chemoembolization 对待的 Hepatocellular 癌: 有参量的提高对比的 ultrasonography 的评估

AIM:To evaluate the response of hepatocellular carcinoma(HCC) to transarterial chemoembolization(TACE) using a simplified protocol of parametric contrastenhanced ultrasound(pCEUS).METHODS:Eighteen patients with HCC(18 target tumors,diameter:2.8-12 cm) were evaluated before,and 20 d after TACE.The distribution and morphology of TACE-induced necrosis in these tumors precluded accurate evaluation by visual assessment or by simple measurements.For pCEUS,a 4.8 mL bolus of SonoVue(Bracco,Milan,Italy) was intravenously administered and analysis of tumor perfusion during the initial phase of enhancement(0-30 s post injection) was performed with dedicated software(Qontrast,Bracco,Milan,Italy).Time-intensity curves were plotted and three parameters were calculated:peak intensity(PI,in percentage %),time to peak(TTP in seconds,s) and area under the curve during wash-in(AUC-WI,in arbitrary units,a.u).Magnetic resonance imaging was the standard imaging modality for post-treatment evaluation.Changes in tumor size were recorded and response was assessed according to response evaluation criteria in solid tumors criteria.RESULTS:A statistically significant decrease in PI and AUC-WI was observed in the treated tumors post TACE;PIpre:21.5% ± 8.7%(mean ± SD),PIpost:12.7% ± 6.7%,P 【 0.001,AUC-WI pre:17493 ± 9563 a.u,AUCWI post:9585 ± 5494 a.u,P 【 0.001.A slight increase in TTP was noted post TACE,but this was not statistically significant;TTP pre:13.1 ± 4.3 s,TTP post:13.6 ± 4.2 s,P = 0.058).The changes in the aforementioned parameters were not accompanied by significant tumor shrinkage.CONCLUSION:pCEUS,even when limited to the study of the arterial phase of tumoral enhancement,can detect and quantify early perfusional changes in HCC post TACE.

Associations among benign prostate hypertrophy, atypical adenomatous hyperplasia and latent carcinoma of the prostate

Aim： To investigate the frequency of atypical adenomatous hyperplasia （AAH） and its associations with benign prostate hypertrophy （BPH） and latent histological carcinoma of the prostate （LPC） in autopsy material. Methods： Two hundred and twelve prostate specimens obtained from autopsy material were subjected to whole mount analysis in an attempt to investigate the associations among BPH, AAH and LPC. Results： Most histological carcinomas and AAH lesions were found in enlarged prostates with intense hypertrophy. No statistically significant relation was found between BPH and the main characteristics of LPC, such as tumor volume, histological differentiation and biological behavior. Our data regarding multi-focal tumors showed a tendency for multi-focal carcinomas to develop in larger prostates, and a tendency of AAH lesions to develop in larger prostates. No statistically significant relation was found between AAH and LPC. Conclusion： There seems not any causative aetiopathogenetical or topographical relation between AAH lesions and prostate adenocarcinoma. AAH lesion seems to be a well-defined mimicker of prostatic adenocarcinoma, and the reported association of AAH with prostatic carcinoma could probably be an epiphenomenon.

Sonographic evaluation of prostatic artery embolization:Far beyond size measurements

Prostatic artery embolization(PAE)has gained acceptance as a minimally invasive,safe and effective treatment of symptomatic benign prostatic hyperplasia.Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes.In this context,ultrasonography(US)has a central and multifaceted role.Gray-scale US is routinely utilized for measurement of significant outcome parameters(prostatic volume,intra-vesical prostatic protrusion and post-void residual volume)before and after PAE.Improvement of these parameters may become more obvious onemonth post-PAE,or later.Contrast-enhanced US(CEUS)with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts(as enhancement defects)immediately post-PAE and monitor their resolution over time.The volume of prostatic infarcts can also be measured and compared to prostatic volume.Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and(at least in some patients)of clinical success.CEUS can also be performed intraoperatively in the angio-suite,for on-site evaluation of the ischemic effect;a variation of this technique,with intraarterial(instead of intravenous)administration of diluted echo enhancer,can also be applied intraoperatively,to map the embolized territory and to prevent non-target embolization.Initial experience with USelastographic techniques(shear-wave and strain elastography)has shown that they can detect and quantify the improvement of tissue elasticity post-PAE,thus providing new insights into the therapeutic mechanisms of this treatment.With utilization of high-end equipment,experience and standardized imaging protocols,US could be the primary modality for imaging evaluation of PAE.