Animals ; Chemoembolization, Therapeutic ; Drugs, Chinese Herbal ; administration & dosage ; Iodized Oil ; administration & dosage ; Liver Neoplasms, Experimental ; therapy ; Mitomycin ; administration & dosage ; Orchidaceae ; Phytotherapy ; Rats ; Rats, Inbred ACI

OBJECTIVESTo analyze the MRI manifestations and pathological changes of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) with lipiodol.

METHODS23 patients with 31 HCC lesions treated by TACE underwent MRI examination within 1 week before their surgical resections. MRI was performed with SE sequence (T1WI and FSE T2WI) and FMPSPGR sequence dynamic multi-phase contrast scans. All resected specimens were cut into 5-10mm thick slices, corresponding to the same plane as that of MRI scans. The specimens were wholly embedded in paraffin, serial sections made and stained with hematoxylin and eosin. The MRI findings were thus compared with the pathology of the specimen sections.

RESULTS(1) MRI findings: In all 31 lesions, the signal intensity of lesions varied and was mostly heterogeneous on SE T1WI and T2WI images. Three lesions were inhomogeneous hyper-intensity and the other 28 lesions were iso- or hypo-intensity on FMPSPGR plain scannings. Twenty-two lesions were enhanced on early-phase dynamic scanning, and no enhancement was found in the other 9 lesions. Partial enhancement was also seen in 6 lesions on delay-phase dynamic scanning. (2) Pathologically, no coagulation necrosis was found in 2 specimens, but 6 lesions showed complete coagulation necrosis and 23 showed various degrees of it. The other pathological changes found included intra-tumoral hemorrhage (n=10), intra-lesional fibrotic septa formation (n=5), capsule-like fibrotic tissue proliferation around the lesions (n=12), inflammatory infiltration (n=28), focal mucoid degeneration (n=2), focal hyaline degeneration (n=2), and lipiodol retention (n=6). (3) Radiological-pathological correlation study: hyper-intense areas on T1WI corresponded to areas of coagulation necrosis with or without hemorrhage and of residual viable tumor; iso- and hypo-intense corresponded to areas of coagulation necrosis or residual viable tumor. Hyper-intense areas on T2WI corresponded to those of residual viable tumor or coagulation necrosis with hemorrhage, and iso-intense areas corresponded to those of coagulation necrosis, small residual viable tumor or intra-lesional fibrotic septa formation, and hypo-intense areas corresponded to those of coagulation necrosis or intra-lesional fibrotic septa formation. Areas of enhancement within the lesions on the early-phase dynamic-contrast images corresponded to areas of residual viable tumors, while areas of no enhancement were those of coagulation necrosis, hemorrhage, intra-lesional fibrotic septa formation or small residual viable tumors. Areas of enhancement on the delay-phase dynamic scanning were those of residual viable tumors or intra-lesional fibrotic septa formation, while no enhancement corresponded to the areas of residual viable tumors, coagulation necrosis, and hemorrhage. Areas of enhancement on the delay-phase dynamic scanning corresponded to those areas of fibrosis tissue or residual viable tumors. Inflammatory infiltration was found in areas of different signal intensity on MRI images.

CONCLUSIONS(1) Different pathological changes in HCCs after TACE are represented by various signal intensities on SE sequence images. The only area of hypo-intensity on T2WI has a specificity in representing coagulation necrosis. (2) FMPSPGR sequence dynamic MRI is superior to SE sequence in demonstrating and determining the necrosis and residual viable tumor. Enhanced areas within the lesions on the early-phase dynamic-contrast images represent residual viable tumors and the enhancement of capsule on early-phase dynamic-contrast images also represent subcapsular residual viable tumors. (3) MRI can demonstrate accurately the areas of necrosis and residual viable HCC tissues after TACE and evaluate the effect of TACE.

Adult ; Antineoplastic Agents ; administration & dosage ; Carcinoma, Hepatocellular ; pathology ; therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; pathology ; therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged

OBJECTIVETo evaluate postoperative transcatheter arterial chemoembolization (TACE) in the prevention of postoperative recurrence of hepatocellular carcinoma (HCC).

METHODSIn TACE group, 987 HCC patients without any evidence of recurrence at the first TACE were treated by prophylactic TACE postoperatively within one or two months. In the control group, 643 HCC patients were not treated by prophylactic TACE for comparison. The correlation between the first recurrence and prophylactic TACE was analyzed.

RESULTSRecurrence rate in the TACE and control group was 22.2% (219/987) and 61.6% (396/643) within 6 months (P < 0.01); 78% (770/987) and 74.7% (480/643) within 12 months (P > 0.05); 88.6% (874/987) and 80.1% (515/643) within 18 months (P < 0.01), respectively.

CONCLUSIONPostoperative prophylactic TACE may be able to suppress the recurrence formation for HCC patients with or without definite residual lesion within 6 months.

Carcinoma, Hepatocellular ; surgery ; therapy ; Chemoembolization, Therapeutic ; Epirubicin ; administration & dosage ; Female ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; surgery ; therapy ; Male ; Neoplasm Recurrence, Local ; prevention & control ; Postoperative Period

OBJECTIVETo work out an individualized lipiodol dose in transcatheter arterial chemoembolization (TACE) for large hepatic carcinoma (HCC) according to its blood supply evaluated by CT.

METHODSOne hundred patients with HCC (diameter more than 8 cm) were studied by triphasic 5-mm-thick-section scan of multidetector helical CT. Patterns of HCC blood supply were divided into sufficient blood supply, poor blood supply, mixed blood supply and arterial-venous shunt. The dose of ultra-fluid lipiodol was determined by diameter and blood supply type of HCC. The patients were divided two groups (50 cases each), with the lipiodol perfused according to the diameter and the blood supply of tumor in one group and the iodized oil perfused according to the actual tumor diameter in the other. The filling of lipiodol in HCC was observed and conformation rate was compared in the two groups. When the diameter of HCC was less than 10 cm, 10 - 20 ml and 5 - 10 ml lipiodol was injected in to the sufficient blood supply and the poor supply groups. When the diameter of HCC was more than 10 cm, 20 - 30 ml iodized oil was injected in the sufficient blood supply group. The lipiodol dose in the mixed blood supply group was determined by the diameter of sufficient blood supply area.

RESULTSThe conformation and effective rate were 82%, 84% in the first group and 36%, 46% in the second group (P < 0.01).

CONCLUSIONA relative individualized lipiodol dose may be determined according to the blood supply pattern and the tumor diameter by CT imaging.

Adult ; Aged ; Chemoembolization, Therapeutic ; methods ; Female ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; blood supply ; diagnostic imaging ; therapy ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods

OBJECTIVETo assess the therapeutic effect of percutaneous intratumoral injection with lipiodol emulsion of chemotherapie agents (CALE) on implanted VX2 tumor in rabbits.

METHODSTwelve New Zealand rabbits with implanted VX2 tumor (24 models) were divided into lipiodol group, chemotherapeutic agent group and CALE group with intratumoral injections of the corresponding agents. The pathological changes of all the lesions were observed and the expression of proliferating cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) were evaluated 7 days after the operation.

RESULTSCompared with the lipiodol group and chemotherapie agent group, intratumoral injection of CALE resulted in the highest tumor necrosis rate and greatest tumor necrosis (P<0.01). The labeling indices of PCNA and VEGF expressions in CALE group were markedly lower than those in the other two groups (P<0.01).

CONCLUSIONPercutaneous intratumoral injection of CALE is an effective ablation approach for treatment of malignant solid tumors.

Animals ; Emulsions ; Injections, Intralesional ; Iodized Oil ; administration & dosage ; therapeutic use ; Neoplasms, Experimental ; metabolism ; pathology ; therapy ; Proliferating Cell Nuclear Antigen ; metabolism ; Rabbits ; Vascular Endothelial Growth Factor A ; metabolism

BACKGROUND AND OBJECTIVETranscatheter arterial chemotherapy and embolization is the main method in the treatment of lung cancer, but most of the reports do not study individually to small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), hypovascular and hypervascular lung cancer. The pre-embolization perfusion of hemotherapeutics is still being used routinely and seldom report to iodized oil embolization. The article summarized the quality of life after the treatment, clinical efficiency, survival time and complications to evaluate the clinical effect of primary hypervascular NSCLC treated with embolization of emulsion of chemotherapeutics and iodized oil.

METHODSThe study totally analyzed 41 cases which confirmed by pathology and follow up study from January, 2008 to January 2009. The CT scan with IV contrast demonstrates over moderate enhanced lesion which indicate hypervascular. Within the 41 cases, 23 cases of central, 18 cases of peripheral. Suqamous carcinoma 21 cases, adenocarcinoma 15 cases and squamoadenocarcinoma 5 cases. Stage IIIb 34 cases, stage IV 7 cases. Superselective incubation with microcatheter under DSA, to embolize the capillary bed with liquefied iodized oil and the emulsion of pharmorubicin, to embolize the supply artery of the tumor with gelatin foam microparticle. The liquefied iodized oil 5 mL-10 mL, pharmorubicin 10 mg-30 mg. The longest follow up is 12 months and to compare with the references of 2007-2009.

RESULTSThe KPS is widely acclaimed after the treatment (P < 0.05), no complete response (CR), 31 cases of partial response (PR), 7 cases of no change (NC) and 3 cases of progressive disease (PD), the total efficiency (CR+PR) is 75.6%. The clinical efficiency (CR+PR+NC) is 92.68%. 33 cases of total survival tome over 12 months (80.48%), IIIb stage 29/34 (85.29%), IV stage 4/7 (57.14%). 1 case with severe complication-spinal injury.

CONCLUSIONTo treat primary hypervascular NSCLC with simple embolization of emulsion of chemotherapeutics and iodized oil is very useful and can avoid the side effect of chemotherapeutics. The key point to avoid spinal injury and other severe complications is to distinguish the spinal aretery and intratumor AV fistula by using superselective incubation with microcatheter under DSA.

Carcinoma, Non-Small-Cell Lung ; blood supply ; mortality ; therapy ; Chemoembolization, Therapeutic ; Emulsions ; Female ; Humans ; Iodized Oil ; administration & dosage ; Lung Neoplasms ; blood supply ; mortality ; therapy ; Male ; Middle Aged

Carcinoma, Hepatocellular ; drug therapy ; therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Intracranial Embolism ; chemically induced ; diagnosis ; Iodized Oil ; administration & dosage ; adverse effects ; Liver Neoplasms ; drug therapy ; therapy ; Middle Aged

OBJECTIVE: While the prognostic factors of survival for patients with hepatocellular carcinoma (HCC) who underwent transarterial chemoembolization (TACE) are well known, the clinical significance of performing selective TACE for HCC patients has not been clearly documented. We tried to analyze the potential factors of disease-free survival for these patients, including the performance of selective TACE. MATERIALS AND METHODS: A total of 151 patients with HCC who underwent TACE were retrospectively analyzed for their disease-free survival (a median follow-up of 23 months, range: 1-88 months). Univariate and multivariate analyses were performed for 20 potential factors by using the Cox proportional hazard model, including 19 baseline factors and one procedure-related factor (conventional versus selective TACE). The parameters that proved to be significant on the univariate analysis were subsequently tested with the multivariate model. RESULTS: Conventional or selective TACE was performed for 40 and 111 patients, respectively. Univariate and multivariate analyses revealed that tumor multiplicity, venous tumor thrombosis and selective TACE were the only three independent significant prognostic factors of disease-free survival (p = 0.002, 0.015 and 0.019, respectively). CONCLUSION: In our study, selective TACE was a favorable prognostic factor for the disease-free survival of patients with HCC who underwent TACE.
Adult ; Aged ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/mortality/*therapy ; *Chemoembolization, Therapeutic ; Contrast Media/administration & dosage ; Disease-Free Survival ; Doxorubicin/administration & dosage ; Female ; Humans ; Iodized Oil/administration & dosage ; Liver Neoplasms/mortality/*therapy ; Male ; Middle Aged ; Prognosis

OBJECTIVE: This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices. MATERIALS AND METHODS: Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure. RESULTS: The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the follow-up period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05). CONCLUSION: Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.
Aged ; Catheterization ; Contrast Media/administration & dosage ; Enbucrilate/*administration & dosage ; Esophageal and Gastric Varices/radiography/*therapy ; Female ; Fluoroscopy ; Humans ; Iodized Oil/administration & dosage ; Male ; Middle Aged ; Portal Vein ; Sclerotherapy/*methods ; Tissue Adhesives/*administration & dosage ; Tomography, X-Ray Computed ; Ultrasonography, Interventional

BACKGROUNDUterine arterial embolization (UAE) is a safe and effective therapy for symptomatic uterine leiomyoma. This study was to assess the effectiveness and the feasibility of pingyangmycin-lipiodol emulsion (PLE) for the management of symptomatic uterine leiomyoma.

METHODSOne hundred consecutive patients (aged 21 - 53 years, with 38 in average) with symptomatic uterine leiomyoma underwent superselective UAE with PLE. Clinical symptoms of the patients (including menorrhagia, bulk-related symptoms, and postprocedure-related abdominal pain) and the changes in uterine volume and tumor size after the embolization were analyzed. The patients were followed up for 8 - 21 months (mean, 15 months).

RESULTSNinety-nine patients (99%, 99/100) were interviewed in their first menses circle after embolization, showing improvements in their abnormal bleeding and bulk-related symptoms to some extent. Imagiological results during follow-up showed a mean of 48% reduction in uterine volume at 6 months and a mean of 75% reduction in tumor size at 9 months. Eighty-three percent of the patients reported complete resolution of postprocedure pain within 7 days.

CONCLUSIONSPLE is effective in the management of uterine leiomyoma, having superiority in alleviating postprocedure-related pain.

Adult ; Antibiotics, Antineoplastic ; administration & dosage ; Bleomycin ; administration & dosage ; analogs & derivatives ; Contrast Media ; administration & dosage ; Embolization, Therapeutic ; methods ; Emulsions ; Female ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Leiomyoma ; therapy ; Middle Aged ; Uterine Neoplasms ; therapy ; Uterus ; blood supply