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Percutaneous Irreversible Electroporation for Portal Vein Tumor Thrombus: Two-Case Report
S188
Ultrasound in Medicine and Biology
be accumulated to calculate the average points of each animal in each group. The lower point indicates a lower level of lesion. Results: In addition to the normal group of synovial membrane has no significant changes, the other groups of synovial cells have varying degrees of congestion and edema, hyperplasia and inflammatory cell infiltration. The rats in the normal group(5 rats) were scored 0.5060.41, PBS group (10 rats) scored 2.6060.94, triptolide group (9 rats) scored 1.8960.97, betamethasone group (10 rats) scored 1.5060.85 and elephantine group (10 rats) scored 2.3561.43 respectively. The scores of triptolide group and betamethasone group were significantly lower than that of PBS group. There was no significant difference between the triptolide group and the betamethasone group (P. 0.05). At present, the most commonly used drugs clinical application of intra-articular injection of RA is glucocorticoids. Our results showed that triptolide can be injected into the joint cavity for treatment of RA, while etanercept intra-articular injection has no significant effect. Conclusions: Triptolide can be used for the treatment of RA and can achieve a better effect(no significant difference compared to the most commonly used hormone drugs(P ,0.05)), and it can become an alternative drug when glucocorticoids are not applicable.
PPT14-010 Intraoperative Ultrasound During Video-Assisted Thoracic Surgery for Solitary Pulmonary Nodules Wu-Huei Hsu, Chia-Hung Chen, Wei-Chih Liao, Tin-Han Chen, Biing-Ru Wu, Chih-Yen Tu, Te-Chun Hsia Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taiwan Objectives: The aim of our study was to evaluate the role of intraoperative echo in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Methods: Patients with pulmonary nodules not touching the visceral pleura on the computed tomography scan, who were scheduled for VATS wedge resection, were enrolled in this study. The lobe of interest was examined by using finger palpation when possible, and by using the intraoperative ultrasound method. 10-MHz linear probe with a flexible angulating tip attached to an ultrasound (US) processor (Aloka Alpha 10) was introduced through one of the VATS ports. Results: One surgeons performed 153 individual VATS-US procedures during an 24-month period. The mean age of these patients were 54.71 years old and female were predominant (n598, 64.1%). Of these 153 patients, one hundred and two patient was malignancy and the other 51 patients was benign nodule. The lung nodules were palpable by finger in 133 cases (86.9%), and detected by intraoperative ultrasound method in 125 cases (81.7%). In 20 cases with not palpable by fingers, 5 patient was malignancy and 15 patients was benign. In 28 cases with invisible by intraoperative echo, 15 patient was malignancy and 13 patients was benign. Conclusions: Intraoperative echo offers a real-time, simple, and effective technique for localization nonsubpleural pulmonary nodules. This technique is completely safe and without any complications. This technique can be considered as the first-instance localization technique during thoracoscopic resection of pulmonary nodules. PPT14-011 Percutaneous Irreversible Electroporation for Portal Vein Tumor Thrombus: Two-Case Report Weilu Chai, Tianan Jiang, Qiyu Zhao, Guo Tian Department of Ultrasonography, First Affiliated Hospital of Zhejiang University, China Objectives: To explore the efficacy and feasibility of irreversible electroporation (IRE) in local ablation of portal vein tumor thrombus (PVTT). Methods: We conducted a retrospective chart review of two PVTT cases that were ablated under the percutaneous ultrasonography (US) guided
Volume 43, Number S1, 2017 IRE in our center. MRI was performed to evaluate the efficacy of this technology at 3-month follow-up. Results: Two PVTT cases were successfully ablated under the US guided IRE. Case 1 suffered from right posterior portal vein (RPPV) tumor thrombus that was 2.331.0cm. Four paralleled electrodes were placed vertically to the maximum plane of the target lesion. Magnetic resonance image (MRI) obtained after 3 months showed no significant recurrence in ablated RPPV. Case 2 was a 3.731.4-cm PVTT lesion located in the right anterior portal vein. Two paralleled electrodes were inserted along the maximum axis of the target lesion in right-to-left approach. 3-month follow-up MRI showed the ablated lesion within the RAPT was non-enhanced during all the phases. Of these cases, the involved portal vein structures were not damaged. Conclusions: Here we introduced a feasible method for PVTT local ablation. As a potential alternative to conventional thermal ablation, IRE may effectively reduce the disease burden in the PVTT cases. PPT14-012 Percutaneous Laser Ablation of Unresectable Metastatic Lesions in Retroperitoneal Regions: A Series of 4 Cases Guo Tian, Tianan Jiang, Qiyu Zhao, Weilu Chai Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Objectives: Metastasis in retroperitoneal lymph nodes is one of the signs of advanced stage or terminal stage of malignancy. We performed a trial to assess the safety and efficacy of ultrasonography (US)-guided local neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation for metastatic lymph nodes in the retroperitoneal region. Methods: We evaluated 4 cases of retroperitoneal metastatic lymph nodes treated using US-guided Nd:YAG laser ablation. At first, a plane-cut optic fiber (300 mm in diameter) along with the sheath of a 21-G needle was advanced with a 10-mm bared fiber into the lesions. Then laser ablation under ultrasonographic guidance was performed by a Nd:YAG laser-beam fiber (EchoLaser X4, ESAOTE, Italy) at a wavelength of 1064 nm. The output power of laser was 5 Wand the time was approximately 5-6 minutes. Power and energy were selected based on previous experience. Immediately after laser ablation, the entire area without enhancement under CEUS was defined as success. If still enhanced in the target lesion, it was regarded as residual area. Supplementary energy was applied to destroy an area larger than the lesional volume. The selective number of fibers was based on the size of the lesion. The tumor size and location near organs and vascular structures were evaluated using computed tomography (CT) or magnetic resonance image (MRI) and US every three months. Preoperative and postoperative tumor markers of Carcinoembryonic Antigen (CEA), Alpha Fetoprotein (AFP) and Carbohydrate Antigen 19-9 (CA19-9) levels were measured. Results: In our study, The total energy was between 2600 J and 3600 J. During laser energy application, ultrasound images showed a hyperechoic area around the fiber tip. It was obtained after a delay about 80-120s. Then the hyperechoic region expanded slowly forward. When the procedure finished, the whole lesion was covered with hyperechoic zone. There were no major complications detected in the patients during the laser ablation. All the pre-admission symptoms like abdominal pain, weakness have relieved. At the 3-month follow-up, all lesions were nearly completely ablated with mild discomfort, including pain and fever. Conclusions: Percutaneous laser ablation could be a theoretically promising approach for retroperitoneal metastatic lesions. Large-scale studies on laser ablation for metastatic retroperitoneal lymph nodes are necessary to confirm our findings. PPT14-013 Real-Time Overlapping Fusion Imaging during Radiofrequency Ablation Zone on 3D Ultrasound Images with Automatic Expectation of Posterior Margin Sun Young Lee,1 Dong Il Choi,2 Min Woo Lee2
Ultrasound in Medicine and Biology
be accumulated to calculate the average points of each animal in each group. The lower point indicates a lower level of lesion. Results: In addition to the normal group of synovial membrane has no significant changes, the other groups of synovial cells have varying degrees of congestion and edema, hyperplasia and inflammatory cell infiltration. The rats in the normal group(5 rats) were scored 0.5060.41, PBS group (10 rats) scored 2.6060.94, triptolide group (9 rats) scored 1.8960.97, betamethasone group (10 rats) scored 1.5060.85 and elephantine group (10 rats) scored 2.3561.43 respectively. The scores of triptolide group and betamethasone group were significantly lower than that of PBS group. There was no significant difference between the triptolide group and the betamethasone group (P. 0.05). At present, the most commonly used drugs clinical application of intra-articular injection of RA is glucocorticoids. Our results showed that triptolide can be injected into the joint cavity for treatment of RA, while etanercept intra-articular injection has no significant effect. Conclusions: Triptolide can be used for the treatment of RA and can achieve a better effect(no significant difference compared to the most commonly used hormone drugs(P ,0.05)), and it can become an alternative drug when glucocorticoids are not applicable.
PPT14-010 Intraoperative Ultrasound During Video-Assisted Thoracic Surgery for Solitary Pulmonary Nodules Wu-Huei Hsu, Chia-Hung Chen, Wei-Chih Liao, Tin-Han Chen, Biing-Ru Wu, Chih-Yen Tu, Te-Chun Hsia Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taiwan Objectives: The aim of our study was to evaluate the role of intraoperative echo in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Methods: Patients with pulmonary nodules not touching the visceral pleura on the computed tomography scan, who were scheduled for VATS wedge resection, were enrolled in this study. The lobe of interest was examined by using finger palpation when possible, and by using the intraoperative ultrasound method. 10-MHz linear probe with a flexible angulating tip attached to an ultrasound (US) processor (Aloka Alpha 10) was introduced through one of the VATS ports. Results: One surgeons performed 153 individual VATS-US procedures during an 24-month period. The mean age of these patients were 54.71 years old and female were predominant (n598, 64.1%). Of these 153 patients, one hundred and two patient was malignancy and the other 51 patients was benign nodule. The lung nodules were palpable by finger in 133 cases (86.9%), and detected by intraoperative ultrasound method in 125 cases (81.7%). In 20 cases with not palpable by fingers, 5 patient was malignancy and 15 patients was benign. In 28 cases with invisible by intraoperative echo, 15 patient was malignancy and 13 patients was benign. Conclusions: Intraoperative echo offers a real-time, simple, and effective technique for localization nonsubpleural pulmonary nodules. This technique is completely safe and without any complications. This technique can be considered as the first-instance localization technique during thoracoscopic resection of pulmonary nodules. PPT14-011 Percutaneous Irreversible Electroporation for Portal Vein Tumor Thrombus: Two-Case Report Weilu Chai, Tianan Jiang, Qiyu Zhao, Guo Tian Department of Ultrasonography, First Affiliated Hospital of Zhejiang University, China Objectives: To explore the efficacy and feasibility of irreversible electroporation (IRE) in local ablation of portal vein tumor thrombus (PVTT). Methods: We conducted a retrospective chart review of two PVTT cases that were ablated under the percutaneous ultrasonography (US) guided
Volume 43, Number S1, 2017 IRE in our center. MRI was performed to evaluate the efficacy of this technology at 3-month follow-up. Results: Two PVTT cases were successfully ablated under the US guided IRE. Case 1 suffered from right posterior portal vein (RPPV) tumor thrombus that was 2.331.0cm. Four paralleled electrodes were placed vertically to the maximum plane of the target lesion. Magnetic resonance image (MRI) obtained after 3 months showed no significant recurrence in ablated RPPV. Case 2 was a 3.731.4-cm PVTT lesion located in the right anterior portal vein. Two paralleled electrodes were inserted along the maximum axis of the target lesion in right-to-left approach. 3-month follow-up MRI showed the ablated lesion within the RAPT was non-enhanced during all the phases. Of these cases, the involved portal vein structures were not damaged. Conclusions: Here we introduced a feasible method for PVTT local ablation. As a potential alternative to conventional thermal ablation, IRE may effectively reduce the disease burden in the PVTT cases. PPT14-012 Percutaneous Laser Ablation of Unresectable Metastatic Lesions in Retroperitoneal Regions: A Series of 4 Cases Guo Tian, Tianan Jiang, Qiyu Zhao, Weilu Chai Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Objectives: Metastasis in retroperitoneal lymph nodes is one of the signs of advanced stage or terminal stage of malignancy. We performed a trial to assess the safety and efficacy of ultrasonography (US)-guided local neodymium-doped yttrium aluminum garnet (Nd:YAG) laser ablation for metastatic lymph nodes in the retroperitoneal region. Methods: We evaluated 4 cases of retroperitoneal metastatic lymph nodes treated using US-guided Nd:YAG laser ablation. At first, a plane-cut optic fiber (300 mm in diameter) along with the sheath of a 21-G needle was advanced with a 10-mm bared fiber into the lesions. Then laser ablation under ultrasonographic guidance was performed by a Nd:YAG laser-beam fiber (EchoLaser X4, ESAOTE, Italy) at a wavelength of 1064 nm. The output power of laser was 5 Wand the time was approximately 5-6 minutes. Power and energy were selected based on previous experience. Immediately after laser ablation, the entire area without enhancement under CEUS was defined as success. If still enhanced in the target lesion, it was regarded as residual area. Supplementary energy was applied to destroy an area larger than the lesional volume. The selective number of fibers was based on the size of the lesion. The tumor size and location near organs and vascular structures were evaluated using computed tomography (CT) or magnetic resonance image (MRI) and US every three months. Preoperative and postoperative tumor markers of Carcinoembryonic Antigen (CEA), Alpha Fetoprotein (AFP) and Carbohydrate Antigen 19-9 (CA19-9) levels were measured. Results: In our study, The total energy was between 2600 J and 3600 J. During laser energy application, ultrasound images showed a hyperechoic area around the fiber tip. It was obtained after a delay about 80-120s. Then the hyperechoic region expanded slowly forward. When the procedure finished, the whole lesion was covered with hyperechoic zone. There were no major complications detected in the patients during the laser ablation. All the pre-admission symptoms like abdominal pain, weakness have relieved. At the 3-month follow-up, all lesions were nearly completely ablated with mild discomfort, including pain and fever. Conclusions: Percutaneous laser ablation could be a theoretically promising approach for retroperitoneal metastatic lesions. Large-scale studies on laser ablation for metastatic retroperitoneal lymph nodes are necessary to confirm our findings. PPT14-013 Real-Time Overlapping Fusion Imaging during Radiofrequency Ablation Zone on 3D Ultrasound Images with Automatic Expectation of Posterior Margin Sun Young Lee,1 Dong Il Choi,2 Min Woo Lee2