Tumor-feeding Vessels Research Articles

Boosting Oncolytic Adenovirus Potency with Magnetic Nanoparticles and Magnetic Force

Oncolytic adenoviruses rank among the most promising innovative agents in cancer therapy. We examined the potential of boosting the efficacy of the oncolytic adenovirus dl520 by associating it with magnetic nanoparticles and magnetic-field-guided infection in multidrug-resistant (MDR) cancer cells in vitro and upon intratumoral injection in vivo. The virus was complexed by self-assembly with core-shell nanoparticles having a magnetite core of about 10 nm and stabilized by a shell containing 68 mass % lithium 3-[2-(perfluoroalkyl)ethylthio]propionate) and 32 mass % 25 kDa branched polyethylenimine. Optimized virus binding, sufficiently stable in 50% fetal calf serum, was found at nanoparticle-to-virus ratios of 5 fg of Fe per physical virus particle (VP) and above. As estimated from magnetophoretic mobility measurements, 3,600 to 4,500 magnetite nanocrystallites were associated per virus particle. Ultrastructural analysis by electron and atomic force microscopy showed structurally intact viruses surrounded by magnetic particles that occasionally bridged several virus particles. Viral uptake into cells at a given virus dose was enhanced 10-fold compared to nonmagnetic virus when infections were carried out under the influence of a magnetic field. Increased virus internalization resulted in a 10-fold enhancement of the oncolytic potency in terms of the dose required for killing 50% of the target cells (IC(50) value) and an enhancement of 4 orders of magnitude in virus progeny formation at equal input virus doses compared to nonmagnetic viruses. Furthermore, the full oncolytic effect developed within two days postinfection compared with six days in a nonmagnetic virus as a reference. Plotting target cell viability versus internalized virus particles for magnetic and nonmagnetic virus showed that the inherent oncolytic productivity of the virus remained unchanged upon association with magnetic nanoparticles. Hence, we conclude that the mechanism of boosting the oncolytic effect by magnetic force is mainly due to the improved internalization of magnetic virus complexes resulting in potentiated virus progeny formation. Upon intratumoral injection and application of a gradient magnetic field in a murine xenograft model, magnetic virus complexes exhibited a stronger oncolytic effect than adenovirus alone. We propose that this approach would be useful during in vivo administration to tumor-feeding blood vessels to boost the efficacy of the primary infection cycle within the tumor. For systemic application, further modification of magnetic adenovirus complexes for shielding and retargeting of the whole magnetic virus complex entity is needed.

Computed Analysis of Three-Dimensional Cone-Beam Computed Tomography Angiography for Determination of Tumor-Feeding Vessels During Chemoembolization of Liver Tumor: A Pilot Study

The purpose of this study was to evaluate computed analysis of three-dimensional (3D) cone-beam computed tomography angiography (CTA) of the liver for determination of subsegmental tumor-feeding vessels (FVs). Eighteen consecutive patients underwent transarterial chemoembolization (TACE) from January to October 2008 for 25 liver tumors (15 hepatocellular carcinomas [HCCs] and 10 neuroendocrine metastases). Anteroposterior projection angiogram (two-dimensional [2D]) and 3D cone-beam CTA images were acquired by injection of the common hepatic artery. Retrospectively, FVs were independently identified by three radiology technologists using a software package (S) that automatically determines FVs by analysis of 3D images. Subsequently, three interventional radiologists (IRs) independently identified FVs by reviewing the 2D images followed by examination of the 3D images. Finally, the “ground truth” for the number and location of FVs was obtained by consensus among the IRs, who were allowed to use any imaging―including 2D, 3D, and all oblique or selective angiograms―for such determination. Sensitivities, durations, and degrees of agreement for review of 2D, 3D, and S results were evaluated. Sensitivity of 3D (73%) was higher than 2D (64%) images for identification of FVs (P = 0.036). The sensitivity of S (93%) was higher than 2D (P = 0.02) and 3D (P = 0.005) imaging. The duration for review of 3D imaging was longer than that for 2D imaging (187 vs. 94 s, P = 0.0001) or for S (135 s, P = 0.0001). The degree of agreement between the IRs using 2D and 3D imaging were 54% and 62%, respectively, whereas it was 82% between the three radiology technologists using S. These preliminary data show that computed determination of FVs is both accurate and sensitive.

Chemoembolization of the Left Inferior Phrenic Artery in Patients With Hepatocellular Carcinoma: 9-Year Single-Center Experience

The purpose of this study was to evaluate retrospectively the radiologic findings and imaging response of hepatocellular carcinoma supplied by the left inferior phrenic artery. From January 2000 through December 2008, chemoembolization of the left inferior phrenic artery was performed on 152 patients (123 men, 29 women; mean age, 55.8 years) with hepatocellular carcinoma. The CT scans and digital subtraction angiograms of these patients were retrospectively reviewed in consensus by two investigators, who evaluated tumor location, tumor-feeding vessels, origin of the left inferior phrenic artery, technical success of chemoembolization, complications, and tumor response. Tumor response was assessed on the basis of the criteria of the European Association for the Study of the Liver. Tumors supplied by the left inferior phrenic artery were located in Couinaud segment 2/3 (n = 100), segment 4 (n = 45), and other segments (n = 7). The most common tumor-feeding vessel was the anteromedial limb of the left inferior phrenic artery (n = 82) followed by the lateral limb (n = 40) and the anterior limb (n = 30). Selective chemoembolization via the left inferior phrenic artery was achieved in 58 of the patients (38%). Complete or partial response as detected on first follow-up CT images (mean follow-up time, 2.5 months) was achieved by 30 patients. In 33 patients in whom the tumor was supplied exclusively by the left inferior phrenic artery, the tumor response was more favorable in patients who underwent selective than in those who underwent nonselective chemoembolization via the left inferior phrenic artery (p = 0.028). Selective chemoembolization via the left inferior phrenic artery is possible and results in good response of tumors supplied exclusively by the left inferior phrenic artery.

Juvenile nasopharyngeal angiofibroma: endoscopic surgery and follow-up results

To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results. The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded. There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03). The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.

Abstract No. 119: Computed analysis of 3D cone beam CT angiography for determination of tumor-feeding vessels during chemo-embolization: A pilot study

Abstract No. 119: Computed analysis of 3D cone beam CT angiography for determination of tumor-feeding vessels during chemo-embolization: A pilot study

Transarterial embolization ablation of hepatocellular carcinoma with a lipiodol-ethanol mixture

To determine the safety and effectiveness of transarterial embolization ablation (TEA) of hepatocellular carcinoma (HCC) with a lipiodol-ethanol mixture. Between January 1 and December 31, 2009, 15 patients with HCC (13 men/two women, aged 38-75 years) accepted TEA treatment and were enrolled in this study, including five newly diagnosed patients and 10 with refractory disease. Two months after TEA, angiography and contrast computed tomography (CT) were performed, and responses were assessed using a modified version of Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). The follow-up period was to June 30, 2010. Every new case was treated once. Angiography was performed immediately after TEA, and showed that the tumor-feeding vessels were completely embolized and that lipiodol was densely deposited inside tumors. Two months after treatment, contrast CT showed no enhanced lesions. Alpha fetoprotein levels returned to normal in four patients and markedly decreased in another. mean ± SD survival after treatment was 10.8 ± 4.5 mo. All five patients survived during the follow-up period. Ten patients with refractory disease were treated a total of 14 times. Angiography immediately after TEA showed that blood flow to the tumors was obviously decreased in all cases, and contrast CT showed obvious depositions of lipiodol. Two months after treatment, the tumors had shrunk (6/10) or were stable (3/10). One had progressed after 2 mo and died of tumor rupture 3 mo after TEA. mean ± SD survival after treatment was 8.6 ± 4.3 mo; two patients survived during the follow-up period. Adverse effects included reversible hepatic decompensation, upper abdominal pain, and fever. TEA is an effective therapy for patients with HCC and might be more effective than transcather arterial chemoembolization for treating refractory disease.

Screw Placement and Osteoplasty Under Computed Tomographic–Fluoroscopic Guidance in a Case of Advanced Metastatic Destruction of the Iliosacral Joint

We present a case of combined surgical screw placement and osteoplasty guided by computed tomography-fluoroscopy (CTF) in a 68-year-old man with unilateral osteolytic destruction and a pathological fracture of the iliosacral joint due to a metastasis from renal cell carcinoma. The patient experienced intractable lower back pain that was refractory to analgesia. After transarterial particle and coil embolization of the tumor-feeding vessels in the angiography unit, the procedure was performed under general anesthesia by an interdisciplinary team of interventional radiologists and trauma surgeons. Under intermittent single-shot CTF, two K wires were inserted into the left iliosacral joint from a lateral transiliac approach at the S1 level followed by two self-tapping surgical screws. Continuous CTF was used for monitoring of the subsequent polymethylmethacrylate injection through two vertebroplasty cannulas for further stabilization of the screw threads within the osteolytic sacral ala. Both the screw placement and cement injection were successful, with no complications occurring during or after the procedure. With additional nonsteroidal anti-inflammatory and opioid medication, the patient reported a marked decrease in his lower back pain and was able to move independently again at the 3-month follow-up assessment. In our patient with intolerable back pain due to tumor destruction and consequent pathological fracture of the iliosacral joint, CTF-guided iliosacral screw placement combined with osteoplasty was successful with respect to joint stabilization and a reduction in the need for analgesic therapy.

Choice of Posterior Subtemporal Transtentorial Approach for Tumor Resection in Deep Anteromedial Superior Cerebellum -Case Report-

The anteromedial superior cerebellar tumor can be accessed by various routes. For tumor presenting at the cerebellar surface in this region, the optimal approach remains contentious. Furthermore, which of the various routes offers the optimal approach to a tumor that is not present at the cerebellar surface but lies deep anteromedial superior cerebellum is a matter of debate. We report herein the case of a 44-year-old woman with hemangioblastoma deep within the subcortex of the anteromedial superior cerebellum. Preoperative magnetic resonance (MR) imaging and three-dimensional anisotropy contrast MR axonography using diffusion-weighted MR imaging demonstrated that the posterior subtemporal transtentorial (PSTT) approach would provide a shorter surgical corridor, minimal cerebellar split, and better preservation of nerve fibers, compared to the other approaches. Surgical tumor removal was successfully achieved using the PSTT approach. During surgery, the PSTT approach provided an operative field that enabled visualization of the proximal side of the superior cerebellar artery as the tumor feeding vessel. Although the vein of Labbé inserted just into the transverse-sigmoid junction, injury to this vein was avoided using optimal head position, cerebrospinal fluid drainage, and various devices. For patients with tumor located within the subcortex of the anteromedial superior cerebellum, the PSTT approach is recommended as an optimal surgical route. Scrupulous evaluation using preoperative neuroimaging is crucial when deciding on the surgical approach.

SIMULTANEOUS IMAGING OF A lacZ-MARKED TUMOR AND MICROVASCULATURE MORPHOLOGY IN VIVO BY DUAL-WAVELENGTH PHOTOACOUSTIC MICROSCOPY

Photoacoustic molecular imaging, combined with the reporter-gene technique, can provide a valuable tool for cancer research. The expression of the lacZ reporter gene can be imaged using photoacoustic imaging following the injection of X-gal, a colorimetric assay for the lacZ-encoded enzyme β-galactosidase. Dual-wavelength photoacoustic microscopy was used to non-invasively image the detailed morphology of a lacZ-marked 9L gliosarcoma and its surrounding microvasculature simultaneously in vivo, with a superior resolution on the order of 10 μm. Tumor-feeding vessels were found, and the expression level of lacZ in tumor was estimated. With future development of new absorption-enhancing reporter-gene systems, we anticipate this strategy can lead to a better understanding of the role of tumor metabolism in cancer initiation, progression, and metastasis, and in its response to therapy.

Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST)

BackgroundGastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas. Only 3–5% of GISTs are localized in the duodenum. There is a controversy, if duodenal GISTs should be treated by a duodenopancreatectomy or by a limited resection of the duodenum.Case presentationA 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater. After an emergency laparotomy with ligation of tumor-feeding vessels in a primary hospital, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Histology revealed a GIST with a diameter of 2.5 cm and <5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore no adjuvant therapy with Imatinib was initiated.ConclusionGISTs of the duodenum are a rare cause of upper gastrointestinal bleeding. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results.

Hepatocellular Carcinoma: Detection of Blood Supply from the Right Inferior Phrenic Artery by the Use of Multi–Detector Row CT

To evaluate retrospectively the ability of multi-detector row computed tomography (CT) to detect blood supply from the right inferior phrenic artery (RIPA) in patients with hepatocellular carcinoma (HCC). Between July 2006 and June 2007, angiography of the RIPA was performed in 178 patients (151 men, 27 women; mean age, 59 years) with HCC who also had undergone multi-detector row CT. CT scans and digital subtraction angiograms of these patients were retrospectively reviewed by consensus by two investigators to evaluate tumor feeder vessels. Tumor staining fed by the RIPA was noted on angiography in 113 patients (63%). Readers interpreted that the tumor feeder vessels were evident on CT images in 63 of these 113 patients (56%). Young age (odds ratio [OR], 0.934; P < .0001), exophytic growth pattern (OR, 2.702; P = .009), and presence of a visible feeder vessel on CT (OR, 6.933; P < .0001) were significant factors for predicting parasitic blood supply from the RIPA. In a subgroup of tumors smaller than 5 cm, multivariate analysis revealed that young age (OR, 0.94; P = .03) and repeated chemoembolization sessions (OR, 8.65; P = .01) were significant factors. Visualization of a tumor feeding vessel from the RIPA on multi-detector row CT could be a clue of a parasitic supply of a large tumor. In patients who have received repeated chemoembolization, small tumors in the dorsal hepatic area can be supplied by the RIPA.

Hepatocellular Carcinoma: Prediction of Blood Supply from an Internal Mammary Artery with Multi–Detector Row CT

To retrospectively evaluate the ability of multi-detector row computed tomography (CT) to predict a blood supply from an internal mammary artery in hepatocellular carcinoma (HCC). Between January 2003 and March 2007, 9,528 transcatheter arterial chemoembolization sessions were performed in 2,815 patients with HCC at the authors' institution. Sixty-three patients (45 men, 18 women; mean age, 61 years) also underwent internal mammary angiography. CT scans and digital subtraction angiograms were retrospectively reviewed by consensus between two authors to evaluate tumor feeding vessels. Univariate analysis and multiple logistic regression analysis were used to identify factors that help predict the presence of a blood supply from an internal mammary artery to HCCs. Tumor staining, supplied by the internal mammary artery, was noted at angiography in 38 of the 63 patients (60%). Readers found that a tumor feeding vessel was present at CT in 30 of these 38 patients (79%) and found no evidence of a tumor feeding vessel at CT in 22 of the 25 patients without a tumor feeding vessel at angiography (88%). A visible feeding vessel at CT (P = .002) and a large tumor size (>5 cm) were found to be significantly related to a blood supply from an internal mammary artery (P = .025). Multi-detector row CT enables interventional radiologists to predict blood supply from an internal mammary artery by demonstrating most of its tumor feeding vessels.

Clinical results of combined therapy of super-selective arterial infusion chemotherapy and irradiation for head and neck cancers: Comparison of two different anticancer agents

17018 Background: Super-selective arterial infusion chemotherapy (SAI) delivers higher anticancer agent dosages than conventional systemic chemotherapy. The purpose of this study was to retrospectively evaluate and compare the efficacy and toxicity of multidisciplinary treatments with radiotherapy and SAI using carboplatin or docetaxel. Methods: 30 cases received concurrent radiotherapy and SAI from July 1995 to May 2003. Patiens backgound are shown in table. Histological diagnoses; epidermoid (29), adenoid cystic (1). Using a trans- femoral procedure, we selected tumor feeding vessels, for administering dosages of carboplatin (300-400 mg/body) or docetaxel (35-80 mg/body). All cases received external or intracavital irradiation by liner accelerator to the tumor and involved regional lymph nodes. Median follow-up duration was 20 months. We evaluated the sub-acute side-effect data according to the NCI-CTCAE ver. 3 classification. Results: There were no significant differences in patients’ characteristics and radiation total dosages between the D-G and C-G. The response rate (RR) was 92.8% (82% in C-G vs. 100% in D-G). D-group patients showed a trend toward a longer 2 year-survival rate (OS; 92% in C-G vs. 100% in D-G). The 2-year cumulative incidence of local recurrence was 17.5% in C-G and 28.6% in D-G. Grade 3 or greater side effects;23 mucositis (C-G: 8 vs. D-G: 15), and 8 leukopenia (C-G: 3 vs. D-G: 5). There was no significant difference as to toxicity, and all side effects were cured by conservative treatment. Conclusions: In the present study, the two treatment groups showed similar activity (response rates and overall survival rates). Our data suggest that these two regimens are feasible SAI drugs for treatment of head and neck cancers, but further evaluation is required to confirm these findings. Patients Background C-G D-G Patients (NO.) 13: Male (10), Female (3) 17: Male (13), Female (4) Age (mean) 67 56 Primary Lesions buccal 1 2 gingiva 3 oral floor 2 2 oropharynx 2 2 tongue 4 13 maxilalry sinus 1 Clinical stages T/UICC stage) T2 (8) T2 (12) T3 (2) T3 (2) r (3)/II (5) r (3)/ II (11) III (3) III (3) IV (2) r (3) r (3) C-G, carboplatin group; D-G, docetaxel group; r, recurrence. No significant financial relationships to disclose.

Präoperative Embolisation mit chirurgischer Resektion von Glomustumoren im Kopf-Hals-Bereich: Analyse der klinischen Ergebnisse

The effectiveness and safety of angiographic embolization was investigated as a preliminary step prior to surgical excision of glomus tumours in the head and neck region. Embolization was performed in 54 patients presenting with a total of 58 chemodectomas, jugular (n=30), tympanicum (n=24) and caroticum (n=4) between the years 1988 and 2006. Embolization was considered successful if complete occlusion of all tumor-feeding vessels was achieved. The procedure was performed using polyvinylalcohol particles and microcoils and lasted for a median duration of 159 minutes. Complete tumor embolization was achieved in 72 % of patients. In 23%, it was partly successful and in 4% it was unsuccessful. 16% of patients experienced minor events during the procedure including hypotension, bradycardia, and vertigo. Following embolization, almost all patients (98%) had their tumour completely excised. Although the majority experienced minor postoperative complications (69%), one patient developed meningitis. There were no reported deaths. Angiographic embolization of glomus tumours in the head and neck before definitive excision can be safe and effective, resulting in an improved surgical outcome and tumour resectability.

Bone cement used as an embolic agent for active bleeding in vertebroplasty of metastatic lesions

We treated two cases of bleeding by injecting bone cement into tumor-feeding vessels of metastatic hypervascular tumors during a percutaneous vertebroplasty (PV) procedure. When the inner needle was pulled out after puncture of the metastatic vertebral tumor, active arterial bleeding from the outer needle cannula was noticed. Bleeding was not stopped by injection of Gelfoam particles through the cannula. Thus, bone cement was injected, which filled the tumor-feeding vessels, and bleeding stopped. Skin rash and high fever occurred 2-3 hours after the PV procedure, probably due to allergic reaction and massive tumor necrosis. To decrease the risk of active bleeding during PV for hypervascular bone metastases, arterial embolization of the feeding arteries should be performed 1 or 2 days prior to PV. If active bleeding occurs through the outer needle when performing PV, injection of bone cement after confirmation of bleeding from the tumor feeding vessels by vertebrography is effective.

4502 ORAL Phase 2 study of irinotecan and cisplatin in epidermoid carcinoma of the penis (EORTC 30992)

To assess the survival time of patients with HCC following transarterial chemoembolization performed in a highly selective and sequential way.124 HCC patients (102 male, 22 female; mean age 63 ± 11 years) treated with selective and sequential chemoembolization at a single center were included. Selective chemoembolization was performed through a coaxially introduced microcatheter in a segmental or subsegmental hepatic artery. Treatment was stopped after complete stasis of the blood flow in the tumor-feeding vessel. The primary endpoint of the study was overall survival.The median overall survival of the entire patient population was 27.2 months (mo) (±8.9 mo, 95% CI 9.8 mo, 44.6 mo). When stratified according to liver function the median survival was 46.1 mo (±9.0 mo; 95% CI 28.5 mo, 63.7 mo) for Child-Pugh A and 11.1 mo (±4.3 mo; 95% CI 2.7 mo, 19.5 mo) for Child-Pugh B (p < .001). The median survival was 46.1 mo (±16.6 mo; 95% CI 13.5 mo, 78.7 mo) for BCLC stage A, 19.7 mo (±2.6 mo; 95% CI 14.6 mo, 24.8 mo) for BCLC stage B, and 14.4 mo (±5.0 mo; 95% CI 4.5 mo, 24.3 mo) for BCLC stage C (p < .01).Selective and sequential chemoembolization offers long survival times in patients with HCC. Those patients with preserved liver function benefit more than patients with limited liver reserve.

Contrast-enhanced time-resolved 3-D MRA: applications in neurosurgery and interventional neuroradiology

The decision-making process in the endovascular treatment of cranial dural AV fistulas and angiomas and their follow-up after treatment is usually based on conventional digital subtraction angiography (DSA). Likewise, acquiring the vascular and hemodynamic information needed for presurgical evaluation of meningiomas may necessitate DSA or different MR-based angiographic methods to assess the arterial displacement, the location of bridging veins and tumor feeders, and the degree of vascularization. New techniques of contrast-enhanced MR angiography (MRA) permit the acquisition of images with high temporal and spatial resolution. The purpose of this study was to evaluate the applicability and clinical use of a newly developed contrast-enhanced 3-D dynamic MRA protocol for neurointerventional and neurosurgical planning and decision making. With a 3-T whole-body scanner (Philips Achieva), a 3-D dynamic contrast-enhanced (MultiHance, Bracco) MRA sequence with parallel imaging, and intelligent k-space readout (keyhole and "CENTRA" k-space filling) was added to structural MRI in patients with meningiomas, dural arteriovenous fistulas and pial arteriovenous malformations. The sequence had a temporal resolution of 1.3 s per 3-D volume with a spatial resolution of 0.566x0.566x1.5 mm per voxel in each 3-D volume and lasted 25.2 s. DSA was performed in selected patients following MRI. In patients with arteriovenous fistulas and malformations, MRA allowed the vascular shunt to be identified and correctly classified. Hemodynamic characteristics and venous architecture were clearly demonstrated. Larger feeding arteries could be identified in all patients. In meningiomas, MRA enabled assessment of the displacement of the cerebral arteries, depiction of the tumor feeding vessels, and evaluation of the anatomy of the venous system. The extent of tumor vascularization could be assessed in all patients and correlated with the histopathological findings that indicated hypervascularization. High temporal and spatial resolution 3-D MRA may allow correct identification and classification of fistulas and angiomas and help to reduce the number of pre-or postinterventional invasive diagnostic angiograms. This sequence is also helpful for characterizing the degree of vascularization in preoperative evaluation of meningiomas and to select meningiomas suitable for embolization. Displacement of normal arteries and depiction of the venous anatomy can be achieved cost-effectively in a short period of time. The high spatial resolution also permits improved demonstration of the major feeding arteries, which helps to reduce the number of conventional angiograms required for meningioma evaluation.

The role of contrast-enhanced ultrasound in planning treatment protocols for hepatocellular carcinoma before radiofrequency ablation

To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) for patients with hepatocellular carcinoma (HCC) in identifying the tumour number, ablation range and feeding vessels before ultrasound-guided radiofrequency ablation (RFA), and to compare the efficacy of RFA after CEUS with the efficacy of RFA after non-enhanced ultrasonography (US) without contrast medium administration. From 2002 to 2005, 81 patients with 110 HCCs underwent CEUS with SonoVue before RFA treatment (group A). Eighty six patients with 112 HCCs who underwent US without contrast enhancement before RFA served as the control group (group B). The average diameters of the lesions in group A and group B were 3.6+/-1.1cm and 3.5+/-1.1cm, respectively. There were no significant differences in clinical data between the two groups. Regular follow-up after treatment was performed using contrast-enhanced computed tomography (CECT). After treatment, complete necrosis was defined as the absence of viable tissue in treated tumours at the 1-year follow-up CECT. Using CEUS an additional seven small lesions (< or =2.0 cm) were found compared with those found using CECT and conventional US. CEUS showed that 56.4% of lesions (62/110 tumours) were larger in size and 49.1% (54/110 tumours) became more irregular in shape during the arterial phase than on conventional US. Feeding vessels were detected using CEUS in 52 (91.2%) of 57 lesions that were larger than 3.5 cm. The follow-up period was at least 1 year for each case. The complete tumour necrosis rate in group A was significantly higher than that in group B (92.2% versus 83.0%; p=0.036). CEUS can be used to more accurately define the size and contour of lesions, and to detect additional small or satellite lesions and the feeding vessel of HCC tumours. CEUS provided important information for designing the ablation protocol, and might improve the efficacy of RFA.

The therapeutic challenge of a nonresectable solitary fibrous tumor in a hypoglycemic patient

We report a patient with a nonresectable histologically benign solitary fibrous tumor who suffered from paraneoplastic non-islet cell tumor hypoglycemia (NICTH). Diagnostic workup revealed malignant characteristics in which the tumor showed up as, presumably, false-negative on fluorodeoxyglucose-positron emission tomography (FDG-PET), while being positive on tyrosine-PET. Neoadjuvant treatment, which consisted of combined chemo-radiation and consecutive selective embolization of the tumor feeding vessels, caused such a therapeutic effect, on both NICTH and reduction in tumor volume, that a secondary resection, with the patient in a normoglycemic status, was possible. Our report highlights several important issues in the management of the patient with a nonresectable solitary fibrous tumor with severe episodes of hypoglycemia due to NICTH.

Tumoricidal and Anti-Angiogenic Actions of Gamma-Linolenic Acid and Its Derivatives

Studies showed that gamma-linolenic acid (GLA) and its derivatives have the potential to be anti-cancer molecules. In vitro, in vivo and limited clinical studies showed that GLA has selective tumoricidal action with little or no side effects. The mechanism of its action appears to be by inducing apoptosis of tumor cells by augmenting free radical generation only in the tumor cells but not normal cells. Intra-arterial injection of a lithium salt derivative of GLA demonstrated its ability to selectively occlude tumor-feeding vessels. Since GLA is an endogenous naturally occurring molecule and has no significant side effects, it calls for more studies to exploit its potential as a novel anti-cancer drug.