Search

Objective: To investigate whether balloon-occluded transcatheter arterial chemoembolization (b-TACE) can produce a more dense accumulation of iodized oil in various stages of hepatocellular carcinoma (HCC), from single to uncountable, to overcome inferior local control. Materials and Methods: We studied 27 patients with HCC, including single to uncountable multiple lesions, who underwent b-TACE between August 2013 and April 2015. Dynamic CT was performed at baseline and 1-3 months after b-TACE. The treatment effect (TE) after b-TACE was evaluated using the Response Evaluation Criteria in Cancer of the Liver (RECICL) proposed by the Liver Cancer Study Group of Japan. Results: In the countable HCC group, contrast-enhanced CT demonstrated RECICL TE4 in 43.8% (14/32), TE3 in 12.5% (4/32), TE2 in 37.5% (12/32), and TE1 in 6.3% (2/32) of patients. For the TACE-naïve cohort, the objective response rate was 52.9%. The objective response rate was 60% for the previously TACE-treated cohort. In the uncountable multiple HCC group, the objective response rate was 0% (0/10), with progressive disease in 90% (9/10) of patients. Conclusion: Our observations suggested that b-TACE did not reduce the efficacy of retreatment for HCC with an insufficient outcome from conventional TACE, but it could not improve the efficacy of treatment for uncountable multiple HCCs. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Simple Summary: Recent advances in fusion imaging technology have made it easier to visualize and estimate ablative margins. This study was conducted to assess the clinical feasibility of a computed tomography (CT)/magnetic resonance imaging (MRI) fusion application for evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Seventeen patients developed local tumor progressions (LTPs) due to wrong initial evaluations of technical success through a side-by-side comparison, and we reevaluated the ablative margins using the CT/MRI overlay fusion application. Eight patients were categorized into grade C (margin-zero ablation) and nine patients into grade D (existence of residual HCC). LTP occurred in re-graded C patients within 4 to 30.3 months (median, 14.3 months), and in re-graded D patients within 2.4 to 6.7 months (median, 4.2 months) (p = 0.006). Overlay fused CT/MRI imaging can allow us to evaluate HCC ablative margin three-dimensionally with high accuracy. Background: We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. Methods: A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. Results: The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. Conclusion: Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy. [ABSTRACT FROM AUTHOR]

Simple Summary: Transcatheter arterial embolization (TAE) with coils is widely used to treat pseudoaneurysms; recently, the use of N-butyl cyanoacrylate (NBCA) in TAE has been reported as a feasible and effective approach. The purpose of our retrospective study was to evaluate the efficacy and safety of TAE with coils and NBCA for pseudoaneurysms associated with pancreatitis or pancreatic surgery. This retrospective study included 42 consecutive patients. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. All cases obtained hemostasis after TAE (the technical success rate was 100%). Complications were seen in only two patients. Clinical success rate that was evaluated in terms of 30-day mortality was 76.2%. TAE is then an effective treatment modality for pseudoaneurysms associated with pancreatitis or pancreatic surgery. Accurate diagnosis using angiography contributes to the proper choice of embolic agents and management of such hemorrhages. Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy. [ABSTRACT FROM AUTHOR]