Volume Reduction Rate Research Articles

Is ultrasound-guided radiofrequency ablation a reliable treatment option for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus: a retrospective comparative study based on large-sample data

Objective To evaluate whether ultrasound-guided radiofrequency ablation (RFA) is reliable for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus (PTCI). Methods 431 patients who underwent ultrasound-guided RFA for unifocal T1aN0M0 papillary thyroid carcinoma (PTC) were divided by location of the lesion into the PTCI group (52 females, 7 males, mean age 43.79 ± 12.04 years, range 22-74 years) and the PTCL group ((291 females, 81 males, mean age 43.42 ± 10.87 years, range 18-75 years) for comparative analysis. The efficacy of ultrasound-guided RFA was evaluated by volume reduction rate (VRR), complete disappearance rate (CDR) and disease progression, and the safety was evaluated by incidence of complications. Results The two groups exhibited a consistent trend of change, with the PTCI group performing better in volume, VRR and CDR at all follow-up time points expect 1 month, but the differences were not statistically significant (p > 0.05). The mean initial volume of the PTCI group vs the PTCL group decreased significantly from 65.4 ± 69.79 vs 86.38 ± 87.09 mm³ (range 10.92-427.58 vs 3.05-471.6 mm³) to 0 vs 0 mm³ at a mean follow-up time of 31.12 ± 12.5 months (range 12-60 months); their VRR increased significantly from −618.62 ± 655.61% vs −789.85 ± 1135.07% at 1 month to 100% vs 100% at 48 months. No disease progression was found in the two groups. The PTCI group had no complications, whereas the PTCL group had a total of 7 complications (1.88%). Conclusions Ultrasound-guided RFA is reliable for unifocal T1aN0M0 PTCI. It can be promoted as an alternative to immediate surgery for selected PTC patients.

Evaluation of the clinical efficacy of microwave ablation for benign thyroid nodules based on contrast-enhanced ultrasound.

This study evaluates the clinical efficacy of microwave ablation in patients with benign thyroid nodules based on contrast-enhanced ultrasound. A total of 92 patients with benign thyroid nodules admitted to our hospital from January 2020 to December 2022 were selected as research subjects and divided into control group and observation group according to different treatment methods, with 46 cases in each group. All patients received microwave ablation. Imaging examination and monitoring were performed before and after microwave ablation. The control group underwent routine ultrasound examination, and the observation group underwent contrast-enhanced ultrasound examination. It was determined whether or not to terminate ablation therapy according to the imaging examination results. Results of enhanced MRI were used as the gold standard to evaluate the clinical efficacy, thyroid nodule volume, thyroid nodule volume reduction rate, nodule recurrence, and complication rate of the 2 groups. Using the results of enhanced MRI as the gold standard, the total ablation rate of observation group was 96.55%, which was significantly higher than that of control group 85.96%, and the nodule survival rate of 3.45% was significantly lower than that of control group 14.04% (P < .05). After 1 month, 3 months, 6 months, and 12 months, the thyroid nodule volume of both groups was significantly reduced, and the thyroid nodule volume of observation group was significantly smaller than that of control group (P < .05). After 1 month, 3 months, 6 months, and 12 months, the reduction rate of thyroid nodule volume in 2 groups was significantly increased, and the reduction rate of thyroid nodule volume in observation group was significantly higher than that in control group (P < .05). After treatment, the recurrence rate of nodule in observation group was 4.35%, which was significantly lower than that in control group, 15.22% (P < .05). After treatment, the complication rate of observation group was 8.70%, which was significantly lower than that of control group 26.09% (P < .05). Contrast-enhanced ultrasound can effectively monitor the treatment range of benign thyroid nodules by microwave ablation, improve clinical efficacy, reduce the recurrence rate of nodules, and has high effectiveness and safety.

Ultrasound-based radiomics to predict the volume reduction rate of benign thyroid nodules after microwave ablation.

To evaluate the predictive power of ultrasound-based radiomics models for benign thyroid nodules with a volume reduction rate (VRR) of < or ≥75% at 12 months after microwave ablation. A retrospective study was conducted on 194 individuals with benign thyroid nodules who received ultrasound-guided microwave ablation between November 2019 and June 2023. The clinical and ultrasound features, including age, gender, volume, echogenicity, duration of ablation, and so on were analysed by t-test or chi-square test. Radiomics features were extracted from longitudinal and transverse ultrasound images of the nodules. The features were selected using methods such as least absolute shrinkage and selection operator (LASSO). Radiomics models were established using longitudinal, transverse, and longitudinal + transverse ultrasound images to predict the VRR of benign thyroid nodules after ablation. Decision curve analysis (DCA) and receiver operating characteristic (ROC) curve analysis were used to assess the models' performance. At 12 months following ablation, the VRR of the nodules was 77.8 ± 19.4% (7.4-98.8%). Statistical analysis revealed that the duration of ablation and the proportion of liquid extracted were significantly correlated with the 12-month VRR (P <0.05). In the radiomics models, Logistic Regression (LR) performed the best. In the training cohorts, the area under the curve (AUC) for the longitudinal, transverse, and combined groups were 0.935, 0.800, and 0.937. The AUC values in the test cohort were 0.820, 0.844, and 0.917. The radiomics models established based on pre-ablation ultrasound images showed good predictive efficacy for the VRR of nodules at 12 months following ablation. The predictive efficacy is best in the combined group. With the models, we can preoperatively predict patients' prognoses and thereby determine whether to proceed with ablation therapy.

Flood mitigation performance of low impact development practice in a coastal city from the perspective of catchment scale

Climate change and urbanization have imposed significant stress on urban drainage systems, resulting in hydraulic overloading and urban flooding. The implementation of Low Impact Development (LID) practices exhibits promising potential in mitigating these impacts. In this study, a modeling task was proposed for the drainage district of Haikou City, Hainan Province, China. The tracer-aided urban flood model was employed to conduct 64 simulation scenarios, aiming to evaluate the hydrological response of LID strategies under varying rainfall intensity, spatial distribution, and initial saturation level. The results have demonstrated the significant utility of the tracer-aided urban flood model in assessing the hydrological impact of LID practices, particularly in accurately identifying both the source area and hazard area affected by flooding. Notably, rainfall intensity plays a crucial role in influencing the hydrological response of LID practices. With the increase in rainfall intensity, the efficacy of LID strategies in mitigating value of peak flood volume gradually intensifies, but the reduction rate of peak flood volume diminishes progressively. In terms of LID strategies with varying spatial distributions, the upstream strategy outperforms both midstream and downstream strategy. Nevertheless, the correlation between reduction value of flood volume across different catchments suggests a complex synergistic effect among them. The reduction value of LID practices on flood volume will gradually decrease as the initial saturation increases, indicating that careful consideration should be given to the impact of rainfall patterns on their initial saturation when incorporating LID practices into an urban flood mitigation strategy. This study provides valuable insights into sustainable stormwater management by examining the effectiveness and influencing factors of LID practices.

Correlation between sonographic classification and the efficacy of microwave ablation for adenomyosis.

Adenomyosis is a common benign gynecological disease. Patients often experience abnormal uterine bleeding, dysmenorrhea, and infertility. Percutaneous microwave ablation (PMWA) is a minimally invasive method used for treating adenomyosis while preserving the uterus. However, no study has examined whether the efficacy of PMWA differs according to the severity of adenomyosis. This study aimed to investigate the correlation between sonographic classification and the efficacy of ultrasound-guided PMWA for adenomyosis. This cross-sectional study included 129 patients with symptomatic adenomyosis who received PMWA in the Longyan First Affiliated Hospital of Fujian Medical University between May 2019 and October 2022. Patients were divided into three groups of sonographic classification: mild (n=31; 1-3 points), moderate (n=50; 4-6 points), and severe (n=48; ≥7 points). To clarify the effect of PMWA treatment in the different degrees of adenomyosis, clinical questionnaire data were obtained for the three groups using the preoperative and 3-, 6-, and 12-month postoperative menstrual pictorial blood loss analysis chart (PBAC), the dysmenorrhea visual analog scale (VAS), symptom severity scale (SSS), and health-related quality of life scale (HRQL). The uterine corpus volume (UCV) and postoperative UCV reduction rate (UCR) were also calculated, and the correlation between the ultrasound scores and these indicators was analyzed. Nonparametric tests were used to examine differences in measures of efficacy between and within groups. The Chi-square or Fisher exact test was used to examine the intergroup differences in the type of adenomyosis composition, satisfaction with efficacy, and complications. The severe group had the highest preoperative menstrual blood loss, uterine volume, and SSS score but the lowest HRQL score. The moderate group had the highest VAS score. Additionally, the PBAC, VAS, SSS, HRQL, and UCV in the three groups improved postoperatively (all P values <0.05). The moderate, mild, and severe groups demonstrated significant improvements in UCR, the highest proportion of satisfactory efficacy, and the highest proportion of unsatisfactory efficacy, respectively. Most adverse reactions were mild. Ultrasound scores were positively correlated with preoperative PBAC [Spearman's rank correlation coefficient (rs) =0.573; 95% confidence interval (CI): 0.384-0.727; P<0.001], SSS (rs =0.299; 95% CI: 0.122-0.467; P=0.002), UCV (rs =0.575; 95% CI: 0.421-0.715; P<0.001), and 12-month postoperative UCR (rs =0.623; 95% CI: 0.485-0.739; P<0.001); meanwhile, ultrasound scores were negatively correlated with preoperative HRQL (rs =-0.301; 95% CI: -0.478 to -0.111; P=0.002). There was no significant correlation between ultrasound scores and preoperative VAS (rs =0.076; 95% CI: -0.119 to 0.262; P=0.450). Sonographic classification reflected the severity of adenomyosis. The therapeutic effect of PMWA on adenomyosis varied across patients according to the severity of adenomyosis. Sonographic classification may potentially serve as a preoperative image-evaluation tool for predicting the ablation effect of PMWA.

Ultrasound-guided high-intensity focused ultrasound for symptomatic uterine fibroids: clinical outcome of two European centers.

The aim of this study is to assess the clinical outcome and mid-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) as a treatment for symptomatic uterine fibroids at two major European HIFU centers. This bi-center longitudinal clinical study involved the treatment of 100 patients with symptomatic uterine fibroids using USgHIFU (n = 59 in Germany, n = 41 in Bulgaria). Clinical outcomes were evaluated at 6 weeks, 6 months, and 1 year follow-up utilizing the uterine fibroid symptoms-quality of life questionnaire for fibroid-related symptoms and health-related quality of life as well as MRI imaging for determining the fibroid volume. The mean fibroid volume reduction rate was 33.2 ± 22.9%, 51.3 ± 24.2%, and 59.1 ± 28.0% at 6 weeks, 6 months, and 1 year, respectively (each p < 0.001). The mean symptom severity score decreased from 43.9 ± 18.8 at baseline to 35.4 ± 18.2 at 6 weeks, 31.1 ± 20.0 at 6 months, and 23.1 ± 14.0 at 1 year (each p < 0.001). The mean QOL score improved from 56.5 ± 23.4 at baseline to 65.4 ± 22.2 at 6 weeks, 72.5 ± 19.5 at 6 months, and 79.4 ± 15.3 at 1 year (each p < 0.001). No major complications were observed, though two patients experienced temporary sciatic nerve irritation following the procedure. Four patients had pregnancies and deliveries without any complications after USgHIFU therapy. To our knowledge, this is the first longitudinal study conducted in two major European HIFU centers that reveals the clinical efficacy of USgHIFU ablation on symptomatic uterine fibroids. Our results confirm that USgHIFU is a non-invasive approach with a low risk of complications, offering an innovative treatment option for affected women. Question To evaluate mid-term clinical efficacy and safety of US-guided high-intensity focused ultrasound (HIFU) for treating symptomatic uterine fibroids and patient outcomes across two European centers. Findings US-guided HIFU treatment resulted in significant fibroid volume reduction (up to 59.1% after 1 year) improving symptoms and quality of life with no major complications. Clinical relevance This prospective longitudinal study provides preliminary data assessing mid-term efficacy and clinical outcomes of ultrasound-guided HIFU. It is shown to be a low-risk, non-invasive treatment option for symptomatic uterine fibroids that reduces fibroid size and improves patients' quality of life.

Clinical outcomes of microwave ablation for solitary T1N0M0 papillary thyroid carcinoma: a more than 5-year follow-up study.

This study aimed to evaluate the long-term efficacy and safety of microwave ablation (MWA) for solitary T1N0M0 papillary thyroid carcinoma (PTC) and compare them between T1a and T1b disease. This retrospective study included 136 patients with solitary T1N0M0 PTC who were treated with MWA and followed up for more than 5 years. Outcomes were compared between patients with T1a and T1b disease. The primary outcomes were disease progression and disease-free survival (DFS). The secondary outcomes included the volume reduction rate (VRR), the rate of complete disappearance, and complications. During a mean follow-up period of 70.6 ± 10.5 months, the overall disease progression rate was 5.88%. The incidences of lymph node metastases (LNMs) and new tumors were 2.21% and 5.15%, respectively. No patient was diagnosed with local recurrence, distant metastasis, or death due to PTC. There were no significant differences between the T1a and T1b groups in terms of disease progression (3.81% vs 12.90%, p = 0.15), LNMs (1.90% vs 3.23%, p = 0.54), or new tumors (2.86% vs 12.90%, p = 0.08). The 5-year DFS rate was 94.85%, the VRR was 99.7% ± 2.0%, and 97.79% of the tumors disappeared. Hoarseness occurred in five patients (3.68%). MWA is a long-term effective and safe option for patients with solitary T1N0M0 PTC, providing a minimally invasive alternative for those who refuse surgery or active surveillance. Question MWA, as a minimally invasive alternative for treating PTC, lacks comparison with surgical resection and active surveillance. Findings MWA resulted in overall disease progression in 5.88% of patients with solitary T1N0M0 PTC over more than 5 years of follow-up. Clinical relevance MWA is a safe, effective, and minimally invasive treatment for solitary T1N0M0 PTC, with high DFS rates and low complication rates, benefiting patients seeking alternatives to surgery or active surveillance.

Application and evaluation of carbonate apatite granules for mandibular bone defect reconstruction after jawbone cyst enucleation-a retrospective case series.

To evaluate the effectiveness of CO3Ap granules in the mandibular bone defects by using computed tomography (CT) images. This study was retrospective case series of mandibular bone defect reconstruction using CO3Ap granules. Six patients with jawbone cysts treated by simultaneous grafting CO3Ap granules after cyst enucleation were enrolled. Patients without grafting CO3Ap granules were excluded. Mandibular bone height including buccolingual bone height, the change of perpendicular distance between the buccolingual line to the alveolar ridge, and the three-dimensional volume of remaining CO3Ap granules were analyzed using CT images obtained at 3, 6, 12, 18, and 24 months postoperatively. Postoperative CT images showed that cortical and cancellous bone-like structures were formed on the grafting area periphery and inside the defect, respectively, with gradual resorption of the CO3Ap granules. Furthermore, there was no evidence of leaving bone defect even at the center of the lesion when the defect was successfully reconstructed by filling it with CO3Ap granules. The percentage volume of remaining CO3Ap granules to the volume at 3 months postoperatively were 76.1 ± 13.1%, 35.8 ± 22.5%, 25.0 ± 13.0%, and 9.9 ± 6.4% at 6, 12, 18, and 24 months postoperatively, and the volume reduction rate increased significantly within 12 months postoperatively. Grafting CO3Ap granules after the enucleation of a jawbone cyst is a good reconstructive treatment option for postoperative prosthetic treatment because CO3Ap granules are gradually replaced by new bone while preserving the contour of the mandibular bone. Not applicable.

Ophthalmic artery feeders in meningioma reduce the effectiveness of transarterial embolization with n-butyl cyanoacrylate

N-butyl cyanoacrylate (n-BCA) is often utilized for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture. We retrospectively analyzed 62 patients with meningioma who underwent preoperative TAE with n-BCA between 2016 and 2021. Patient variables, including characteristics, intraoperative findings, and outcomes, were collected. Feeder architecture was classified into seven groups: 1) internal maxillary artery, 2) occipital artery, 3) ascending pharyngeal artery, 4) posterior meningeal artery, 5) infraclinoidal internal carotid artery, 6) ophthalmic artery (OphA), and 7) pial feeder group, based on preoperative angiography. We set primary outcome as the embolization rate, representing the reduction rate of the gadolinium-enhanced lesion volume observed on contrast-enhanced magnetic resonance imaging. Angiographic findings following n-BCA injection were classified as feeder occlusion (FO) or intratumoral embolization (IE). We analyzed the factors associated with the embolization rate. The OphA feeder group showed a decrease in the embolization rate (P = 0.008). The number of feeder groups with IE showed a robust positive correlation (r = 0.557). The OphA feeder group showed an increase in the number of feeder groups (P < 0.001) and larger tumor volume (P = 0.005). The OphA feeder group was associated with a lower embolization rate. Our study suggested that the vascular architecture in meningioma affected the efficacy of TAE with n-BCA.

Evaluation of Volumetric Magnetic Resonance Imaging in Determining the Indication for Total Neoadjuvant Therapy in Rectal Cancer.

This study aims to evaluate the relationship between volumetric measurements of residual tumor via magnetic resonance imaging (MRI) and pathologic complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT). Patients with locally advanced rectal cancer who had pelvic MRI for clinical staging and completed nCRT followed by radical resection were included. Two experienced radiologists measured tumor volume on MRI obtained before and after nCRT. We compared the pre- and post-CRT tumor volume and measured tumor volume reduction rates. The median value of tumor volume reduction rate in all patients was 64.7% (min-max - 81.1-98.1%). When the relationship between tumor volume and tumor regression grade (TRG) after nCRT was assessed, it was found that 18 of 21 (86%) patients with a good response (TRG 1) had a post-CRT tumor volume of ≤ 8 cm3 (p = 0.001). While 9 of 10 patients with pCR after nCRT had a tumor volume of ≤ 8 cm3, one patient had pCR despite having a tumor volume greater than 8 cm3 (p = 0.015). The correlation between post-nCRT residual tumor volume and pCR underscores the potential of volumetric MRI as a predictive tool in tailoring rectal cancer treatment. For patients with residual tumor volumes greater than 8 cm3, extending neoadjuvant chemotherapy as part of TNT may enhance the likelihood of achieving pCR. This approach advocates for a more personalized treatment strategy, potentially optimizing outcomes for rectal cancer patients.

Thermal Ablation for Papillary Thyroid Carcinoma

Image-guided thermal ablation has been administered for patients with T1N0M0 papillary thyroid carcinoma (PTC) who elect to not undergo surgery or receive active surveillance. Considering the indolent nature of PTC, long-term outcomes of ablation are needed. To investigate l0-year outcomes of thermal ablation in treating T1N0M0 PTC. This multicenter study was conducted at 4 university-affiliated hospitals in China and included 179 consecutive patients with T1N0M0 PTC (median [IQR] volume, 88.0 [163.2] mm3) who underwent thermal ablation between June 2010 and March 2014. Patients who were ineligible to undergo surgery or elected not to were included, and patients had PTC tumors that were smaller than 20 mm as confirmed by biopsy; no clinical or imaging evidence of extrathyroidal extension, lymph node metastasis (LNM), or distant metastasis; and no history of neck irradiation. The primary outcomes were disease progression (LNM, newly developed tumors, persistent tumors, and distant metastasis) and disease-free survival (DFS). Secondary outcomes were technical success, volume reduction rate, tumor disappearance, complications, and delayed surgery. DFS was calculated using a Kaplan-Meier analysis. Among the 179 patients, the mean (SD) age was 45.8 (12.7) years, and 118 (65.9%) were female. During a mean (SD) follow-up period of 120.8 (10.8) months, disease progression was found in 11 of 179 patients (6.1%), including LNM in 4 patients (2.2%), newly developed tumors in 6 patients (3.3%), and persistent tumor in 1 patient (0.6%). The 10-year DFS was 93.9%. The technical success, median volume reduction rate, and tumor disappearance rate was 100%, 100%, and 97.2%, respectively. The magnitude of the disease progression (6.1% vs 7.1%; difference, 1.0%; 95% CI, -6.5% to 25.6%) and DFS (93.9% vs 92.9%; difference, 1.0%, 95% CI, -6.5% to 25.6%) between patients with T1a and T1b tumors was small. The difference in the rate of tumor disappearance between T1a and T1b tumors was large (99.4% vs 71.4%; difference, 28.0%; 95% CI, 10.9%-54.0%). One patient experienced transient voice hoarseness (0.6%). Because of anxiety, 1 patient underwent delayed surgery (0.6%). The results of this 10-year multicenter cohort study suggest that thermal ablation is an effective and safe alternative for patients with T1N0M0 PTC who do not undergo surgery or receive active surveillance. For safe and effective treatment, accurate radiologic evaluation, an understanding of ablation techniques, and experienced physicians are recommended.

Ultrasound-guided ablation for T1N0M0 papillary thyroid carcinoma adjacent and non-adjacent danger triangle area: a retrospective comparative study

Objectives To compare the safety and efficacy of ultrasound-guided radiofrequency ablation (RFA) in the treatment of T1N0M0 papillary thyroid carcinoma (PTC) with adjacent and non-adjacent danger triangle area (DTA). Materials and methods This retrospective study involved collecting clinical data of all T1N0M0 PTC patients who underwent RFA between January 2018 and December 2020 at the hospital. A total of 211 patients were enrolled in the study (mean age 43.25 ± 12.30 years, male-to-female ratio = 1:3). Among them, 91 had adjacent DTA involvement, while 120 had non-adjacent DTA involvement. Comparisons were made between the two groups patients regarding tumor volume changes, technical success rates, tumor disappearance, disease progression, complications. Results In both groups, the technical success rate was 100%, with a median follow-up period of 30 months. The rates of complete tumor disappearance were 78% (71/91) and 74.2% (89/120) for the adjacent and non-adjacent DTA(p = .517). Disease progression rates were 2.2% (2/91) and 1.7% (2/120) (p > .99), Complication rates were 3.3%(3/91) in the adjacent DTA group and 1.7% (2/120) in the non-adjacent DTA group (p = .654). At 6th month after ablation, the volume reduction rate (VRR) in the non-adjacent DTA group (42.3%) was higher than in the adjacent DTA group (37.3%) (p = .002). However, no significant differences were observed in VRR between the two groups at 1, 3, 12, 18, 24, 30, and 36 months (p > .05). Conclusion In the treatment of T1N0M0 PTC, the complication rates and short-term efficacy of RFA in adjacent to the DTA did not differ from those of non-adjacent DTA.

Determining the gross tumor volume for hepatocellular carcinoma radiotherapy based on multi-phase contrast-enhanced magnetic resonance imaging

PurposeThe aim of this study was to quantitatively analyze of the differences in determining the gross tumor volume (GTV) for hepatocellular carcinoma (HCC) radiotherapy using multi-phase contrast-enhanced magnetic resonance imaging (CE-MRI) and provide a reference for determining the GTV for radiotherapy of HCC. MethodsThis retrospective study analyzed 99 HCC patients (145 lesions) who underwent MR simulation. T1-weighted imaging (T1WI), contrast-enhanced T1WI (CE-T1WI) at 15 s, 45 s, 75 s, 150 s, and 20 min after contrast agent injection were performed, comprising a total of six imaging sequences. The GTVs identified on different sequences were grouped and fused in various combinations. The internal GTV (IGTV), which was the reference structure, was obtained by the fusion of all six sequences. Mean signal intensity (SI), volume, shape, and fibrous capsule (FC) thickness among GTVs were compared. Results(1) The mean SI value of GTV-T1WI, GTV-15s-GTV-20min in patients with transarterial chemoembolization (TACE) was lower by 14.09 % (GTV-T1WI) to 31.31 % (GTV-15s) compared with that in patients without TACE. Except for GTV-T1WI, the differences in SI values between the two groups for other GTVs were statistically significant (p < 0.05). (2) The volumes of GTV-T1WI, GTV-15s-GTV-20min ranged from 32.66-34.99 cm3. The volume differences between GTV-45s and the other GTVs were statistically significant (p < 0.05), excluding the GTV-T1WI. (3) Compared with the IGTV, the change trend of GTV volume reduction rate is consistent with that of dice similarity coefficients (DSC). (4) In the CE-T1WI sequences (except for CE-T1WI-15s), FC measurement was possible in 39.31 % of lesions (57/145), with the largest mean thickness observed at 75 s. ConclusionAlthough single-phase CE-MRI introduces uncertainty in HCC GTV determination, combining different phases CE-MRI can enhance accuracy. The CE-T1WI-45s should be routinely included as a necessary scanning sequence.

Stormwater runoff volume reduction and pollutant removal efficiency via bioretention cell using rock wool as the media

ABSTRACT Bioretention cells have been widely used in stormwater management. Media plays an important role in stormwater runoff reduction and pollutant removal. A novel bioretention media of rock wool has been proposed, and its effect on stormwater runoff reduction was investigated via a laboratory-scale experiment. The results showed that compared with the conventional bioretention (CB) using medium sand as media, the volume capture ratio of annual rainfall (VCRAR) of the rock wool bioretention (RWB) was 2.66–5.5% higher, and the peak flow reduction rate was 2.97–11.32% higher. The removal efficiency rates of the RWB on COD, NH4+ -N, TN, and TP were 25–30%, 10–31%, 20–40%, and 5–14% higher than the CB, respectively. The removal efficiency of the RWB on botht Pb and Zn was &amp;gt;99%. The microbial high-throughput sequencing results showed that the RWB can provide a better breeding environment for Bacteroides and Actinobacteria, which is conducive for the removal of pollutants. The RWB had a better stormwater runoff volume reduction rate and pollutant removal efficiency than the CB, therefore, it could be used as a better media for bioretention cells to improve stormwater management efficiency by using rock wool, obtained from construction waste, as the media.

The Usefulness of Portable Echo in the Preoperative Mapping of Lymphaticovenular Anastomosis.

This study evaluated the effectiveness of a pocket-sized ultrasound device in preoperative planning for lymphaticovenular anastomosis (LVA) to enhance lymphedema treatment outcomes. A retrospective analysis was performed on 24 patients who underwent LVA for secondary upper extremity lymphedema between June 2020 and August 2022. Patients were categorized into two groups: the ultrasound group, which used a pocket-sized device (Vscan Air), for preoperative vein identification, and a control group that did not. Preoperative lymphatic mapping was performed using indocyanine green lymphography, and suitable veins for anastomosis were identified using ultrasound. Upper extremity lymphedema index and incision length were compared. Participants in the ultrasound group had a shorter average incision length (2.85 ± 0.48 cm) than those in the control group (3.23 ± 0.78 cm, p = 0.038), indicating a more targeted and minimally invasive approach. Although volume reduction rates were not significantly different, the pocket ultrasound device facilitated more precise vein selection, enhancing surgical planning. Pocket-sized ultrasound devices provide a cost-effective and practical solution for vein identification during LVA, particularly in resource-limited settings. While high-frequency ultrasound offers superior resolution, portable devices could become standard tools for lymphatic surgery with continued technological advancement.

Microwave versus Radiofrequency Ablation in Treating Predominantly Solid Benign Thyroid Nodules: A Randomized Controlled Trial.

Background Current guidelines recommend radiofrequency ablation (RFA) as the first-line treatment for benign thyroid nodules. Purpose To compare the efficacy and safety of microwave ablation (MWA) and RFA for the treatment of predominantly solid benign thyroid nodules. Materials and Methods This prospective, randomized, open-label, multicenter study was conducted from August 2019 to February 2023. Participants with nonfunctioning, predominantly solid benign thyroid nodules from five institutions were randomly assigned with a 1:1 ratio to receive MWA or RFA treatment. Participants were followed up for at least 2 years. Primary outcomes were 6-month and 2-year volume reduction rate (VRR) of nodules after ablation. Secondary outcomes included VRR change over time, complications, and technique efficacy (defined as volumetric reduction ≥ 50% of the initial nodule volume). Continuous variables and categorical variables were compared using the t test and the χ2 test or Fisher exact test, respectively. Results This study included 76 participants in the MWA group (mean age, 46 years ± 12 [SD]; 58 female participants) and 76 in the RFA group (mean age, 50 years ± 13; 56 female participants). MWA was noninferior to RFA in terms of 6-month (mean difference, -5.6%; P = .01) and 2-year (-2.4%; P < .001) VRR after ablation. Comparing MWA and RFA, no evidence of a difference was observed for VRR change over time (mean difference from mixed-effects analysis, 6.9% [95% CI: -0.5, 13.9]; P = .73) or technique efficacy (91% vs 86%; P = .40). The most common major complication was voice change, which occurred in 6.6% of participants in the MWA group and 1.3% of participants in the RFA group (P = .21). Conclusion MWA and RFA showed comparable efficacy for treating participants with predominantly solid benign thyroid nodules. However, a larger sample size is needed to demonstrate that safety is comparable between the procedures. ClinicalTrials.gov Identifier: NCT04046354 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by McGahan in this issue.

Ultrasound-guided suction using negative pressure, curettage, and percutaneous drainage to treat rectus sheath hematoma

BackgroundThis study aimed to introduce and evaluate a new treatment method for rectus sheath hematoma: ultrasound-guided suction using negative pressure, curettage, and percutaneous drainage. MethodsThis retrospective study involved five patients with rectus sheath hematoma rectus sheath hematoma who had cesarean sections. For all patients, ultrasound revealed that the maximum diameter of their hematoma exceeded 70 mm. We summarized and analyzed the therapeutic effects of five patients and introduced the procedure, technical points, precautions, advantages, and indications of the procedure. ResultsIn all five patients, hematoma area was significantly reduced as confirmed by ultrasound at follow-up, and all patients’ abdominal pain were significantly relieved. No complications, including bleeding or infection, were detected at both the 2-h postoperative and 3-day follow-up assessments. The hematoma volume reduction rates were 90 %, 67 %, 81 %, 68 %, and 70 % at three days re-examinations, and 99 %, 96 %, 98 %, 98 %, and 90 % at the 30-day follow-up. ConclusionThe removal of rectus sheath hematoma by suction using negative pressure can prevent patients from undergoing abdominal wall exploration, offering a less invasive alternative while potentially achieving comparable therapeutic effect to surgical hematoma removal in certain cases. This treatment method shows potential for clinical application, particularly in relatively young and healthy postpartum women, and is expected to be popularized and applied in clinical practice.

Efficacy and safety of dienogest on ovarian endometrioma

Objective: To observe the effects and safety of dienogest on the volume and symptoms of ovarian endometrioma (OMA). Methods: The clinical data of 75 patients with OMA who underwent treatment with dienogest (2 mg/day) at the First Affiliated Hospital of Nanjing Medical University from July 1st 2020 to March 31st 2024 were retrospectively analysed, mainly comparing the changes in the volume of OMA and the visual analogue scale (VAS) scores of endometriosis-related pain before and after the treatment, as well as observing the changes in the blood biological indicators, liver and kidney function, coagulation function and changes in breast. Results: The median cyst volumes of the OMA patients at 3, 6 and 12 months of dienogest treatment were 13.21 cm3 (volume reduction rate: 36.00%), 8.33 cm3 (volume reduction rate: 56.00%) and 4.10 cm3 (volume reduction rate: 77.62%), respectively, which were all significantly decreased from the pre-treatment period (all P<0.05). The VAS scores of pain of the OMA patients at 3, 6 and 12 months of dienogest treatment all were 0 mm. Blood cancer antigen 125 (CA125) and cancer antigen 19-9 (CA19-9) levels decreased progressively during treatment (all P<0.05). There were no statistical differences in the coagulation indexes, liver and kidney function indexes of the patients during dienogest treatment compared with those before treatment (all P>0.05). During the follow-up period, there were a few patients with changes in the growth sites or lesion category of the breast nodules, but there were no occurrence of breast cancer or precancerous lesions. Conclusion: Dienogest is effective in reducing OMA volume and alleviating endometriosis-related pain with few adverse effects.

A Prospective Clinical Trial of Radiofrequency Ablation in Patients with Low-Risk Unifocal Papillary Thyroid Microcarcinoma Favoring Active Surveillance Over Surgery.

Background: Active surveillance (AS) of papillary thyroid microcarcinomas (PTMC) is emerging as an alternative to immediate surgery. While thermal ablation has also shown promise for low-risk PTMC, it has not been prospectively studied in patients appropriate for AS. This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for tumor control and quality of life (QoL) management in patients with PTMC who favored AS over immediate surgery. Methods: This prospective clinical trial was conducted at a single tertiary referral hospital from 2018 to 2021. Of 227 adult patients aged ≤60 years with low-risk unifocal PTMC favoring AS over immediate surgery, 100 patients underwent RFA for their management. The primary endpoint was the disease progression rate, and secondary endpoints were technical success, volume reduction rate (VRR), complication rates, and QoL. Results: The median age of the study population was 42 years (range, 27-59 years), and 83% (83/100, [CI: 66.1-100]) were female. The median follow-up was 30 months (range, 12-56 months). All 100 patients underwent RFA with technical success. Most of the ablation zones showed continuous volume reduction, and 95.9% (94/98, [CI: 77.5-100.0]) showed complete disappearance at the last follow-up. The median VRR was 100.0% at 1-year follow-up and persisted throughout the last follow-up. The cumulative disease progression rate among 98 patients who underwent at least 1-year follow-up was 3.1% (3/98, [CI: 0.6-9.0]); one patient had lymph node metastasis (treated with surgery), and two patients had new PTMC (1 treated with RFA, 1 ongoing AS). Major complications were not observed. Psychological (baseline vs. last follow-up, 7.3 vs. 8.0, p = 0.002) and social (8.0 vs. 8.7, p = 0.005) QoL scores significantly improved during follow-up without compromising physical QoL (8.6 vs. 8.5, p = 0.99). Conclusions: RFA can be a reasonable strategy for effectively and safely controlling tumors and improving QoL in non-elderly patients with low-risk PTMC appropriate for AS. Clinical Trial registration: This trial is registered with ClinicalTrials.gov: NCT03432299.

Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up.

To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.