Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recent...Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.展开更多
This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incid...This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.展开更多
This manuscript is based on a case reported by Song et al published in the World Journal of Clinical Cases.Several challenges remain in the field of hepatocellular carcinoma(HCC)conversion therapy.Consequently,only a ...This manuscript is based on a case reported by Song et al published in the World Journal of Clinical Cases.Several challenges remain in the field of hepatocellular carcinoma(HCC)conversion therapy.Consequently,only a limited number of patients with HCC accompanied by portal vein tumor thrombosis(PVTT)and hepatic vein tumor thrombosis(HVTT)are eligible for resection.This clinical case demonstrates that considering the complexity of the disease,a multimodal and multidisciplinary approach is essential for managing HCC accompanied by PVTT and HVTT.However,the outcomes of such surgeries remain controversial.In conclusion,research on HCC conversion therapy is extremely useful for impro-ving treatment strategies for intermediate and advanced HCC,which currently have disappointing clinical outcomes.展开更多
Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma(ICC),percutaneous thermal ablation can be an alter-native treatment for patients unfit for surgery.Ou...Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma(ICC),percutaneous thermal ablation can be an alter-native treatment for patients unfit for surgery.Our aim was to compare long-term results of percutaneous sonographi-cally-guided radiofrequency ablation(RFA)with high-powered microwave ablation(MWSA)in treatment of ICC.Methods: Results of 71 ICC patients with 98 nodules treated with RFA(36 patients)or MWSA(35 patients)between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed.Cu-mulative overall survival curves were calculated with the Ka-plan-Meyer method and differences with the log-rank test.Eleven possible factors affecting survival were analyzed.Results: Overall survival of the entire series was 88%,65%,45%and 34%at 12,36,60 and 80 months,respec-tively.Patients treated with MWSA survived longer than pa-tients treated with RFA(p < 0.005).The MWSA group with ICC nodules ≤3 cm or nodules up to 4 cm survived longer than the RFA group(p < 0.0005).In patients with nodules>4 cm,no significant difference was found.Disease-free sur-vival and progression-free survival were better in the MWSA group compared to the RFA group(p < 0.005).Diameter of nodules and MWSA were independent factors predicting a better survival.No major complications were observed.Conclusions: MWSA is superior to RFA in treating ICC unfit for surgery,achieving better long-term survival in small(≤3 cm)ICC nodules as well as nodules up to 4 cm of neo-plastic tumors and should replace RFA.展开更多
Contrast-enhanced ultrasound(CEUS)with pure blood stream contrast agents allow the study of blood supply of focal liver lesions and especially of hepatocellular carcinoma(HCC)in cirrhosis.Its sensitivity and specifici...Contrast-enhanced ultrasound(CEUS)with pure blood stream contrast agents allow the study of blood supply of focal liver lesions and especially of hepatocellular carcinoma(HCC)in cirrhosis.Its sensitivity and specificity in diagnosis of small tumors is very high.This review summarizes the recent results on CEUS with SonoVue,which is one of the second generation contrast agents,in the diagnosis of early HCC in cirrhosis emphasizing its increasing role in routine clinical practice.展开更多
Among the 3 sub-types of cholangiocarcinoma (CH), [intrahepatic CH, hylar (CH) and extrahepatic (CH)], intrahepatic cholangiocarcinoma (ICC) accounts for up 8–10% of cholangiocarcinomas and 10–20% of all primary liv...Among the 3 sub-types of cholangiocarcinoma (CH), [intrahepatic CH, hylar (CH) and extrahepatic (CH)], intrahepatic cholangiocarcinoma (ICC) accounts for up 8–10% of cholangiocarcinomas and 10–20% of all primary liver tumors (1).展开更多
The last 30 years have shown the increasing role of Ablation in the treatment of malignant liver tumors. By the introduction of percutaneous ethanol injection (PEI) as first ablation tool for percutaneous treatment of...The last 30 years have shown the increasing role of Ablation in the treatment of malignant liver tumors. By the introduction of percutaneous ethanol injection (PEI) as first ablation tool for percutaneous treatment of hepatocellular carcinoma (HCC) in cirrhosis that firstly showed very high efficacy (1), several ablation techniques (mainly thermal) have been introduced in clinical practice aimed at destroying primary and secondary hepatic tumors as alternative or substitute tools to surgery. Radiofrequency ablation (RFA) was the first thermal technique that showed a good efficacy to ablate liver metastases (2). Among the secondary liver tumors, colorectal liver metastases (CRLM) represent the unique indication for ablation (2). Unlike HCC in cirrhosis where the role of RFA is well defined as first line therapy for HCC nodules < or equal to 2 cm or as alternative to surgery in 1-3 HCC nodules with the maximum diameter<3 cm (3), in the case of CRLM it is not possible to reproduce the same paradigm. Liver resection remains the standard of care for CRLM and the indications to ablation remain confined to nonresectable patients (4). The review article by Takahashi and Berber recently published in HBSN wells illustrates the current role of ablation in treatment of CRLM (5).展开更多
文摘Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.
文摘This manuscript is based on a recent study by Pillay et al that was published in recently.Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin.The incidence rate in Europe is lower than in developing countries,but it is a major complication with high morbidity,particularly in immunocompromised patients.They are most frequently caused by Enterobacterales infections,but hypervirulent Klebsiella strains are an emerging problem in Western countries.Amoebiasis has been a public health problem in Europe,primarily imported from other endemic foci.At the same time,this infection is becoming an emerging disease,as the number of infected patients who have not traveled to endemic areas is rising.Treatment options for hydatid liver cyst include chemotherapy,open or laparoscopic surgery,percutaneous treatment(percutaneous aspiration,re-aspiration and injection and its modification)and“wait and watch”strategy.Most hydatid liver cyst patients in Pillay et al’s study received surgical treatment,but several studies have confirmed the safety and efficacy of percutaneous aspiration,re-aspiration and injection.
文摘This manuscript is based on a case reported by Song et al published in the World Journal of Clinical Cases.Several challenges remain in the field of hepatocellular carcinoma(HCC)conversion therapy.Consequently,only a limited number of patients with HCC accompanied by portal vein tumor thrombosis(PVTT)and hepatic vein tumor thrombosis(HVTT)are eligible for resection.This clinical case demonstrates that considering the complexity of the disease,a multimodal and multidisciplinary approach is essential for managing HCC accompanied by PVTT and HVTT.However,the outcomes of such surgeries remain controversial.In conclusion,research on HCC conversion therapy is extremely useful for impro-ving treatment strategies for intermediate and advanced HCC,which currently have disappointing clinical outcomes.
文摘Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma(ICC),percutaneous thermal ablation can be an alter-native treatment for patients unfit for surgery.Our aim was to compare long-term results of percutaneous sonographi-cally-guided radiofrequency ablation(RFA)with high-powered microwave ablation(MWSA)in treatment of ICC.Methods: Results of 71 ICC patients with 98 nodules treated with RFA(36 patients)or MWSA(35 patients)between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed.Cu-mulative overall survival curves were calculated with the Ka-plan-Meyer method and differences with the log-rank test.Eleven possible factors affecting survival were analyzed.Results: Overall survival of the entire series was 88%,65%,45%and 34%at 12,36,60 and 80 months,respec-tively.Patients treated with MWSA survived longer than pa-tients treated with RFA(p < 0.005).The MWSA group with ICC nodules ≤3 cm or nodules up to 4 cm survived longer than the RFA group(p < 0.0005).In patients with nodules>4 cm,no significant difference was found.Disease-free sur-vival and progression-free survival were better in the MWSA group compared to the RFA group(p < 0.005).Diameter of nodules and MWSA were independent factors predicting a better survival.No major complications were observed.Conclusions: MWSA is superior to RFA in treating ICC unfit for surgery,achieving better long-term survival in small(≤3 cm)ICC nodules as well as nodules up to 4 cm of neo-plastic tumors and should replace RFA.
文摘Contrast-enhanced ultrasound(CEUS)with pure blood stream contrast agents allow the study of blood supply of focal liver lesions and especially of hepatocellular carcinoma(HCC)in cirrhosis.Its sensitivity and specificity in diagnosis of small tumors is very high.This review summarizes the recent results on CEUS with SonoVue,which is one of the second generation contrast agents,in the diagnosis of early HCC in cirrhosis emphasizing its increasing role in routine clinical practice.
文摘Among the 3 sub-types of cholangiocarcinoma (CH), [intrahepatic CH, hylar (CH) and extrahepatic (CH)], intrahepatic cholangiocarcinoma (ICC) accounts for up 8–10% of cholangiocarcinomas and 10–20% of all primary liver tumors (1).
文摘The last 30 years have shown the increasing role of Ablation in the treatment of malignant liver tumors. By the introduction of percutaneous ethanol injection (PEI) as first ablation tool for percutaneous treatment of hepatocellular carcinoma (HCC) in cirrhosis that firstly showed very high efficacy (1), several ablation techniques (mainly thermal) have been introduced in clinical practice aimed at destroying primary and secondary hepatic tumors as alternative or substitute tools to surgery. Radiofrequency ablation (RFA) was the first thermal technique that showed a good efficacy to ablate liver metastases (2). Among the secondary liver tumors, colorectal liver metastases (CRLM) represent the unique indication for ablation (2). Unlike HCC in cirrhosis where the role of RFA is well defined as first line therapy for HCC nodules < or equal to 2 cm or as alternative to surgery in 1-3 HCC nodules with the maximum diameter<3 cm (3), in the case of CRLM it is not possible to reproduce the same paradigm. Liver resection remains the standard of care for CRLM and the indications to ablation remain confined to nonresectable patients (4). The review article by Takahashi and Berber recently published in HBSN wells illustrates the current role of ablation in treatment of CRLM (5).
