Outcomes of ultrasound-guided percutaneous ablation of >5 versus ≤ 5 colorectal liver metastases: a propensity score matching study

OBJECTIVES

To investigate the effectiveness and safety of microwave ablation (MWA) in patients with 1-5 colorectal liver metastases (CRLM) versus those with 6-9 CRLM.

METHODS

Data from patients with 1-9 CRLM, who underwent ultrasound (US)-guided percutaneous MWA between January 2018 and May 2023, were retrospectively analyzed. Propensity score matching (PSM) at a ratio of 1:2 was used to balance potential bias between the groups.

RESULTS

Data from 264 patients were included in the analysis. After PSM, there were 43 and 75 patients in the CRLM >5 and ≤5 groups, respectively. Even with higher tumor burden and technical difficulty, there was no statistical difference in the local tumor progression (LTP)-free survival (LTPFS) between the groups (p > 0.05). Patients with an ablation margin (AM) ≤5 mm exhibited a significantly higher rate of LTP than those with AM >5 mm in both groups(p < 0.05). Patients with 6-9 CRLM experienced a higher incidence of intrahepatic recurrence (iHR) (p = 0.041) and shorter progression-free survival (PFS) at any site (p < 0.05). CRLM > 5 is an independent risk factor for poor PFS (p = 0.008). The minor complication rate was lower in the CRLM ≤ 5 group (p < 0.05) and the major complication rate showed no difference (p > 0.05).

CONCLUSIONS

When the number of CRLM was limited to 9, single-session MWA was feasible and safe for radical local treatment. An AM >5 mm was critical for local tumor control. Compared with patients with 1-5 CRLM, those with 6-9 CRLM experienced inferior PFS at any site, which mainly lies in more iHR.

Thyroid nodule rupture after thermal ablation for benign thyroid nodules: incidence, risk factors, and clinical management

BACKGROUND

Thyroid nodule rupture (TNR) is a rare and severe complication after thermal ablation (TA), mostly from benign thyroid nodules (BTN).

OBJECTIVE

To summarize the incidence of TNR after TA and analyze the causes and prevention strategies.

MATERIALS AND METHODS

This retrospective study enrolled 3971 patients who underwent TA for BTN from January 2014 to March 2024. The incidence, causes, and risk factors of TNR were analyzed. Propensity score matching (PSM) controlled for confounding factors. Multivariate regression identified risk factors for TNR. ROC curves determined the optimal cutoff value for the maximum diameter (MD) for TNR.

RESULTS

TNR occurred in 8 cases [0.2% (8/3971)]. The mean time from TA to TNR was 29.6 ± 13.0 days (range, 20-60 days). After PSM, MD was larger in the TNR group than in the non-TNR group [mean 4.1 ± 1.6 cm vs. mean 1.8 ± 1.2 cm; p < 0.001]. The optimal cutoff value of MD for TNR was 2.75 cm. After PSM, the incidence of pressure on the ablation zone was significantly higher in the TNR group than in the non-TNR group [100% (8/8) vs. 0 (0/32); p < 0.001], which has been suspected as a case of TNR. Antibiotic drugs, aspiration, or incision drainage could successfully manage all TNR cases.

CONCLUSION

TNR could be encountered in case of pressure on the BTN after TA. Protecting the ablation site from pressure might be crucial in preventing TNR, especially within two months. TNR is more likely to occur if the MD of BTN exceeds 2.75 cm under pressure. Observation, antibiotics, and aspiration could successfully manage all TNR cases.

Comparison of US-guided thermal ablation and surgery for papillary thyroid cancer: a systematic review and meta-analysis

OBJECTIVE

We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

METHODS

PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

RESULTS

A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

CONCLUSION

As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

Hepaticojejunostomy and long-term interventional treatment for recurrent biliary stricture after proximal bile duct injury: A case report

BACKGROUND

Proximal bile duct injury (BDI), which often occurs after laparoscopic cholecystectomy (LC), can lead to complex biliary stricture and recurrent cholangitis. This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017, leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018. Despite these interventions, persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment. Imaging studies revealed persistent stricture at the site of hepaticojejunostomy, prompting a series of percutaneous procedures, including balloon dilatation and biliary drainage. In August 2024, she underwent biodegradable biliary stenting, which significantly improved her condition. Subsequently, she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests. This case highlighted the complexities of managing postinjury biliary stricture, underscored the potential of biodegradable stents as an effective treatment option, and emphasized the need for a multidisciplinary approach in managing such complications. Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.

CASE SUMMARY

A 39-year-old female had a routine LC in 2017. The patient sustained a proximal BDI during the surgery. In the months that followed, recurrent bouts of cholangitis occurred. A hepaticojejunostomy biliary reconstruction was performed in 2018. However, hepatic cholangitis persisted. In 2021 and 2022, MRCP scans revealed biliary stasis, duct dilation, and a stricture at the hepaticojejunostomy site. A subsequent percutaneous transhepatic cholangiography (PTC) confirmed these findings and led to drain placement. The treatment included internal and external biliary drain placements, repeated balloon dilations of the stricture, percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis, and insertion of a biodegradable biliary stent. Since the first PTC intervention, there have been no hospital admissions for cholangitis. Liver function tests showed improvement, and for five months following the biodegradable stenting, the condition remained stable. Long-term surveillance with regular imaging and blood work has been emphasized. The final diagnosis is recurrent biliary stricture secondary to proximal BDI. Treatment, including hepaticojejunostomy, repeated PTC with balloon dilation, and biodegradable biliary stenting, has led to complete drainage of the biliary system. Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.

CONCLUSION

This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC. A customized and multidisciplinary approach to control chronic biliary disease was proven effective, as shown by the patient’s good outcome. This was achieved by integrating balloon dilatation sessions, biliary drainage, stone clearing, and biodegradable stent placement. Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.

Environmental mineral density and thyroid malignancy: A multicenter cross-sectional study

BACKGROUND

Several trace minerals have been shown to be associated with thyroid cancer. Democratic Republic of Congo (DRC) is deemed the most mineral-rich country globally. Data on the characteristics of thyroid nodules in various mineral-rich regions of the DRC is scarce.

AIM

To analyze the differential spectrum of thyroid nodules based on locoregional variance in mineral density.

METHODS

We conducted a cross-sectional study on 529 patients with thyroid nodules residing in Katanga, South Kivu and Kinshasa between 2005 and 2019. Of these three provinces, Katanga and South Kivu have the highest mineral density with the DRC.

RESULTS

Mean patient age was 44.2 years ± 14.6 years with a female predominance, with a female to male ratio of 5.4. The 66.5% of patients had a family history of thyroid disease. Total 74 patients had simple nodules, and the remaining 455 patients had multiple nodules. The 87.7% of patients were euthyroid. The nodules exhibited varying characteristics namely hypoechogenicity (84.5%), solid echostructure (72.2%), macronodular appearance (59.8%), calcifications (14.4%) and associated lymphadenopathy (15.5%). The 22.3% of the nodules were malignant. Factors independently associated with malignancy were older age (≥ 60 years) [adjusted odds ratio (aOR) = 2.81], Katanga province (aOR = 8.19), solid echostructure (aOR = 7.69), hypoechogenicity (aOR = 14.19), macronodular appearance (aOR = 9.13), calcifications (aOR = 2.6) and presence of lymphadenopathy (aOR = 6.94).

CONCLUSION

Thyroid nodules emanating from the mineral-laden province of Katanga were more likely to be malignant. Early and accurate risk-stratification of patients with thyroid nodules residing in high-risk areas could be instrumental in optimizing survival in these patients.

Pediatric gonadal torsion in radiology: A comprehensive literature and pictorial review using surgically proven cases

Pediatric gonadal torsion is a critical surgical emergency requiring immediate diagnosis and intervention to preserve reproductive capabilities. This review addresses the diagnostic challenges, imaging patterns, and management strategies for both ovarian and testicular torsion, including a brief discussion on the emerging role of Contrast-Enhanced Ultrasound (CEUS), therefore filling a significant gap in the literature. We emphasize the need for a high index of suspicion due to often nonspecific clinical presentations, particularly in ovarian torsion. An accurate and swift diagnosis allows conservative surgical intervention to be offered, which is crucial to maximize gonadal salvage and minimize recurrence. While we highlight CEUS's potential benefits in enhancing diagnostic clarity without ionizing radiation, ultrasound and other modalities such as MRI and CT, have a paramount role in this setting. Future research comparing CEUS with MRI is essential to validate its diagnostic accuracy and effectiveness, potentially revolutionizing acute care diagnostics. Incorporating CEUS into diagnostic workflows, along with a deep understanding of the condition's epidemiology, pathophysiology, and clinical presentation, may probably significantly improve patient outcomes. We detail the characteristic imaging features, diagnostic pitfalls, and differential diagnoses essential for radiologists, with particular relevance for residents and those with limited pediatric radiology exposure. This review aims to bridge existing knowledge gaps and serve as a robust educational tool, facilitating better clinical decision-making and outcomes in pediatric gonadal torsion cases.

Ultrasound-responsive nanoparticles for imaging and therapy of brain tumors

Central nervous system (CNS) cancers, particularly glioblastoma (GBM), are associated with high mortality and disability rates. Despite aggressive surgical resection, radiotherapy, and chemotherapy, patient survival remains poor. The blood-brain barrier (BBB) significantly impedes therapeutic efficacy, making BBB penetration a critical focus of research. Focused ultrasound (FUS) combined with microbubbles (MBs) can transiently open the BBB through mechanisms such as cavitation, modulation of tight junction protein expression, and enhanced vesicular transport in endothelial cells. This review highlights precision delivery and personalized treatment strategies under ultrasound visualization, including precise control of ultrasound parameters and modulation of the immune microenvironment. We discuss the applications of ultrasound-responsive nanoparticles in brain tumor therapy, including enhanced radiotherapy, gene delivery, immunotherapy, and sonodynamic therapy (SDT), with a particular emphasis on piezoelectric catalytic immunotherapy. Finally, we provide insights into the clinical translation potential of ultrasound-responsive nanoparticles for personalized and precision treatment of brain tumors.

Contrast-enhanced ultrasound for differentiation of gallbladder sludge from polyp: A case report demonstrating clinical utility

Gallbladder lesion characterization remains a common diagnostic dilemma in abdominal imaging, particularly when differentiating between polyps and organized sludge. Findings on conventional gray-scale ultrasound may be equivocal, especially when typical imaging features such as mobility are absent. We present a case of a 65-year-old patient who presented with a concerning nonmobile 3.7 cm gallbladder lesion on initial ultrasound assessment. Due to the superior sensitivity of contrast-enhanced ultrasound (CEUS) for blood flow compared to other imaging modalities, CEUS was able to demonstrate complete absence of enhancement within the lesion, consistent with tumefactive sludge rather than solid tissue, and averting the need for additional cross-sectional imaging. Surgical pathology following cholecystectomy confirmed these findings. This case highlights the utility of CEUS as a valuable tool in gallbladder imaging, potentially reducing healthcare costs and expediting appropriate patient care while avoiding the risks associated with other contrast-enhanced imaging modalities.

The use of machine learning in transarterial chemoembolisation/transarterial embolisation for patients with intermediate-stage hepatocellular carcinoma: a systematic review

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Intermediate-stage HCC is often treated with either transcatheter arterial chemoembolisation (TACE) or transcatheter arterial embolisation (TAE). Integrating machine learning (ML) offers the possibility of improving treatment outcomes through enhanced patient selection. This systematic review evaluates the effectiveness of ML models in improving the precision and efficacy of both TACE and TAE for intermediate-stage HCC. A comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Library databases was conducted for studies applying ML models to TACE and TAE in patients with intermediate-stage HCC. Seven studies involving 4,017 patients were included. All included studies were from China. Various ML models, including deep learning and radiomics, were used to predict treatment response, yielding a high predictive accuracy (AUC 0.90). However, study heterogeneity limited comparisons. While ML shows potential in predicting treatment outcomes, further research with standardised protocols and larger, multi-centre trials is needed for clinical integration.

Outcomes and Complications of Image-Guided Percutaneous Tumour Ablation for Hepatocellular Carcinoma at the Irish National Liver Transplant Centre

Background: Image-guided tumour ablation is a minimally invasive treatment for early stage hepatocellular carcinoma (HCC). Our study reviews the complications and long term outcomes in patients treated at a tertiary referral centre. Methods: Retrospective study. All patients with HCC who underwent microwave ablation (MWA) or radiofrequency ablation (RFA) from 1st January 2014 to 31st December 2022 were identified. Treatment response of target lesion, complications, and survival were recorded. Results: One hundred seventy ablations were performed in 118 patients; 70% MWA, 30% RFA. Median radiological follow-up 21 months (range 3-107). Follow-up imaging was reported using LI-RADS and mRECIST. At first follow-up imaging, 94 patients had complete response (primary efficacy rate 80.3%) while 19.7% (n = 23) had residual disease. Fifteen of these had repeat ablation; 10 had complete response (secondary efficacy rate 85.6%). By end of study duration, 70.5% (n = 79) achieved sustained local complete response from single ablation without documented recurrence. 14.3% (n = 16) required more than one ablation of target lesion. Overall, 84.8% (n = 95) demonstrated long term local complete response to ablation. Complication occurred in 5.9% (n = 10); 40.0% Grade I, 40.0% Grade II, 10.0% Grade III, 10.0% Grade IV as per the CIRSE Classification. 1-, 3-, and 5-year overall survival (OS) rate was 97%, 68%, and 61% respectively. Mean OS was 5.3 years (median 4.7). No difference in OS (P = .7) or local progression free survival (P = .5) between patients treated with MWA versus RFA. Conclusion: This study demonstrates excellent long-term response to TA, with acceptable complication profile. No difference in survival between RFA versus MWA.

Bolus-Tracked Biphasic Contrast-Enhanced CT Imaging Following Microwave Liver Ablation Improves Ablation Zone Conspicuity and Semi-automatic Segmentation Quality

PURPOSE

Contrast-enhanced CT (CECT) may be performed immediately following microwave liver ablation for assessment of ablative margins. However, practices and protocols vary among institutions. Here, we compare a standardized bolus-tracked biphasic CECT protocol and compare this with a single venous phase fixed delay protocol for ablation zone (AZ) assessment.

METHODS

An institutional review board approved study performed at a specialist cancer centre. A prospective cohort of patients undergoing bolus-tracked biphasic imaging was compared with a retrospective cohort of patients who underwent fixed delay venous phase imaging. AZ conspicuity and segmentation quality were semi-quantitatively scored using Five-point Likert scales. Time between ablation and image acquisition was recorded for each AZ and was correlated to AZ conspicuity and segmentation quality.

RESULTS

Forty patients, median age 59 years (IQR 48-66 years), 24 men, underwent microwave ablation of 68 liver tumours. AZ conspicuity was higher in the bolus-tracked (n = 33) vs. fixed delay (n = 35) cohorts, 4.5 vs. 2.5, P < 0.0001. Commensurate segmentation quality was also higher, 5.0 vs. 3.0 respectively, P < 0.0001. Ordinal regression showed that image quality scores declined by 3-4% for each minute that passes after ablation, particularly for arterial phase images, where regression coefficients were - 0.04, P = 0.007, and -0.03, P = 0.012 for conspicuity and segmentation quality, respectively.

CONCLUSION

Bolus-tracked biphasic contrast-enhanced CT protocols improve both conspicuity and semi-automatic segmentation quality of microwave liver ablation zones, particularly if imaged soon after ablation.

EVIDENCE-BASED MEDICINE

Level 2b; exploratory prospective cohort study.

Ultrasound‑guided Percutaneous Radiofrequency and Microwave Ablation for Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Systematic Review and Meta‑analysis of Clinical Efficacy and Safety

AIM

To evaluate the efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) for treating cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC).

METHODS

Medline, EMBASE, Web of Science, and Cochrane Library were searched for studies on the efficacy and safety of thermal ablations for treating CLNM from PTC until July 2024. Among 544 papers, 11 articles were reviewed involving 233 patients and 432 CLNM cases. Random- or fixed-effects models assessed pooled proportions of volume reduction rate (VRR), complete disappearance, recurrence, major and minor or other complications. Similarly, pooled estimates of changes in the largest diameter, volume, and serum thyroglobulin (Tg) were evaluated post-ablation. Subgroup analysis by treatment modality was performed. Study heterogeneity was analyzed using Q statistics and inconsistency index (I2). The quality of the studies was assessed using the MINORS scale.

RESULTS

Eleven studies with 233 patients and 432 CLNM were analyzed. The pooled VRR was 95.24% [95% Confidence Interval (CI): 91.97- 98.51%], complete disappearance was 63.1%, and recurrence was 1.6%. Changes in largest diameter, volume, and serum Tg were 8.36 mm (95%CI: 6.46-10.26mm), 216.09mm³, and 6.12ng/ml, respectively. Major complications occurred at 3.0%, while minor complications were 25.6%. Significant heterogeneity was found for diameter, volume, VRR, Tg, and minor complications. Subgroup analysis showed that MWA had a higher VRR (97.18%) than RFA (93.84%) (P < 0.001).

CONCLUSION

Both RFA and MWA were effective and safe for treating CLNM from PTC. However, RFA showed lower volume reduction than MWA with significant heterogeneity in VRR.

DATA AVAILABILITY STATEMENT

The original contributions revealed in the study are included in the article/Supplemental Material. Further inquiries can be made to the corresponding author.

Percutaneous thermal ablation in hepatocellular carcinoma patients with and without TIPS

PURPOSE

Managing hepatocellular carcinoma (HCC) in patients with a transjugular intrahepatic portosystemic shunt (TIPS) is becoming increasingly common. This study aimed to evaluate the safety and efficacy of percutaneous thermal ablation for treating HCC in patients with TIPS.

METHODS

This retrospective longitudinal study was conducted at Nantes University Hospital. The main inclusion criteria were patients undergoing percutaneous thermal ablation for HCC. Patients with a pre-existing TIPS were included in the 'TIPS group'. A 1:1 control group without TIPS, the 'n-TIPS group', was created for this case-control study. The primary endpoints were overall survival and progression-free survival over 12 months. Safety was assessed by comparing complications between the groups.

RESULTS

Between 2008 and 2020, 371 patients underwent percutaneous thermal ablation for HCC. The 'TIPS group' included 34 patients (66 nodules), while 34 patients (84 nodules) were randomly assigned to the 'n-TIPS group.' Overall survival rates at 1 year were 97% and 94% respectively (p = 0.52). The progression-free survival rate was 68% and 57% respectively (p = 0.35). No deaths occurred within 30 days post-procedure. There were 3 immediate complications in the TIPS group and 4 in the n-TIPS group (p = 1), none of which were related to the TIPS, including thrombosis.

CONCLUSION

Percutaneous thermal ablation for HCC in patients with TIPS appears to be as safe and effective as in TIPS-naïve patients. These results suggest that the presence of a TIPS should not be considered a contraindication for percutaneous thermal ablation in treating HCC.

The Value of no Evidence of Disease (NED) in Intermediate-Stage Hepatocellular Carcinoma After TACE: A Real-World Study

BACKGROUND AND AIMS

One-third of patients with intermediate-stage hepatocellular carcinoma (HCC) can achieve imaging-based no evidence of disease (NED) during treatment after transarterial chemoembolization (TACE) and sequential therapies; however, its temporal dynamics, contributing factors and prognostic value remain unknown.

METHODS

The longitudinal data of 1665 intermediate-stage HCC patients from Sun Yat-sen University Cancer Center were included as a derivation cohort; 414 patients from three external medical centers served as the validation cohort. Image-Only NED is defined as no evidence of disease based on imaging exams while having a serum level of alpha-fetoprotein (AFP) above the upper limit; Image-Bio NED pertains to an additional achievement of a normal level of AFP. A semi-Markov multistate model was adopted to identify the transitions between intermediate states, which included NED unreached, Image-Only NED, Image-Bio NED, recurrence after NED and death. A time-dependent Cox proportional hazards model for overall survival (OS) was utilised to evaluate the dynamic prognostic value of NED states.

RESULTS

The percentage of patients who reached Image NED and Image-Bio NED was 35.2% and 24.7% in the derivation cohort, and 37.4% and 31.4% in the validation cohort. The proportion of Image-Only NED and Image-Bio NED peaked by the end of the second year since initial treatment and declined gradually. Patients with Image-Only NED had a higher risk of recurrence compared to the Image-Bio NED subgroup (p < 0.05). With the subgroup of NED unreached as reference, the multivariate time-dependent Cox model showed Image-Only NED (HR 0.44; 95% CI 0.33-0.59) and Image-Bio NED (HR 0.26; 0.20-0.33) were significant intermediate states that predict distinct OS for patients with intermediate-stage HCC, which was further confirmed in the multi-centre validation cohort.

CONCLUSIONS

Our study highlights the clinical course of NED states and demonstrates its dynamic prognostic significance in patients with intermediate-stage HCC after TACE. The Image-Bio NED is recommended to serve as an important endpoint during the dynamic management of intermediate-stage HCC.

Quantitative Ablation Confirmation Methods in Percutaneous Thermal Ablation of Malignant Liver Tumors: Technical Insights, Clinical Evidence, and Future Outlook

Percutaneous image-guided thermal ablation is an established local curative-intent treatment technique for the treatment of primary and secondary malignant liver tumors. Whereas margin assessment after surgical resection can be accomplished with microscopic examination of the resected specimen, margin assessment after percutaneous thermal ablation relies on cross-sectional imaging. The critical measure of technical success is the minimal ablative margin (MAM), defined as the minimum distance between the tumor and the edge of the ablation zone. Traditionally, the MAM has been assessed qualitatively using anatomic landmarks, which has suboptimal accuracy and reproducibility and is prone to operator bias. Consequently, specialized software-based methods have been developed to standardize and automate MAM quantification. In this review, the authors discuss the technical components of such methods, including image acquisition, segmentation, registration, and MAM computation, define the sources of measurement error, describe available software solutions in terms of image processing techniques and modes of integration, and outline the current clinical evidence, which strongly supports the use of such dedicated software. Finally, the authors discuss current logistical and financial barriers to widespread use of ablation confirmation methods as well as potential solutions. Keywords: Ablation Techniques, CT, Image Postprocessing, Liver Supplemental material is available for this article. © RSNA, 2025.

Software-based versus visual assessment of the minimal ablative margin in patients with liver tumours undergoing percutaneous thermal ablation (COVER-ALL): a randomised phase 2 trial

BACKGROUND

Tumour coverage with an optimal minimal ablative margin is crucial for improving local control of liver tumours following thermal ablation. The minimal ablative margin has traditionally been assessed through visual inspection of co-registered CT images. However, rates of local tumour control after thermal ablation are highly variable with visual assessment. We aimed to assess the use of a novel software-based method for minimal ablative margin assessment that incorporates biomechanical deformable image registration and artificial intelligence (AI)-based autosegmentation.

METHODS

The COVER-ALL randomised, phase 2, superiority trial was conducted at The University of Texas MD Anderson Cancer Center (Houston, TX, USA). Patients aged 18 years or older with up to three histology-agnostic liver tumours measuring 1-5 cm and undergoing CT-guided thermal ablation were enrolled. Thermal ablation was performed with the aim of achieving a minimal ablative margin of 5 mm or greater. Patients were randomly assigned (1:1) to the experimental group (software-based assessment) or the control group (visual assessment) by use of dynamic minimisation to balance covariates. Randomisation was performed intraprocedurally after placement of the ablation applicator. Assessment of oncological outcomes and adverse events were masked to treatment allocation. All analyses were conducted on an intention-to-treat basis. The primary endpoint was the minimal ablative margin on post-ablation intraprocedural CT. A preplanned interim analysis for superiority was done at 50% patient enrolment. Adverse events were recorded with the Common Terminology Criteria for Adverse Events. This trial is registered with ClinicalTrials.gov (NCT04083378), and recruitment is complete.

FINDINGS

Patients were enrolled and treated with thermal ablation between June 15, 2020, and Oct 5, 2023. 26 patients were randomly assigned to the control group (mean age 58·1 [SD 14·8] years; 18 [69%] male and eight [31%] female; 11 [42%] colorectal cancer liver metastasis; median tumour diameter 1·7 cm [IQR 1·3-2·3]) and 24 to the experimental group (mean age 60·5 [14·4] years; 16 [67%] male and eight [33%] female; ten [42%] colorectal cancer liver metastasis; median tumour diameter 1·8 cm [1·5-2·5]). The interim analysis showed a mean minimal ablative margin of 2·2 mm (SD 2·8) in the control group and 5·9 mm (2·7) in the experimental group (p<0·0001), prompting halting of enrolment in the control group. A further 50 patients were enrolled to a non-randomised experimental group (mean age 56·5 [SD 11·7] years; 27 [54%] male and 23 [46%] female; 30 [60%] colorectal cancer liver metastasis; median tumour diameter 1·5 cm [IQR 1·3-2·2]); among these patients, the mean minimal ablative margin was 7·2 mm (SD 2·8). Grade 1-3 adverse events were reported in five (5%) of 100 patients: three (12%) of 26 in the control group and two (3%) of 74 in the experimental groups. No grade 4-5 adverse events or treatment-related deaths were reported.

INTERPRETATION

Software-based assessment during CT-guided thermal ablation of liver tumours is safe and significantly improves the minimal ablative margin compared to visual assessment. Adoption of software-based assessment as a standard component of thermal ablation should be considered to achieve the intended minimal ablative margin.

FUNDING

US National Institutes of Health and US National Cancer Institute.

Thyroid Dysfunction Following Thermal Ablation of Large Solid and Solid-Predominant Thyroid Nodules

OBJECTIVES

Thermal ablation (TA) is an alternative to lobectomy for thyroid nodules (TNs). While it is believed that thyroid function remains stable after TA for cystic TNs, the impact of TA on solid TNs, especially the large ones, is less explored. This study investigates changes in thyroid hormones after TA in patients with solid-predominant TNs and identifies potential risk factors for thyroid dysfunction after TA.

METHODS

Euthyroid patients with solid-predominant TNs (≥ 80% solid) were enrolled. The volume, diameter, and cytopathology of TNs were assessed before TA. TA was performed using either microwave or radiofrequency ablation. Thyroid hormone levels were measured at 1 week and 1, 3, 6, and 12 months after TA.

RESULTS

Seventy-seven euthyroid patients with TNs were included. The euthyroid rate dropped to 70.1% at 1 week after TA but improved to over 90% by 1 month and returned to 100% by 12 months. At 1 week after TA, subclinical hyperthyroidism and hyperthyroidism were observed, with elevated thyroxine, free triiodothyronine, free thyroxine, and thyroglobulin antibody levels, along with decreased thyroid-stimulating hormone (TSH) levels. The diameter and total volume of TNs were positively correlated with thyroid dysfunction, while TSH-baseline was negatively correlated with thyroid dysfunction 1 week after TA. A larger diameter and lower baseline TSH were identified as independent risk factors for thyroid dysfunction.

CONCLUSIONS

TA may cause short-term thyroid dysfunction, especially in patients with large TNs. Monitoring of thyroid hormone levels is recommended from 1 week to 3 months after TA to manage potential thyroid dysfunction effectively.

MR-Guided Microwave Ablation for Patients with Cirrhosis Complicated by Small Hepatocellular Carcinoma

PURPOSE

To assess the technical effectiveness and therapeutic outcomes of percutaneous magnetic resonance (MR)-guided microwave ablation (MWA) in the treatment of patients with cirrhosis complicated by small hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

A single-center, retrospective analysis of consecutive cases involving 1.5T MR-guided MWA for HCC was performed. Fifty-three patients with cirrhosis, harboring 74 HCC lesions with mean diameter of 13.0 mm (SD ± 6.0; range, 6.0-29.0 mm; median, 10.0 mm), were included in this study. Follow-up MR imaging was performed postprocedurally to assess technical effectiveness, whereas local progression-free survival (LPFS) and overall survival (OS) rates were calculated over the study period.

RESULTS

MR-guided MWA was performed with technical success in all cases with no severe adverse events occurring during the single-session treatment. The mean follow-up duration was 46.1 months (SD ± 17.9; median, 52 months). Local tumor progression was observed in 1 perivascular lesion, accounting for 1.9% of the cases. The mean recurrence-free survival was 31.1 months (SD ± 22.2), with a median of 24.5 months. LPFS rates at 1, 3, and 5 years were 98.1%. The OS rates at 1, 3, and 5 years were 96.2%, 84.9%, and 71.6%, respectively.

CONCLUSIONS

Percutaneous MR-guided MWA for small HCC in patients with cirrhosis demonstrated high technical success, accurate evaluation of ablation margins, and minimal local tumor progression after a single treatment session, resulting in favorable therapeutic outcomes.

Percutaneous cryoablation of renal tumors adjacent to critical structures: impact of adjacent organ type on local tumor control

BackgroundRenal cell carcinomas (RCCs) adjacent to critical structures can be safely treated using percutaneous cryoablation with adjunctive techniques. However, there are only a few reports describing the factors affecting local tumor control after percutaneous cryoablation for such RCCs.PurposeTo evaluate the factors affecting local tumor control in the percutaneous cryoablation of RCCs adjacent to critical structures.Material and MethodsA total of 403 tumors from 328 patients were retrospectively reviewed. Patients with histologically proven RCCs adjacent to critical structures with at least 1 year of follow-up after treatment were included. Hereditary RCCs were excluded. Of the 403 tumors, 40 met the criteria. Owing to the tumor location, all procedures were performed using adjunctive techniques. Baseline, perioperative, and follow-up data were collected and factors affecting local tumor progression were evaluated. Comparisons between groups with and without local tumor progression were performed using Fisher's exact test or Wilcoxon's rank sum test.ResultsThe median follow-up was 1289.5 days. Local tumor progression was observed in 7/40 (17.5%) patients. Univariate analysis revealed that significant factors affecting local tumor progression were situated adjacent to the ureter (P = 0.005), requiring adjunctive techniques other than hydro- and/or pneumo-dissection (P = 0.005), as well as the distance between tumors and critical structures (P = 0.04). The ice-ball margin tended to be smaller in the group with local tumor progression but this was not significant (P = 0.07).ConclusionRenal tumors adjacent to the ureter may result in local tumor progression after cryoablation compared with tumors adjacent to other organs.

Transarterial chemoembolization combined with percutaneous ethanol injection for the treatment of hepatocellular carcinoma at high-risk areas

PURPOSE

To analyze the efficacy and safety of the combination of transarterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) at high-risk areas.

MATERIALS AND METHODS

Data from cases involving TACE combined with PEI for HCC treatment in high-risk regions were analyzed from January 2016 to December 2023 at three medical centers. High-risk areas were defined as those less than 10 mm from the diaphragm, gallbladder, gastrointestinal tract, or secondary branches of the portal vein or bile duct. The guidance modalities for PEI were computed tomograph (CT) and cone beam computed tomograph (CBCT). Each lesion received only one session of TACE combined with PEI. Treatment efficacy was assessed by complete ablation rate of target lesions at the 2-month follow-up. Factors affecting the efficacy were determined by binary logistic regression analysis. The difference in efficacy between CT-guided and CBCT-guided PEI was analyzed by Chi-square test.

RESULTS

About 62 patients with 67 target lesions were included in the analysis. The overall complete ablation rate lesion-based was 80.6% (54/67). Lesion diameter was significantly associated with the probability of achieving complete ablation (OR = 6.89, 95% CI: 1.57-30.234, P = 0.011). There was no significant difference in the complete ablation rates between CT- and CBCT-guided approaches (83.3% vs. 80%, P = 0.867). No severe complications occurred during treatment or follow-up.

CONCLUSION

The combination of TACE with a single PEI proves to be a safe and effective treatment for HCC in high-risk areas. There was no difference between CBCT-guided and CT-guided outcomes.

Renal Arteriography and C-arm CT-Guided Ablation (RenACAGA) for Thermal Ablation of Challenging Renal Tumors

PURPOSE

We present a technique that combines Renal arteriography with C-arm CT-Guided Ablation (RenACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of renal tumors.

MATERIALS AND METHODS

The RenACAGA technique was used for thermal ablation of challenging renal tumors (intraparenchymal or US-occult lesions). All patients treated with RenACAGA between January 1, 2022, and July 1, 2024, were retrospectively evaluated. Procedures were performed in the angiography suite, with catheterization of the renal artery for selective contrast infusion. C-arm CT and guidance software were used for tumor visualization and ablation needle placement. Pre- and post-ablation C-arm CTs were fused to assess ablation margins. Technical success and local tumor recurrence (LTR) rate were evaluated. Complications were graded according to the Common terminology criteria for adverse events (CTCAE) version 5.0.

RESULTS

Seven patients with 10 tumors were treated using the RenACAGA technique. All tumors were successfully identified, punctured and ablated (technical success 100%). During a median follow-up period of 8 months (range 7-25 months), no signs of tumor recurrence at the ablation site were observed (LTR rate 0%). One CTCAE grade 3 periprocedural complication was observed (urinary leakage through the needle tract), along with two CTCAE grade 1 complications (genitofemoral neuralgia (n = 1), and asymptomatic partial splenic infarction (n = 1)).

CONCLUSION

The RenACAGA technique was successfully used for renal tumor ablation. Further studies are warranted to establish the potential benefits of this technique in terms of superior tumor visualization, targeting, ablation margin assessment, and combination with embolization.

Integrated Needle Guide on Smartphone for Percutaneous Interventions Using Augmented Reality

PURPOSE

This study aimed to describe the workflow and evaluate the accuracy of a novel smartphone augmented reality (AR) application that includes an integrated needle guide, in a phantom.

MATERIALS AND METHODS

A smartphone cover with an integrated needle guide was designed and 3D-printed. An AR application for percutaneous application was developed, which integrated a projected needle path based on the rigid needle guide. After planning the needle path using this novel tool, the operator could place the needle through the guide to reach the target. Six lesions with out-of-plane entry points were targeted on an abdominal phantom. Timing and accuracy of needle placements were measured on post-procedural CT both using smartphone AR guidance and with a freehand approach. Results were compared using Wilcoxon rank sum and Pearson's chi-squared tests.

RESULTS

A total of 108 needle placements were performed by 9 physicians with widely varying experience. The median accuracy was 4 mm (IQR 3-6 mm) using the smartphone versus 18 mm (IQR 9-27 mm) for freehand (P < 0.001). Using the smartphone AR application, planning time was 91 s (IQR 71-151 s), and puncture time was 68 s (IQR 57-77 s). There was no difference in accuracy, planning, or puncture times according to experience level when using the AR tool.

CONCLUSION

This smartphone application with an integrated needle guide allows path planning and accurate needle placement on phantoms with real-time angular feedback in less than 3 min. This technology could promote standardization, reduce experience requirements, or provide accurate low-cost guidance in environments without procedural imaging for percutaneous interventions.

PET/CT-guided Tumor Ablation: Technical Insights and Clinical Applications

PET/CT-guided ablation is increasingly being used in interventional oncology, due to its unique ability for precise tumor targeting and real-time intraprocedural evaluation of treatment completeness. This modality is extremely useful for targeting hypermetabolic tumors that may not be conspicuous on anatomic imaging. Intraprocedural postablation PET/CT can detect residual unablated tumor and depict ablation margins, permitting repeat ablation within the same treatment session. Moreover, intraprocedural PET metrics are a predictive biomarker of local tumor progression. This review summarizes the indications, workflow, and outcomes of PET/CT-guided tumor ablations.

Enhancing tumor control in liver metastases treated with SBRT: dosimetric predictors and clinical outcomes from a single-center analysis

Liver metastases, a hallmark of systemic disease, carry a poor prognosis despite advancements in systemic therapies. Stereotactic body radiation therapy (SBRT) has emerged as a promising local treatment, offering durable tumor control with minimal toxicity. However, the optimal dosimetric strategies to maximize outcomes remain an area of active investigation. This retrospective study evaluated 76 patients with 101 liver metastases treated with SBRT between November 2012 and June 2024. Dosimetric parameters were analyzed, including prescribed dose (PD) and dose metrics for planning target volume (PTV) and gross tumor volume (GTV), with doses converted to equivalent doses in 2 Gy fractions (EQD2, α/β = 10). Tumor control probability (TCP) models and survival outcomes were assessed, with a focus on the prognostic impact of dosimetric and clinical factors. Median overall survival (OS) was 33 months, with 1-year and 3-year OS rates of 74.1% and 39.4%, respectively. Freedom from local progression (FFLP) was 82.5% at 12 months. PD emerged as the strongest independent predictor of local control, with an optimal threshold of 77.44 Gy EQD2 significantly improving 1-year FFLP rates (96.8% vs. 67.2%; p = 0.007). Advanced motion management techniques, including internal breath-hold (iBH) with image-guided radiotherapy (IGRT), demonstrated superior local control outcomes. Predictive modeling confirmed PD as the most robust dosimetric metric, correlating with a high TCP and outperforming other dose metrics. Toxicity was minimal, with only 3.9% experiencing grade ≥ 3 adverse events. SBRT represents a highly effective and safe approach for liver metastases, with PD and advanced imaging emerging as pivotal determinants of tumor control. These findings underscore the importance of precise dosimetric planning and motion management in optimizing SBRT outcomes. This study provides a robust framework for personalized treatment strategies, contributing to the integration of SBRT as a cornerstone in the multidisciplinary management of liver metastases.

Thermal ablation for local tumor recurrence after previous partial nephrectomy: Perioperative and oncological outcomes

OBJECTIVES

Percutaneous thermal ablation (PTA) has emerged as an alternative to salvage radical nephrectomy (RN) for the treatment of renal cell carcinoma (RCC) local recurrence. We report perioperative and oncological outcomes of patients treated with PTA for RCC local recurrence.

MATERIALS AND METHODS

Twenty-seven patients with on-site recurrence received PTA from 2008 to 2022. Primary endpoints were perioperative outcomes, complications, and readmission rates. Secondary endpoints were on site and out site tumor recurrence. Last, we collected renal function outcomes after PTA.

RESULTS

Median (IQR) treatment time was 75 (63-106) minutes. Intraoperative complications occurred in 1 (3.7%) patient, while postoperative in 2 (7.4%). Three patients (11%) received incomplete ablation, which required in one an adjunctive PTA and in 2 RN. Overall, 4 (16%) patients developed on site recurrence after a median follow-up of 30 (23-43) months: complete local control was achieved with subsequent PTA in 3 patients, while one developed bone metastases and, therefore, no other local treatments were performed. Moreover, 6 (24%) patients developed out-site recurrence after a median follow-up of 16 (10-23) months. Last, median creatinine drop at 1 month and at 1 year after PTA was -0.03 (-0.11 to 0.01) and -0.11 (-0.20 to -0.05), while median eGFR drop was 2 (0-7.65) and 9.5 (5-13.45).

CONCLUSION

PTA is a safe and feasible approach for management of on-site recurrences after PN. Low perioperative complication rates and optimal local cancer control were achieved in most patients, with no significant impairment of residual renal function.

Efficacy and safety of radiofrequency ablation for hyperparathyroidism: a meta-analysis and systematic review

OBJECTIVE

Radiofrequency ablation (RFA) is increasingly being investigated as a treatment for parathyroid lesions, with favorable outcomes, especially in patients who are ineligible for surgery or decline surgery. We aimed to assess the efficacy and safety of RFA in treating hyperparathyroidism.

MATERIALS AND METHODS

PubMed and Embase were searched for original literature published on or before July 18, 2024. We included 14 eligible studies with 593 patients (241 with primary hyperparathyroidism [PHPT], 310 with secondary hyperparathyroidism [SHPT], and 42 with tertiary hyperparathyroidism [THPT]). Serial pooled means of biochemical indexes (parathyroid hormone [PTH], calcium, phosphorus), volume reduction ratio (VRR) after RFA, and complication rate were calculated.

RESULTS

In PHPT, the pooled mean baseline PTH value of 158.7 pg/mL and serum calcium value of 10.96 mg/dL significantly decreased to 57.3 pg/mL and 9.55 mg/dL, respectively, at 12 months (both p < 0.001), with both being within normal ranges. The pooled mean VRR gradually increased, reaching 95.6% at 12 months. In SHPT, the pooled mean baseline PTH value of 1683.7 pg/mL significantly decreased to 267.2 pg/mL at 12 months (p < 0.001), which was within the target reference level (PTH ≤ 585 pg/mL). In THPT, the mean baseline PTH value of 1284.9 pg/mL decreased to 161.6 pg/mL at 1 year (p < 0.001). The pooled incidence rates of total, major, and minor complications were 27.9%, 7.5%, and 20.0%, respectively.

CONCLUSIONS

RFA showed promising effectiveness and safety profiles, particularly for patients who are ineligible for surgery or decline surgical intervention.

KEY POINTS

Question What is the efficacy and safety of RFA in treating hyperparathyroidism? Findings In PHPT, pooled mean values of biochemical indexes (serum PTH, calcium) were normal throughout 12-month follow-up. In SHPT and THPT, pooled mean PTH stayed within target ranges throughout 12-month follow-up. Clinical relevance RFA showed efficacy and safety in treating hyperparathyroidism, maintaining biochemical indexes within normal or target ranges throughout 12-month follow-ups. RFA would be a valuable treatment option for patients who are ineligible for surgery or who decline surgical intervention.

Treatments and cancer: implications for radiologists

This review highlights the critical role of radiologists in personalized cancer treatment, focusing on the evaluation of treatment outcomes using imaging tools like Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Ultrasound. Radiologists assess the effectiveness and complications of therapies such as chemotherapy, immunotherapy, and ablative treatments. Understanding treatment mechanisms and consistent imaging protocols are essential for accurate evaluation, especially in managing complex cases like liver cancer. Collaboration between radiologists and oncologists is key to optimizing patient outcomes through precise imaging assessments.

Surgery or Percutaneous Ablation for Liver Tumors? The Key Points Are: When, Where, and How Large

The most recent comparisons between liver resection (LR) and percutaneous thermal ablation (PTA) reported similar efficacy and survival outcomes for primary and secondary liver tumors ≤ 3 cm in size. Nevertheless, LR still remains the most popular treatment strategy worldwide, and percutaneous ablation is usually reserved to patients who are not surgical candidates. However, in our opinion, the debate should no longer be what is the most effective treatment for patients with resectable small liver cancer who are not candidates for liver transplantation, but rather when LR or PTA are best suited to the individual patient. Subcapsular tumors or tumors closely adjacent to critical structures or vulnerable organs should undergo LR because ablation can often not achieve an adequate safety margin. Conversely, PTA should be considered the first choice to treat central tumors because it has lower complication rates, lower costs, and shorter hospital stay. Furthermore, recent technical improvements in tumor targeting and accurate assessment of the extent of the safety margin, such as stereotactic navigation, fusion imaging and software powered by Artificial Intelligence enabling the immediate comparison between the pre-procedure planned margins and the ablation area, are also changing the approach to tumors larger than 3 cm. The next trials should be aimed at investigating up to what tumor size PTA supported by these advanced technologies can achieve outcomes comparable to LR.

Abdominal and Bowel Ultrasound Knowledge Among Young Gastroenterologists: Results of an Italian Survey

Background: The diagnostic accuracy of abdominal ultrasound (US) is operator-dependent and, therefore, influenced by inadequate training and lack of continuous medical education. To fill this gap, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has developed guidelines to identify minimum training requirements for US. The aim of our survey was to assess the self-reported overall US education level among young Italian gastroenterologists. Methods: The Italian Association of Young Gastroenterologists and Endoscopists (Associazione Giovani Gastroenterologi ed Endoscopisti Italiani, AGGEI) developed a web-based survey with a multiple-choice test with images, based on the EFSUMB recommendations. The survey was distributed via e-mail to AGGEI members. Results: The questionnaire was filled out by 110 participants from all over Italy. Most of the respondents worked in academic hospitals and were gastroenterology residents or PhD students. More than half (58.9%) learned US during their gastroenterology training and 8.2% attended specific courses. During their training participants performed a median number of 320 abdominal USs and 240 bowel USs. Participants receiving a longer training period ranked significantly better in the knowledge questionnaire. Conclusions: Young Italian gastroenterologists show heterogeneous training in residencies across the country. In the future learning and hands-on training courses endorsed by academies are needed to fill this knowledge and skill gap.

Oncolytic peptide LTX-315 plus an anti-CTLA-4 antibody induces a synergistic anti-cancer immune response in residual tumors after radiofrequency ablation of hepatocellular carcinoma

Preventing tumor recurrence after radiofrequency ablation (RFA) of malignant solid tumors with large size or in high-risk locations represents a great challenge. In this study, we explored the feasibility of using oncolytic peptide LTX-315 plus an anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) antibody for inhibiting residual tumors after RFA of hepatocellular carcinoma (HCC). In in vitro experiment, the CD8+T cells from Hepa1-6 tumors, after being subjected to three different treatments (control, iRFA, iRFA + LTX-315), were extracted and were then co-cultured with Hepa1-6 cells and an anti-CTLA-4 antibody. The enzyme-linked immunospot, flow cytometry, and cell counting kit-8 assay were employed to assess the cytotoxicity of extracted CD8+T cells on Hepa1-6 cells. In in vivo experiment, different murine orthotopic HCC models were variously treated by: (1) pseudo iRFA + phosphate-buffered saline (PBS); (2) iRFA + PBS; (3) iRFA + LTX-315; (4) iRFA + anti-CTLA-4 antibody; and (5) iRFA + LTX-315 + anti-CTLA-4 antibody. The treatment effects were compared among different groups and were pathologically confirmed. The possible mechanisms of the combination treatment (LTX-315+anti-CTLA-4 antibody) for residual tumors after iRFA of HCC were explored. LTX-315 significantly reduced the PD-1 expression and significantly increased CTLA-4 expression of CD8+T cells in residual tumors, and additional treatment of anti-CTLA-4 antibody could significantly enhance the cytotoxicity of CD8+T cells for Hepa1-6 cells in vitro experiments. Compared with the other treatments, the combined treatment of LTX-315 with anti-CTLA-4 antibody achieved a better tumor response and longer survival, and it could synergistically activate the cGAS-STING pathway and elicit an immunogenic cell death, leading to a strong anti-tumor immunity after iRFA of HCC. The immunosuppressive microenvironment of residual tumors was significantly improved by the combination therapy with a significantly increased ratio of M1-like tumor-associated macrophages to M2-like tumor-associated macrophages, a significantly decreased infiltration of regulatory T cells and myeloid-derived suppressor cells, and a significantly lower expression of PD-1 and CTLA-4. Overall, the results of this study demonstrated that LTX-315 plus anti-CTLA-4 antibody could synergistically improve the immunosuppressive microenvironment of residual tumors and induce a strong anti-tumor immunity after iRFA of HCC. This combination treatment strategy may offer a new alternative to reduce the tumor recurrence after RFA of malignant solid tumors with large sizes or in high-risk locations.

Predicting the efficacy of microwave ablation of benign thyroid nodules from ultrasound images using deep convolutional neural networks

BACKGROUND

Thyroid nodules are frequent in clinical settings, and their diagnosis in adults is growing, with some persons experiencing symptoms. Ultrasound-guided thermal ablation can shrink nodules and alleviate discomfort. Because the degree and rate of lesion absorption vary greatly between individuals, there is no reliable model for predicting the therapeutic efficacy of thermal ablation.

METHODS

Five convolutional neural network models including VGG19, Resnet 50, EfficientNetB1, EfficientNetB0, and InceptionV3, pre-trained with ImageNet, were compared for predicting the efficacy of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules using ultrasound data. The patients were randomly assigned to one of two data sets: training (70%) or validation (30%). Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were all used to assess predictive performance.

RESULTS

In the validation set, fine-tuned EfficientNetB1 performed best, with an AUC of 0.85 and an ACC of 0.79.

CONCLUSIONS

The study found that our deep learning model accurately predicts nodules with VRR < 50% after a single MWA session. Indeed, when thermal therapies compete with surgery, anticipating which nodules will be poor responders provides useful information that may assist physicians and patients determine whether thermal ablation or surgery is the preferable option. This was a preliminary study of deep learning, with a gap in actual clinical applications. As a result, more in-depth study should be undertaken to develop deep-learning models that can better help clinics. Prospective studies are expected to generate high-quality evidence and improve clinical performance in subsequent research.

Evaluating Pre-Interventional Administration of a Liver-Specific Contrast Agent During MRI-Guided Thermal Ablation of Malignant Liver Lesions

Background/Objectives: Hepatocyte-specific contrast agent (Gd-EOB-DTPA) can improve the detection of liver lesions during MRI-guided thermal ablation. This study aimed to assess the impact of contrast agent administration on the delineation of the ablation zone during therapy monitoring. Methods: From 2010 to 2020, 358 patients with primary and secondary hepatic malignancies underwent MRI-guided thermoablation. A total of 27 patients with 30 liver lesions received Gd-EOB-DTPA during the procedure to improve target lesion visibility (Group 1), while 30 patients with 30 lesions underwent MRI-guided thermoablation without contrast administration (Group 2). T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences were used for intraprocedural imaging, and post-procedural control imaging involved intravenous Gadobutrol administration in both groups. The contrast-to-noise ratio (CNR) was assessed for three key structures: the target lesion before applicator placement, the ablation zone during unenhanced therapy monitoring, and the ablation zone in contrast-enhanced control imaging. A statistical comparison of CNR values between the two groups was performed using the non-parametric Wilcoxon test (p < 0.05). Results: The CNR of lesions in group 1 significantly increased following the administration of Gd-EOB-DTPA. During therapy monitoring, the ablation zone in group 2 exhibited a significantly higher CNR compared to group 1 (median: 7.9 vs. 2.1; p < 0.001). Similarly, at the contrast-enhanced final control, the CNR of the ablation zone remained significantly greater in group 2 than in group 1 (median: 7.7 vs. 2.0; p < 0.001). Conclusions: The administration of a hepatocyte-specific contrast agent (Gd-EOB-DTPA) prior to intervention improves the visualization of liver lesions that are poorly demarcated but significantly reduces the contrast of the ablation zone during intra- and post-procedural imaging. Therefore, its use should be reserved for cases in which the target lesion cannot be sufficiently delineated without contrast.

Interventional oncology and immunotherapy: current status and future perspectives

Interventional oncology has become an important part of multidisciplinary cancer treatment following the development of interventional radiology. Tumors can release antigens, activate immunity, and cause an abscopal effect after interventional therapy. However, the activated immune response is limited and involves a complex process. New methods to solve the problems were developed following the advent of immunotherapy. The combination therapies enhanced the antitumor immune response and improved patient outcomes with good application prospects. In this review, we have summarized the interventional therapies used to improve immune efficacy and discussed the advancements in combining interventional therapy and immunotherapy.

Lipoic Acid/Choline Ionic Liquid Enhanced Intratumoral Heat/Mass Transfer for Suppressing Thermo-Mediated Tumor Relapse and Metastasis

Thermal ablation (TA) is widely used for clinical treatment of various cancers. However, TA often struggles to efficiently kill tumor cells without injuring adjacent normal tissues/cells, leading to thermo-mediated tumor relapse and metastasis, owing to the immunosuppressive microenvironment surrounding residual tumor cells. In this study, a temperature-sensitive ionic liquid composed of lipoic acid and choline (LACH/PNA) is developed as a multifunctional TA sensitizer to suppress tumor metastasis induced by incomplete microwave ablation. LACH/PNA exhibits a high diffusion coefficient by disrupting the tumor matrix and modulating cancer-associated fibroblasts, thereby facilitating heat and mass transfer in tumors. LACH/PNA demonstrates greater cytotoxicity toward hepatoma cells than on normal hepatocytes with this effect further intensified by thermal treatment. These findings highlight LACH/PNA as a promising multifunctional sensitizer for clinical chemoablation-microwave ablation synergy.

Prognostic Comparison of Complete vs. Incomplete Radiofrequency Ablation for Colorectal Liver Metastases: A Multicenter Prospective Study

BACKGROUND

Radiofrequency ablation (RFA) is a curative treatment for colorectal liver metastases (CLMs) in selected patients. NCCN guidelines recommend RFA for both unresectable and select resectable CLMs when complete ablation with adequate margins is feasible. While RFA can achieve oncologic outcomes comparable to surgery in well-selected patients, residual tumors are associated with a poorer prognosis.

OBJECTIVES

To identify predictors of residual tumor after percutaneous RFA for CLMs and evaluate their impact on overall survival (OS) and new intrahepatic metastases (NIHM).

METHODS

We prospectively included patients with CLMs who underwent percutaneous RFA from November 2019 to November 2022. Dynamic contrast-enhanced computed tomography assessed CLMs before and after RFA. Residual tumor was defined as active tumor visible immediately post-ablation or within 4-8 weeks, within 1 cm of the ablation zone. Data from three centers formed a developmental cohort, validated with patients from a fourth center. Cox regression and Kaplan-Meier analysis assessed local tumor progression-free survival (LTPFS), NIHM, and OS.

RESULTS

Among 200 patients (mean age 61 years, 126 men) with 410 tumors, independent predictors of residual tumors included perivascular tumor location (odds ratio [OR] = 6.673), tumor size ≥ 20 mm (OR = 3.925), and minimal ablative margin (OR = 0.599). These factors also predicted LTPFS. NIHM was more frequent in the residual tumor group than in the complete RFA (cRFA) group (p = 0.002). Median OS was 45 months, shorter in the residual tumor group (30 vs. 48 months, p = 0.009). Patients with NIHM who received transarterial chemoembolization combined with hepatic arterial infusion chemotherapy had a median OS of 43 months, compared to 34 months with RFA alone (p = 0.039).

CONCLUSIONS

A non-perivascular tumor location, tumor size < 20 mm, and a sufficient ablation margin are essential for achieving complete RFA. Residual tumors are associated with increased NIHM and shorter OS.

How I Do It: Contrast-enhanced US Applications in Children

Contrast-enhanced US (CEUS) allows a detailed assessment of the tissue microvasculature after intravenous injection of contrast material. The use of CEUS also allows opacification of nonvascular hollow organs and fluid compartments after intracavitary instillation of dilute contrast material. This capability is far beyond that of grayscale and Doppler US techniques. The advantages of CEUS include its ease of use, high safety profile, and absence of ionizing radiation, making it an ideal tool for pediatric imaging. In 2016, the U.S. Food and Drug Administration approved CEUS for use in children for characterization of focal liver lesions and diagnosis of vesicoureteral reflux. Because the US contrast agent is distributed throughout the vascular pool, additional off-label imaging studies have focused on a variety of anatomic structures. This review of pediatric CEUS discusses the safety and technical aspects of CEUS, provides practical information on how to perform intravascular and intracavitary examinations, addresses the most common clinical applications of this method, and offers advice regarding the integration of CEUS into pediatric daily clinical practice.

A Novel tRF, HCETSR, Derived From tRNA-Glu/TTC, Inhibits HCC Malignancy by Regulating the SPBTN1-catenin Complex Axis

tRNA-derived fragments (tRFs), a novel class of small non-coding RNAs cleaved from transfer RNAs, have been implicated in tumor regulation. In this study, the role of a specific tRF, HCETSR is investigated, which is significantly downregulated in hepatocellular carcinoma (HCC) and correlates with advanced tumor burden and higher HCC mortality. Functional analyses revealed that HCETSR inhibits HCC malignancy and serves as an independent predictor of poor prognosis. Mechanistically, a novel SPTBN1/catenin complex axis regulated by HCETSR is identified. HCETSR binds to a critical domain of SPTBN1, disrupting its interaction with the catenin complex (comprising β-catenin, α-catenin, and P120-catenin), and facilitates the transfer of the catenin complex from the cell membrane to the nucleus. Specifically, HCETSR decreases the proteasomal degradation of β-catenin and inhibits the synthesis of nascent β-catenin. Furthermore, HCETSR suppresses the transcriptional activity of LEF1 through P120-catenin rather than α-catenin, thereby reducing β-catenin's influence on LEF1 activity. It is demonstrated that HCETSR is spliced from tRNA-Glu/TTC. The biogenesis of HCETSR and tRNA-Glu/TTC is regulated by the spliceosome and Dicer1. In conclusion, These findings suggest that HCETSR, derived from tRNA-Glu/TTC, inhibits HCC malignancy via modulation of the SPTBN1/catenin axis and may represent a promising prognostic marker and therapeutic strategy for HCC.

Advancements in the application of ablative therapy and its combination with immunotherapy in anti-cancer therapy

Cancer is a significant health issue impacting humans. Currently, systemic therapies such as chemotherapy have significantly increased the life expectancy of cancer patients. However, some patients are unable to endure systemic treatment due to its significant adverse effects, leading to an increased focus on local therapies including radiation and ablation therapy. Ablation therapy is a precise, low-toxicity, and minimally invasive localized therapy that is increasingly acknowledged by clinicians and cancer patients. Many cancer patients have benefited from it, with some achieving full recovery. Currently, numerous studies have shown that ablation therapy is effective due to its ability to kill cancer cells efficiently and activate the body's anti-cancer immunity. It can also convert "cold cancers" into "hot cancers" and enhance the effectiveness of immunotherapy when used in combination. In this article, we categorize ablation therapy into thermal ablation, cryoablation, photodynamic therapy (PDT), irreversible electroporation (IRE), etc. Thermal ablation is further divided into Radiofrequency ablation (RFA), microwave ablation (WMA), high-frequency focused ultrasound (HIFU), photothermal therapy (PTT), magnetic heat therapy (MHT), etc. We systematically review the most recent advancements in these ablation therapies that are either currently used in clinic or are anticipated to be used in clinic. Then, we also review the latest development of various ablative therapies combined with immunotherapy, and its future development. CLINICAL RELEVANCE STATEMENT: Ablation therapy, an invasive localized treatment, offers an alternative to systemic therapies for cancer patients who cannot tolerate their adverse effects. Its ability to kill cancer cells efficiently and activate anti-cancer immunity. This article reviews recent advancements in ablation therapies, including thermal, cryoablation, PDT, and IRE, and their potential clinical applications, both standalone and in combination with immunotherapy.

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging

V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2025; 197: 436-446.

Low Intrahepatic Distant Recurrence Rate Following RFA Using Linear Mode in Patients With Hepatocellular Carcinoma

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Radiofrequency ablation (RFA) can be utilized in elderly patients and those with cirrhosis with reduced functional liver reserve as it is less invasive. The arfa RFA system is the first system to offer a linear mode. However, the differences in performance between the linear and existing (nonlinear) modes remain unknown.

AIM

This retrospective observational study compared the performance of the linear (linear group) and nonlinear RFA modes (nonlinear group) in HCC.

METHODS

Data of 425 patients with one to three HCC tumors measuring ≤ 3 cm who underwent RFA were analyzed. Recurrence (local and distant), survival, and complication rates between the linear and nonlinear groups were determined.

RESULTS

The intrahepatic distant recurrence rate was lower in the linear group than in the nonlinear group (p < 0.05). Multivariate analysis showed that the high platelet count, low AFP-L3 levels, initial case, and linear mode were independent factors associated with a low intrahepatic distant recurrence rate following RFA. Liver disease-related survival, HCC survival, overall survival of the initial HCC, local recurrence, and complication rates were comparable between the linear and nonlinear groups.

CONCLUSION

The linear mode of the RFA protocol results in a lower intrahepatic distant recurrence rate compared with the nonlinear protocol.

Treatment strategies for solitary hepatocellular carcinoma: comparative outcomes of radiofrequency ablation vs. laparoscopic liver resection based on tumor location

INTRODUCTION

The treatment of early stage hepatocellular carcinoma (HCC) has become increasingly complex. This study evaluates the effectiveness of radiofrequency ablation (RFA) versus laparoscopic liver resection (LLR) for treating solitary hepatocellular carcinoma (HCC) ≤ 3 cm, with a focus on tumor location and depth.

METHODS

We conducted a retrospective analysis of patients treated for solitary HCC ≤ 3 cm in the right liver lobe from 2004 to 2022. Tumor depth was categorized into three zones based on proximity to portal vein branches: Zone I (near first-order branches), Zone II (adjacent to second-order branches), and Zone III (near third-order branches). Outcomes were measured using overall survival (OS) and recurrence-free survival (RFS) rates.

RESULTS

Of the 662 patients, for Zone I, II, and III, 240 (65 LLR, 175 RFA); 174 (100 LLR, 74 RFA); and, 248 patients were treated (244 LLR, 4 RFA), respectively. Statistically significant differences in the treatment outcomes based on the tumor depth were observed. For Zone I, LLR demonstrated superior OS (p = 0.043) and RFS rates (p = 0.030) than did RFA. For Zone II, both treatments had comparable survival outcomes, with no statistically significant differences in the OS (p = 0.460) and RFS (p = 0.358). For Zone III, LLR was principally favored, due to easier surgical access and cleaner margins.

CONCLUSIONS

This study highlighted the importance of including tumor location and depth, in addition to the tumor size and liver function, in the management of early stage HCC. A multidisciplinary approach is essential for treatment planning and optimizing survival outcomes.

Comparative Analysis of Systemic Immune Responses and Metastatic Risks in Tumor Ablation: An Animal Study of Radiofrequency Ablation and Irreversible Electroporation with Immune Modulation

PURPOSE

This study aimed to compare systemic immune responses and metastatic effects induced by radiofrequency ablation (RFA) and irreversible electroporation (IRE) in murine tumor models. We assessed cytokine production, growth of treated and untreated metastatic tumors, and synergy with immune checkpoint inhibitors (ICIs).

MATERIALS AND METHODS

Hep55.1c murine hepatoma cells were implanted in C57BL/6N mice to establish primary tumors. In Experiment 1 (n = 50), RFA or IRE was applied to primary tumors, followed by CD8+ T cell depletion in some groups to assess anti-tumor immune responses. Experiment 2 (n = 45) tested RFA and IRE combined with anti-PD-1 therapy for enhanced abscopal effects. In Experiment 3 (n = 28), anti-IL-6 antibody was administered in IRE-treated mice to examine IL-6's role in secondary tumor growth. Tumor volumes and cytokine/chemokine levels were monitored.

RESULTS

Both techniques induced significant CD8+ T cell-mediated anti-tumor responses, with abscopal effects observed in untreated secondary tumors. CD8+ T cell depletion abolished these effects, confirming their role in systemic tumor control. Anti-PD-1 therapy combination further suppressed secondary tumor growth. However, IRE uniquely elevated IL-6 and other inflammatory cytokines, unexpectedly accelerating secondary tumor growth. Administration of an anti-IL-6 antibody mitigated this effect, reducing secondary tumor progression.

CONCLUSION

The results of this animal study indicate that both techniques promote systemic anti-tumor immunity, though IRE uniquely induces an inflammatory response that risks exacerbating micro-metastases through IL-6. Combining IRE with IL-6 blockade may offer a promising strategy for nonthermal tumor ablation therapies. Further studies are warranted to refine ablation-immune therapy combinations for optimal therapeutic outcomes.

2024 International Expert Consensus on US-guided Thermal Ablation for T1N0M0 Papillary Thyroid Cancer

Thermal ablation has started to gain acceptance as a therapeutic approach for the management of papillary thyroid cancer (PTC), mainly in the T1 stage (tumor size ≤ 2 cm in greatest dimension and limited to the thyroid). Despite its increasing popularity, a lack of uniformity in the technical details persists, and existing guidelines do not fully align with recent research advancements. To standardize the use of US-guided thermal ablation for T1N0M0 PTC, a panel of experts jointly issued this expert consensus on thermal ablation for PTC. This consensus was developed by experts with specific competence and expertise in this field through rounds of the modified Delphi method. An evidence-based approach incorporating the practical experience of the panelists was adopted. The consensus was developed through extensive discussions, systematic literature review with meta-analysis, and expert evaluations. In this consensus, a total of 27 recommendations are made, addressing the indications and contraindications for thermal ablation for PTC, physician training, preoperative preparation, technical procedures, complications, efficacy assessment, and follow-up strategies. This expert consensus provides up-to-date, high-quality, standardized guidance to harmonize treatment practices, enhance patient outcomes, and potentially shape future research and policy developments in the management of T1N0M0 PTC using US-guided thermal ablation.

Complications of ultrasound-guided thermal ablation of thyroid nodules and associated risk factors: an experience from 9667 cases

OBJECTIVES

To evaluate the safety of ultrasound-guided thermal ablation (UGTA) for thyroid nodules (TNs) by analysing complications and related risks.

MATERIALS AND METHODS

This retrospective, single-centre study reviewed patients who underwent UGTA (microwave or radiofrequency ablation) between January 2018 and March 2023. The incidence of complications was recorded and assessed during and immediately after ablation,1-3 h later, and at 1 month, 3 months, and 6 months. Univariate and multivariate analyses were performed to identify risk factors for hoarseness and haemorrhagic complications.

RESULTS

We reviewed 9667 cases in this study. Overall, 4494 (46.49%) cases underwent microwave ablation, while 5173 (53.51%) cases underwent radiofrequency ablation. The overall complication rate was 4.43%. The incidence of major complications was 1.94% (haemorrhage, 1.32%; hoarseness, 0.54%; and symptomatic aseptic necrosis, 0.08%). The incidence of minor complications was 2.45%. A large nodule volume, radiofrequency ablation, hyper-enhancing nodules, benign nodules, higher preoperative blood pressure, hyperthyroidism, and higher ablation power were independent risk factors for haemorrhage. Dorsal nodules and a higher ablation power were independent risk factors for hoarseness. All complications were resolved.

CONCLUSION

This study suggests that UGTA is a safe treatment for TNs. Several risk factors for haemorrhage and hoarseness should be considered before performing UGTA. Different ablation modalities should be considered for patients with different conditions.

CLINICAL RELEVANCE STATEMENT

Thermal ablation may be a safe treatment for eligible patients with TNs.

KEY POINTS

We analysed the complications and risk factors associated with UGTA in 9667 cases. The complication rate was 4.43%; 1.94% were major complications. Risk factors of haemorrhage and hoarseness should be considered. UGTA was a safe method for the treatment of TNs.

The Association Between the Thickness of the Hypoechoic Halo of Thyroid Nodules and Thyroid Cancer: A Retrospective Study

RATIONALE AND OBJECTIVES

The association between hypoechoic halos and thyroid cancer in patients with thyroid nodules remains a contentious issue. The objective of this study was to examine the potential correlation between the thickness of hypoechoic halos and the presence of thyroid cancer in individuals with thyroid nodules.

METHODS

The study retrospectively analyzed a cohort of 320 patients with thyroid nodules presenting hypoechoic halos from January 2019 to December 2022. Logistic regression models, both univariate and multivariate, were applied to investigate the association between hypoechoic halo thickness and thyroid cancer, with adjustments for potential confounding variables. Interaction and stratified analyses were conducted to assess the influence of demographic and tumor-specific characteristics, such as age, sex, halo thickness, tumor size, and tumor location, on the relationship between halo thickness and thyroid cancer risk.

RESULTS

After adjusting for multiple covariates, the odds ratios (ORs) (95% confidence intervals (CIs)) of thyroid cancer for participants with a halo thickness ≥1 mm were 3.99 (2.4-6.62), 3.73 (2.09-6.67), and 3.16 (1.61-6.19), compared to those with a thickness <1 mm. The association between thyroid cancer and the thickness of the halo remained stable across different subgroups (all P for interaction > 0.05). The area under the curve (AUC) for the hypoechoic halo in nodules for diagnosing thyroid cancer was 0.821 (95% CI: 0.774-0.868), with the highest sensitivity and specificity observed at a thickness cutoff value of 1.29 mm.

CONCLUSION

Our single-center study on adults reveals a positive correlation between halo thickness and thyroid cancer risk, indicating that halo thickness may potentially serve as a valuable predictor for thyroid cancer incidence.

A preliminary study of microwave ablation for Bethesda IV follicular neoplasms (≤3 cm)

OBJECTIVES

To evaluate the feasibility, safety, and efficacy of microwave ablation (MWA) for the treatment of patients with Bethesda IV follicular neoplasms (FNs) (≤3 cm).

METHODS

In the retrospective study, patients who underwent MWA for Bethesda IV FNs (≤3 cm) were included. Technical success, volume reduction, disease progression, and adverse event (AE) rates were analysed postablation.

RESULTS

The study cohort consisted of 44 patients with a mean age of 48.2 ± 15.7 years. The median follow-up period was 16 months (interquartile range [IQR]: 9-24 months). The technical success rate was 100%. The median volume reduction ratio (VRR) reached 100% (IQR: 98.8%-100.0%) after the 18th month of follow-up. The disease progression rate was 4.5% (2/44), and both of those patients experienced local recurrence. The overall AE rate was 9.1% (4/44), and AEs included 3 cases of voice hoarseness and 1 case of cough.

CONCLUSION

This study presents promising clinical outcomes regarding the feasibility, efficacy, and safety of MWA for the treatment of patients with Bethesda IV FNs ≤ 3 cm.

ADVANCES IN KNOWLEDGE

The study highlights the high technical success rate, low disease progression rate and AE rate of MWA for FNs, which underscores its potential for broader application. Future research should aim to validate these results in larger populations to increase the scope of therapy for FNs.

Ultrasound-Computed Tomography Fusion-Guided Lumbar Plexus Block Treatment After Spinal Fixation: A Case Report

Ultrasound (US)-guided percutaneous lumbar plexus block (LPB), enhanced by ultrasound-computed tomography (US-CT) fusion imaging, offers precise targeting for interventions. In this case, a patient with lumbar disk herniation at L4-L5 level, who had undergone pedicle screw internal fixation, continued to experience persistent low back pain and numbness in both lower limbs. US-CT fusion-guided medial branch block at L4-L5 level significantly alleviated symptoms within 24 hours, with sustained relief for 1 month. Posttreatment, Oswestry Disability Index (ODI) dropped from 88 to 40, confirming effective pain control.

Sonolucent Cranioplasty for Transcranial Ultrasonographic Imaging: Windows to the Brain

This Surgical Innovation discusses the use of sonolucent materials in cranial reconstruction to allow for ultrasonographic imaging following cranial neurosurgery.

Thermal Ablation for Low-risk Papillary Thyroid Carcinoma: Comparing Outcomes in T1N0M0 and T2N0M0 PTC

BACKGROUND

Thermal ablation (TA) has demonstrated promising treatment efficacy and safety in T1N0M0 papillary thyroid carcinoma (PTC). However, the efficacy and safety of TA for T2N0M0 PTC still lack sufficient evidence.

PURPOSE

To compare the technical effectiveness, disease progression, and complications of TA in the treatment of solitary T1N0M0 versus solitary T2N0M0 PTC.

MATERIALS AND METHODS

In this retrospective study, 1159 patients with PTC treated with TA from January 2015 to June 2024 were included and divided into two groups according to tumor stage. Propensity score matching (PSM) was used to control for confounding factors. Kaplan-Meier curves were used to analyze the disease progression.

RESULTS

After PSM (1:4), 41 patients (median age 35 years [IQR 30-49]; 30 women) were included in the T2 group, and 164 patients (median age 34 years [IQR 29-43]; 108 women) were included in the T1 group. The median follow-up durations were 26 months (IQR 13-49) for the T2 group and 25 months (IQR 12.3-43) for the T1 group. The technical success rates were 100% in the two groups. Statistical analysis showed no significant differences in disease progression between the T1 and T2 groups (0.6% vs. 4.9%, P=0.103), nor in disease progression-free survival rates (98.2% vs. 88.6%, log-rank P=0.052). The incidence of major complications was higher in the T2 group than that in the T1 group (1.8% vs. 17.1%, P=0.001). No permanent hoarseness was observed in the two groups.

CONCLUSION

TA could be a safe and effective option in the treatment of solitary T2N0M0 PTC. No significant difference was observed in disease progression between T1N0M0 and T2N0M0 PTC.

Efficacy, safety, and risk factors of thermal ablation for follicular thyroid neoplasms: a multicentric study

PURPOSE

To assess the efficacy and safety of thermal ablation (TA) in managing follicular thyroid neoplasms (FN).

METHODS

This multicenter retrospective study involved participants diagnosed with FN across nine hospitals, undergoing microwave ablation or radiofrequency ablation from January 2014 to January 2024. Primary outcomes assessed were technical success and disease progression, with secondary outcomes including tumor size and volume changes, complete tumor disappearance, complications, and side effects. Subgroup analyses aimed to identify factors influencing tumor progression and complete disappearance.

RESULTS

The study enrolled 375 patients (mean age: 43.2 years ± 14.9 [standard deviation]; 298 women) with 482 FNs, tracked over an average of 23.6 months, achieving a 100% technical success rate. Disease progression was observed in 4.8% (18/375) of patients, with a local recurrence rate of 3.7% (14/375) and new neoplasm occurrence of 1.1% (4/375). Multifocal neoplasms emerged as an independent risk factor for disease progression (hazard ratio [HR], 3.48; 95% CI, 1.16-10.45; P = 0.026). Tumor volume significantly reduced (P < 0.001), particularly within 1-3 months post-ablation, with complete tumor disappearance observed in 10.4% (39/375) of cases, more likely in tumors smaller than 2 cm (HR, 0.11; 95% CI, 0.06-0.23; P < 0.001). Complications occurred in 2.9% of patients, with major events in 2.1% and minor in 0.8%.

CONCLUSION

TA is a safe and efficacious method for treating FN, showing low rates of disease progression and complications. Optimal outcomes may be achieved in patients with unifocal FN and neoplasms under 2 cm.