Liver metastasis is the advanced stage of gastric cancer,which is a leading cause of death.Radiofrequency ablation (RFA) is an alternative method of comprehensive treatment in patients with gastric cancer liver metastasis due to its advantages of safety,minimal invasion and repetition.The efficacy of RFA alone,the efficacy of the combined treatment of RFA with other therapies and prognostic factors of RFA in gastric cancer liver metastasis were reviewed in this article.

Humans ; Pancreatic Neoplasms ; surgery ; therapy

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) for preoperative detection of colorectal liver metastases.Methods 42 consecutive patients with colorectal liver metastases confirmed by histopathology after surgery were recruited in the study.They all had undergone preoperative CEUS examination with contrast agent SonoVue.The number,location and size of the hepatic lesions found by CEUS were correlated with postoperatively histopathologic results on a lesion-by-lesion basis.Results 96 liver metastases in 42 patients with colorectal cancer had been resected and confirmed by histophathology.The size of the metastatic lesions ranged from 0.3～8.5 cm [average (2.6 ± 1.8)cm].From one to eight metastatic lesions were detected in one patient.21 (21.9％) metastatic lesions were equal to or less than 1.0 cm.86 of 96 metastatic lesions were correctly depicted by CEUS,with a sensitivity of 89.6％.And the sensitivity for metastatic lesions equal to or less than 1.0 cm was 71.4％ (15 of 21 tumors) by CEUS.35 metastatic lesions were found between the portal venous phase and late phase by CEUS and 19 (54.3％) metastatic lesions among them could not be detected at conventional ultrasound.The curative resection was performed in 37 (88.1％) of 42 patients.With 3 - 39 months follow-up,the intrahepatic recurrence rate within two years was 32.4％ (12 of 37 patients) and the one-year survival rate was 90.0％.Conclusions CEUS is highly sensitive for detecting liver metastases resulted from colorectal cancer,especially for small metastatic lesions.CEUS is helpful to choose reasonable therapeutic strategies and can be regarded as one of the most importantly and noninvasively preoperative imaging modalities.

Objective To analyze the changes of celluar and humoral immunity in children with juvenile idiopathic arthritis(JIA),as well as the changes in different subtypes,and to investigate the role of cellular and humoral immunity in the pathogenesis of JIA.Methods Ninety-two JIA subjects and 82 controls(healthy children) were included into this study.The levels of T lymphocyte subsets,natural killer (NK)cells,and B cells were analyzed by using flow cytometry.The serum interleukin-1 (IL-1),tumor necrosis factor-α (TNF-α),interleukin-l0 (IL-10),transforming growth factor-β(TGF-β) levels were detected by using enzyme-linked imnmunosorbent assay (ELISA).The serum IgG,IgM,IgA and C3,C4 levels were detected by using velocity scatter turbidimetry.Independent t-test,One-Way ANOVA test and Pearson analysis were adopted for data analysis.Results 1.In the group of JIA,the levels of CD3,CD4,IL-1,TNF-α,IgG,IgM,IgA and C3 were higher than those in the control group(all P ＜ 0.05),while the levels of CD4CD25,CD8,NK cells,IL-10 and TGF-β were lower than those in the control group(all P ＜0.05),and the ratio of CD4/CD8 was higher than that in the control group (P ＜ 0.05).2.In the group of systemic-onset JIA (so-JIA),the levels of CD4,IL-1,TGF-β,IgG,IgM,IgA,C3 and the ratio of CD4/CD8 were higher than those in the oligoarthritis JIA group(all P ＜ 0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group(all P ＜ 0.05).In the group of polyarthritis JIA,the levels of IL-1,TNF-α,IgG,IgM and IgA were higher than those in the oligoarthritis JIA group(all P ＜0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group (all P ＜ 0.05) ; In the group of so-JIA,the levels of CD4,TGF-β,C3 and C4 were higher than those in the polyarthritis JIA group (all P ＜ 0.05).3.The value of IL-1,TNF-α were positively correlated with that of C-reactive protein (CRP),erythrocyte sedimentation rate(ESR) in the JIA group(all P ＜ 0.05),while the value of IL-10,TGF-β was negatively correlated with that of CRP,ESR(all P ＜ 0.05).Conclusions There are cellular immunity and humoral immunity disorders in the JIA.Cellular immunity and humoral immunity are all involved in the pathogenesis of JIA.T helper cells are activated and Th1 cytokines increase,suppressive T cells,regulatory T cells impairment and suppressive cytokines decrease but immunoglobin increase,which involve in auto inflammation reaction and articular destruction in JIA.The immunity disturbances are more striking in so-JIA and polyarthritis JIA.IL-1,TNF-α,IL-10 and TGF-β are correlated with the disease activity.

Objective To observe the enhancement pattern of focal liver lesions in cirrhotic patients and to evaluate the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of dysplastic nodule with hepatocellular carcinoma(DN-Ca). Methods One hundred and forty-one cirrhotic patients with 163 focal liver lesions with the size of 1 - 3 cm were included in this study. All the nodules were examined using CEUS with SonoVue and underwent biopsy. The biopsies were performed using 18G needles in the different parts of enhancement. The enhancement patterns of DN-Ca, HCC and regenerative nodule(RN) were analyzed.Results Twenty-one lesions were diagnosed as DN-Ca by biopsy,45 lesions as hepatocellular carcinoma (HCC) and 97 lesions as RN. All the 21 lesions of DN-Ca presented partial enhancement during arterial phase or portal phase and wash-out during the late phase; the other areas of the lesions presented delayed or simultaneous enhancement during arterial phase and 23.8 % (5/21 ) slight wash-out in the late phase. Of the 45 lesions of HCC,82.2 % (37/45) presented global enhancement during arterial phase or portal phase, and 17.8% (8/45) presented inhomogeneous enhancement with no-enhancement in the central area during arterial phase, 100% (45/45) presented wash-out during the late phase. In 97 RNs, 96.9% (94/97)presented delayed or simultaneous enhancement during arterial phase, 3.1% (3/97) presented slightly enhancement during arterial phase;25.8% (25/97) showed wash-out and 74. 2% (72/97) showed no washout during the late phase. The pathological diagnosis was HCC in the enhanced area and hepatocytes regeneration in the un-enhanced area in the 21 DN-Ca. Conclusions CEUS is helpful in predicting the progress from RN to HCC by analyzing the hemodynamics. CEUS can improve the diagnostic accuracy of biopsy by providing more accurate information.

Objective To summarize the manifestation of solid pseudopapillary tumor of the pancreas (SPTP) on ultrasound and contrast-enhanced ultrasound (CEUS) and to investigate the diagnostic value of CEUS. Methods The ultrasound and CEUS images of six patients with SPTP confirmed by pathology were reviewed. According to CEUS record,the enhanced and wash-out time,enhanced speed and degree of tumor were analyzed. Results On ultrasound, SPTP presented as solid, well-circumscribed masses, usually heterogeneous in echo texture, and some of them contained macro-calcification. On CEUS, the tumor enhanced simultaneously or slightly late compared with normal pancreatic tissues. The contrast agent washed out quickly in all tumors than in normal pancreatic tissues. The enhanced degrees were equal to or less than that of the normal pancreatic tissues. Some tumors showed capsule and septum enhancement. Conclusions The manifestation of SPTP on CEUS had some features and may be helpful for differentiation diagnosis combine with ultrasound.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

Objective To investigate the clinical application of contrast enhanced ultrasonography (CEUS) in performing percutaneous biopsy for peripheral lung lesions. Methods A total of 132 patients with peripheral lung lesions underwent ultrasonography-guided percutaneous biopsy. Of the 132 patients, 72 received CEUS examinations before biopsy (CEUS group), and 60 received simple biopsy with no CEUS examination (control group). The ultrasonography imaging characteristics, the times of puncture biopsy, the diagnostic accuracy rate and the incidence of complications were recorded , and the results were compared between the two groups. The clinical value of CEUS in improving the success rate of percutaneous biopsy for peripheral pulmonary lesions was analyzed. Results Necrosis(areas of echoless) was demonstrated in 44.4%of the patients (32/72) in CEUS group, while it was displayed in only 6.7% of the patients (4/60) in the control group. The demonstration rate of necrosis in CEUS group were statistically higher than that in the control group (P <0.01). In CEUS group coexisting local pulmonary atelectasis was found in 12.5%of the patients (9/72), and the pulmonary lesion within the atelectasis could be clearly displayed. In the control group, local pulmonary atelectasis was demonstrated only in 1.7% of patients (1/60), the difference between the two groups was statistically significant (P<0.05). The diagnostic accuracy rate of CEUS group and the control group was 95.8% (69/72) and 80% (48/60) respectively, the difference was significant (P<0.01). The average number of punctures in CEUS group and the control group was (2.4 ± 0.6) and (2.6 ± 0.6) times respectively, the difference was not significant. The incidence of complications in CEUS group and the control group was 2.8% and 3.3%respectively, the difference was not significant. No severe complications occurred in both groups. Conclusion CEUS examination that is carried out before percutaneous pulmonary biopsy can effectively demonstrate the inner structure of the lesion, thus the diagnosis can be correctly made. Therefore, CEUS is of great value in guiding percutaneous pulmonary biopsy.

Objective To evaluate the role of contrast-enhanced ultrasound (CEUS) on the the detection of hepatic metastases in comparison with conventional ultrasonography (US) and contrastenhanced computed tomography (CECT).MethodsNinety-seven patients with hepatic metastases underwent US,CEUS and CECT images.Their detection of hepatic metastases were compared.Results Hepatic metastases showed five enhancement patterns with CEUS,including bolus hyper-enhancement,peripheralrimenhancement,inhomogeneousenhancementwithnecrosis,hypo-enhancement,isoenhancement with liver parenchyma,all hepatic metastases showed dark defects in portal and delayed phase.The mean number of metastases at CEUS was greater than that of US (2.6±1.9 vs 1.6 ±1.2,P＜0.05).The detection of hepatic metastases was 53.4％ and 87.1％ respectively(P＜0.05).CEUS and CECT have no statistically significant difference in the detection of hepatic metastases (P＞0.05).ConclusionsCEUS can improve detection of hepatic metastases.

Objective To evaluate the clinical value of contrast enhanced uhrasound(CEUS)for uhrasoundguided radiofrequency ablation(RFA)of liver metastasis.Methods One hundred and forty-one consecutive patients with liver metastasis asked for RFA treatment in our department.Of them,102 patients with received CEUS with SonoVue before RFA treatment.Eighty-six of the 102 patients were regarded as indications for RFA by CEUS(Group A).During the same period,another 39 patients who received conventional US without contrast before RFA were served as the control group(Group B).In Group A,the RFA protocol for each case was designed according to CEUS finding,which included perfusion feature,lesion number,size,shape,invasive range,location and relationship between tumor and surrounding structures.In Group B.the RFA protocol for each case was designed according to conventional ultrasound and CT/MRI result.Results In 102 patients who intended to receive RFA treatment,1 6 were excluded from RFA after CEUS examination.Of them,3 patients with 10 tumors received 6-10 sessions of chemotherapy and there were no enhancement within or around tumors.Another 13 cases were found that the invasive range being more than 8 cm in size,tumor number more than 7,and tumor location adhered to diaphragm and second hepatic helium by CEUS.In Grou0 A,CEUS detected additional 1-3 tumors in 36 patients(41.9%).The size range of the 58 new tumors was 8-15 mm.Of these,79.4%(46/58 tumors)were visualized in parenchymal phase.A total of 209 liver metastasis tumors were treated by RFA.CEUS before RFA demonstrated 49.7%(75/151 tumors)were 1arger in size compared with conventional US.Of these,69.3%(52/75 tumors)presented larger in arterial phase,the remaining 30.7%(23/75 tumors)presented larger in parenchymal phase,and the increased area was also ablated.On 1-3 months follow up with CT,the tumor necrosisrate in Group A was 94.7%(198/209 tumors),which was significantly higher than 87.6%(99/113 tumors)in Group B ( P=0.013). During follow-up period, local recurrence were found in 15 tumors (7.1 %) 2-17 months after REA and intrahepatic new tumors developed in 32 patients (37.2%) 2-17 months after RFA in group A,While local recurrence were found in 16 tumors (14.1%) and intrahepatic new tumors developed in 17 patients (43.5%) in group B ( P=0. 041, P ＞0.05, respectively). Conclusions CEUS provides important information for selecting candidation and designing optimal protocol for RFA in liver metastasis. The use of CEUS can increase tumor necrosis rate and decrease post-RFA tumor local recurrence,and then improve efficacy of RFA therapy.