共查询到14条相似文献，搜索用时 15 毫秒
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Nathan E. Frenk Dania Daye Kemal Tuncali Ronald S. Arellano Paul B. Shyn Stuart G. Silverman Florian J. Fintelmann Raul N. Uppot 《Journal of vascular and interventional radiology : JVIR》2018,29(2):276-284
Purpose
To evaluate local control and survival after image-guided ablation of adrenal gland metastases.Materials and Methods
Image-guided ablations of adrenal metastases measuring < 5 cm performed at 2 academic medical centers between July 2002 and June 2016 were analyzed. There were 51 procedures performed on 46 tumors (mean diameter 2.8 cm ± 1.1; range, 0.7–4.9 cm) in 38 patients (mean age 66 y; range, 41–80 y) with renal cell carcinoma (n = 17 patients; 45%), non–small cell lung cancer (n = 10 patients; 26%), and other primary malignancies (n = 11 patients; 29%). Treatment modalities included cryoablation (n = 30 procedures; 59%), radiofrequency ablation (n = 12 procedures; 24%) and microwave ablation (n = 9 procedures; 18%). Technical success, primary and secondary efficacy, local progression rate, local progression-free survival, and overall survival were assessed. Mean follow-up was 37 months (range, 2–128 months). Statistical analysis was performed with univariate Cox hazards regression and Kaplan-Meier analyses.Results
Technical success, primary efficacy, and secondary efficacy were 96%, 72%, and 76%. Local progression rate during all follow-up was 25%. Local tumor progression-free survival at 1, 3, and 5 years was 82%, 69%, and 55%. Overall survival at 1, 3, and 5 years was 82%, 44%, and 34%. In 16 patients with isolated adrenal metastasis, median disease-free survival was 8 months; 4 patients had no evidence of disease during follow-up. Lung cancer was associated with decreased survival (hazard ratio 4.41, P = .002).Conclusions
Image-guided ablation can achieve local control for adrenal metastases < 5 cm. 相似文献3.
Timothy W.I. Clark Micah M. Watts Tak W. Kwan 《Cardiovascular and interventional radiology》2016,39(12):1750-1758
Purpose
To report preliminary experience with femoropopliteal revascularization using a completely transpedal/transtibial approach.Materials and Methods
Three patients with Rutherford 3–4 disease underwent revascularization of TASC C/D lesions using a pedal/tibial artery as the only site of arterial access.Results
One patient with a chronic superficial femoral artery occlusion had continuity achieved to the common femoral artery using a dedicated reentry device and stenting; in a second patient, an occluded popliteal artery stent was successfully revised with an endograft; and in a third patient with morbid obesity, a chronic SFA occlusion was successfully stented. All patients experienced complete resolution of presenting symptoms; no puncture site complications were seen.Conclusions
Use of a pedal/tibial approach as the sole site of arterial access may become an important access technique for femoropopliteal revascularization when patients have limited femoral access options.4.
Waleed Shady Elena N. Petre Kinh Gian Do Mithat Gonen Hooman Yarmohammadi Karen T. Brown Nancy E. Kemeny Michael D&#x;Angelica Peter T. Kingham Stephen B. Solomon Constantinos T. Sofocleous 《Journal of vascular and interventional radiology : JVIR》2018,29(2):268-275.e1
Purpose
To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs).Materials and Methods
This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering.Results
Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P = .47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P < .001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P = 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P < .001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2–40.9) and perivascular tumors (P = .021) (HR: 2.2; 95% CI: 1.1–4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P < .001) (subhazard ratio: 11.6; 95% CI: 3.1–42.7) and no history of prior liver resection (P < .013) (HR: 3.2; 95%: 1.3–7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P = .43).Conclusions
Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors. 相似文献5.
Alberto V. Mansilla Eugene E. Bivins Francisco Contreras Manuel A. Hernandez Nathan Kohler Julie W. Pepe 《Journal of vascular and interventional radiology : JVIR》2017,28(2):222-229
Purpose
To develop a scoring system that stratifies complexity of percutaneous ablation of renal tumors.Materials and Methods
Analysis was performed of 36 consecutive patients (mean age, 64 y; range, 30–89 y) who underwent CT-guided microwave (MW) ablation of 45 renal tumors (mean tumor diameter, 2.4 cm; range, 1.2–4.0 cm). Technical success and effectiveness were determined based on intraprocedural and follow-up imaging studies. The RENAL score and the proposed percutaneous renal ablation complexity (P-RAC) score were calculated for each tumor.Results
Technical success was 93.3% (n = 42). Biopsy of 38 of 45 renal tumors revealed 23 renal cell carcinomas. Median follow-up period was 9.7 months (range, 2.9–46.8 months). There were no tumor recurrences. One major complication, ureteropelvic junction stricture, occurred (2.6%). The P-RAC score was found to differ statistically from the RENAL score (t = 3.754, df = 44, P = .001). A positive correlation was found between the P-RAC score and number of antenna insertions (r = .378, n = 45, P = .011) and procedure duration (r = .328, n = 45, P = .028). No correlation was found between the RENAL score and number of MW antenna insertions (r = .110, n = 45, P = .472) or procedure duration (r = .263, n = 45, P = .081). Hydrodissection was significantly more common in the P-RAC high-complexity category than in low-complexity category (χ2 = 12.073, df = 2, P = .002).Conclusions
The P-RAC score may be useful in stratifying percutaneous renal ablation complexity. Further studies with larger sample sizes are necessary to validate the P-RAC score and to determine if it can predict risk of complications. 相似文献6.
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Wenhui Zhou Sanna E. Herwald Raul N. Uppot Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2018,29(12):1685-1691
Purpose
To assess safety and renal-function outcomes after microwave (MW) ablation of localized stage T1 renal cell carcinoma (RCC).Materials and Methods
A retrospective review was conducted of 38 patients (28 men; mean age, 69 y; range, 51–88 y) who underwent computed tomography (CT)–guided MW ablation for stage T1N0M0 RCC. Baseline and follow-up renal function surrogates including creatinine level and estimated glomerular filtration rate (eGFR) were statistically compared. Peri- and postoperative complication rates, technical success, and treatment response were also assessed.Results
A total of 44 biopsy-proven stage T1N0M0 RCCs measuring 1.2–6.9 cm (mean, 2.5 cm) were treated, and renal function was measured 1 mo after treatment. Mean eGFRs were 60 mL/min/1.73 m2 at baseline and 59 mL/min/1.73 m2 at 1 month after ablation. At 1-year and last follow-ups, the means of difference were 3.3% (95% confidence interval, ?4.4 to 4.3; P = .99) and 3.3% (95% confidence interval, ?4.3 to 4.8; P = .91), respectively. The 2-years freedom from eGFR decrease to < 60 mL/min/1.73 m2 was 2% (P = .91). Among the 5 patients (13%) with preexisting stage 4 chronic kidney disease (CKD; eGFR < 30 mL/min/1.73 m2) before ablation, there was no significant postablative onset of decline or CKD upstaging (P = .001). There were no major complications, and 5 patients (13%) had small asymptomatic perinephric hematomas (Society of Interventional Radiology minor complication, class A/B) that were managed conservatively.Conclusions
At 2-year follow-up, CT-guided percutaneous MW ablation is safe and well-tolerated and achieves nephron preservation similar to existing ablative modalities. 相似文献8.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370
Purpose
To retrospectively assess long-term outcomes of percutaneous renal cryoablation, including factors affecting complications and local recurrence rates.Materials and Methods
A total of 357 computed tomographic (CT) fluoroscopy–guided percutaneous cryoablation procedures were performed for 382 masses in 302 outpatients; 347 were biopsy-proven renal-cell carcinoma (RCC) or Bosniak category > III masses (n = 28). Benign pathologic conditions (n = 18) or metastatic non-RCC disease (n = 17) were included to analyze procedural complication rate, but recurrence rates, tumor staging, and nephrometry score were limited to RCCs. The average tumor diameter was 2.9 cm (range, 1–10.3 cm), and median nephrometry score for RCC was 8 (mean, 7.4). Protection of adjacent vital structures was performed in 34% of procedures (n = 121), and ureteral stent placement was performed for 9.2% (n = 33). All major complications were graded per surgical Clavien–Dindo criteria.Results
The average CT-visible cryoablation zone diameter was 5 cm (range, 2.5–10.5 cm). Grade ≥ 3 complications occurred in 2.8% of procedures (n = 10), and appeared related to only high nephrometry scores (P = .0086) and larger tumors (P = .0034). No significant changes in renal function before and after the procedure were noted (P = .18). At a mean follow-up of 31.8 months, the local tumor recurrence rate was 3.2% (11 of 347) for RCC, and no significant difference was noted between tumors larger or smaller than 3 cm (P = .15). The difference reached significance only among the small number of stage ≥ T2 RCC tumors (P = .0039).Conclusions
Long-term follow-up of percutaneous renal cryoablation demonstrates low recurrence rates with preserved renal function, even for patients with high nephrometry scores and body mass index, assuming thorough cytotoxic technique and protection measures. 相似文献9.
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Amandine Crombé Xavier Buy Yann Godbert Nicolas Alberti Michèle Kind Françoise Bonichon Jean Palussière 《Cardiovascular and interventional radiology》2016,39(12):1779-1784
An 82-year-old man, who was diagnosed in 2002 with an oncocytic (Hürthle cell) thyroid carcinoma, was initially treated by local surgery and was refractory to radioiodine treatment. The patient had successive secondary recurrences from 2006 onwards. Metastases were suspected due to an elevation of thyroglobulin in serum. Hypermetabolic nodules were targeted using FDG PET as well as CT-guided radiofrequency ablations. Thyroglobulin levels decreased following each procedure. 10 years later, tolerance and efficacy are excellent; 23 lung metastases have been treated during 11 sessions without current relapse. Respiratory function and quality of life are not altered. This report illustrates how radiofrequency ablation can be efficiently integrated into the long-term management of poorly aggressive oligometastatic cancer, in combination with other local and/or systemic therapies. 相似文献
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Purpose
To compare effectiveness of transarterial chemoembolization (TACE) combined with microwave ablation (MWA; TACE–MWA) with TACE alone for treating hepatocellular carcinoma (HCC) tumors ≤5 cm.Materials and Methods
We reviewed data of 244 patients treated for HCC by TACE–MWA or TACE from June 2014 to December 2015. Median follow-up period was 505 days (TACE–MWA group: 485 days; TACE group: 542 days). Patients were propensity score matched (1:2 ratio); outcomes of TACE–MWA and TACE groups were compared. Primary endpoints were tumor responses, including tumor necrosis rates after initial treatment, tumor responses at 6 months [per modified Response Evaluation Criteria in Solid Tumors (mRECIST)], and time to tumor progression (TTP). Secondary endpoints were overall survival (OS) and re-intervention times.Results
After initial treatments, tumor necrosis rates were higher in the TACE–MWA group (n = 48; 92.1% [58/63]) than the TACE group (n = 96; 46.3% [56/121]; P < 0.001). At 6 months’ follow-up, the TACE–MWA group had better tumor responses (CR + PR + SD [per mRECIST]: TACE–MWA, 95.8%; TACE, 64.5%; P < 0.001). The TACE–MWA group had better TTP (P < 0.001), but did not significantly differ in OS (P = 0.317). TACE–MWA decreased re-TACE times from 1.90 to 0.52; and re-MWA times from 0.22 to 0.17. In subgroup analysis, TACE–MWA also showed better TTP in patients with tumors ≤3 cm (P < 0.001) and 3–5 cm (P = 0.004).Conclusions
Compared with TACE, TACE–MWA leads to better responses for HCC tumors ≤5 cm.12.
Objective
To evaluate the effect of the heat-sink phenomenon induced by artificial ascites on the size of the ablation zone during percutaneous radiofrequency (RF) ablation of the hepatic subcapsular area in an in vivo rabbit model.Materials and Methods
A total of 21 percutaneous rabbit liver RF ablations were performed with and without artificial ascites (5% dextrose aqueous solution). The rabbits were divided into three groups: a) control group (C, n = 7); b) room temperature ascites group (R, n = 7); and c) warmed ascites group (W, n = 7). The tip of a 1 cm, internally cooled electrode was placed on the subcapsular region of the hepatic dome via ultrasound guidance, and ablation was continued for 6 min. Changes in temperature of the ascites were monitored during the ablation. The size of the ablation zones of the excised livers and immediate complications rates were compared statistically between the groups (Mann-Whitney U test, Kruskal-Wallis test, linear-by-linear association, p = 0.05).Results
One rabbit from the "W" group expired during the procedure. In all groups, the ascites temperatures approached their respective body temperatures as the ablations continued; however, a significant difference in ascites temperature was found between groups "W" and "R" throughout the procedures (39.2±0.4℃ in group W and 33.4±4.3℃ in group R at 6 min, p = 0.003). No significant difference was found between the size of the ablation zones (782.4±237.3 mL in group C, 1,172.0±468.9 mL in group R, and 1,030.6±665.1 mL in group W, p = 0.170) for the excised liver specimens. Diaphragmatic injury was identified in three of seven cases (42.9%) upon visual inspection of group "C" rabbits (p = 0.030).Conclusion
Artificial ascites are not likely to cause a significant heat-sink phenomenon in the percutaneous RF ablation of the hepatic subcapsular region. 相似文献13.
Liang Zhang Na Wang Jingsong Mao Xiaofei Liu Zhichun Gao Xu Dai Bo Feng 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1455-1461
Purpose
To evaluate whether changes in volumetric iodine concentration (VIC) could serve as a suitable predictor of therapeutic response to microwave (MW) ablation in a rabbit intrahepatic VX2 tumor model.Materials and Methods
Sixteen intrahepatic VX2 tumors were transplanted in 8 New Zealand White rabbits treated with MW ablation. Contrast-enhanced dual-energy CT scans were obtained at baseline and follow-up. Therapeutic response assessment by modified Response Evaluation Criteria In Solid Tumors (mRECIST), Choi criteria, and VIC changes was performed. An intraclass correlation coefficient (ICC) was used to characterize consistency of assessment results among the criteria used. Technical success was evaluated with explant pathologic findings as a reference. Correlations between technical success and variations in diameter, CT density, and VIC were analyzed.Results
Disease control was observed in 4, 8, and 10 of the 16 tumors per mRECIST, Choi criteria, and VIC changes, respectively. VIC exhibited strong consistency (ICC = 0.807, P < .0001) with Choi criteria. According to explant pathology, technical success was achieved in 10 of the 16 tumors. There was a moderate correlation between VIC changes and technical success (r = 0.532, P = .034), and no correlation was found between technical success and variations in diameter or CT density.Conclusions
Compared with mRECIST and Choi criteria, dual-energy CT–derived VIC allowed for better prediction of therapeutic response after MW ablation and could provide a potential imaging biomarker of tumor response to MW ablation in patients with hepatocellular carcinoma. 相似文献14.
Onik G 《Cardiovascular and interventional radiology》2008,31(1):98-106
Background Prostate cancer in men raises many of the same issues that breast cancer does in women. Complications of prostate cancer treatment,
including impotence and incontinence, affect the self-image and psyche of a man no less than does the loss of a breast in
a woman. We present a pilot study in which 21 patients were treated with a focal cryoablation procedure.
Methods Focal cryoablation was performed using biplane transrectal ultrasound if the tumor was confined to only one prostate lobe.
Preoperative PSA values were recorded. Cryoablation was planned to encompass the area of known tumor. PSA values were obtained
every 3 months for 2 years and every 6 months thereafter. Potency and continence status was obtained at the same intervals.
Routine biopsy was obtained at 1 year.
Results Twenty-one patients had focal cryoablation. Follow-up ranged from 24 to 105 months with a mean of 50 months. Twenty of 21
(95%) patients have stable PSA values with no evidence for cancer, despite 10 patients being at medium to high risk for recurrence.
All patients biopsied (n = 19) were negative for tumor. Potency was maintained in 17 of 21 patients (80%). No other complications, including incontinence
or fistula formation, were noted.
Conclusion These preliminary results indicate a “male lumpectomy,” in which the prostate tumor region itself is destroyed, appears to
preserve potency in a majority of patients and limits other complications, without compromising cancer control. If these results
are confirmed by further studies and long-term follow-up, this treatment approach could have a profound effect on prostate
cancer management. 相似文献