Background and Aim
Liver fibrosis and steatosis are important factors affecting chronic hepatitis B (CHB) disease outcome. Multiparametric magnetic resonance (MR) imaging of the liver measures ...fibroinflammation, fat, and iron through iron‐corrected T1 relaxation time (cT1), proton density fat fraction (PDFF), and T2*‐weighted imaging, respectively. We assessed the utility of MR metrics for prognostication in CHB.
Methods
Chronic hepatitis B patients receiving nucleos(t)ide analogs with advanced fibrosis documented by vibration‐controlled transient elastography were recruited. Paired multiparametric MR liver and transient elastography were performed at baseline and after at least 2 years. Adverse outcomes including death, hepatocellular carcinoma (HCC), and liver decompensation were monitored.
Results
One hundred and ninety‐two patients (mean age 60.3 ± 8.5 years; 76.0% male) were recruited. Eight patients (4.2%) developed HCC after 11.6 (8.8–22.8) months, and increased baseline liver iron independently predicted HCC (hazard ratio 2.329 1.030–5.266; P = 0.042). Liver MR metrics were not predictive of death or hepatic decompensation. Among 150 patients with follow‐up liver MR at 30.3 (25.2–35.6) months, longitudinal liver PDFF increase was associated with liver cT1 increase (odds ratio 1.571 1.217–2.029; P = 0.001). Ninety patients received simultaneous multiparametric MR pancreas during the follow‐up MR. Pancreatic PDFF correlated with liver PDFF (r = 0.501, P < 0.001), while pancreatic T1 had no correlation with liver cT1 (r = −0.092, P = 0.479). Pancreatic T1 and PDFF were not associated with adverse outcomes.
Conclusion
Among CHB patients with advanced disease, liver iron level on MR predicts HCC. Multiparametric MR can also simultaneously assess the pancreas and the liver. Multiparametric MR should be further studied as a one‐stop option for monitoring and prognosticating CHB.
Background
Single‐shot diffusion‐weighted imaging (ssDWI) has been shown useful for detecting active bowel inflammation in Crohn's disease (CD) without MRI contrast. However, ssDWI suffers from ...geometric distortion and low spatial resolution.
Purpose
To compare conventional ssDWI with higher‐resolution ssDWI (HR‐ssDWI) and multi‐shot DWI based on multiplexed sensitivity encoding (MUSE‐DWI) for evaluating bowel inflammation in CD, using contrast‐enhanced MR imaging (CE‐MRI) as the reference standard.
Study Type
Prospective.
Subjects
Eighty nine patients with histological diagnosis of CD from previous endoscopy (55 male/34 female, age: 17–69 years).
Field Strength/Sequences
ssDWI (2.7 mm × 2.7 mm), HR‐ssDWI (1.8 mm × 1.8 mm), MUSE‐DWI (1.8 mm × 1.8 mm) based on echo‐planar imaging, T2‐weighted imaging, and CE‐MRI sequences, all at 1.5 T.
Assessment
Five raters independently evaluated the tissue texture conspicuity, geometry accuracy, minimization of artifacts, diagnostic confidence, and overall image quality using 5‐point Likert scales. The diagnostic performance (sensitivity, specificity and accuracy) of each DWI sequences was assessed on per‐bowel‐segment basis.
Statistical Tests
Inter‐rater agreement for qualitative evaluation of each parameter was measured by the intra‐class correlation coefficient (ICC). Paired Wilcoxon signed‐rank tests were performed to evaluate the statistical significance of differences in qualitative scoring between DWI sequences. A P value <0.05 was considered to be statistically significant.
Results
Tissue texture conspicuity, geometric distortions, and overall image quality were significantly better for MUSE‐DWI than for ssDWI and HR‐ssDWI with good agreement among five raters (ICC: 0.70–0.89). HR‐ssDWI showed significantly poorer performance to ssDWI and MUSE‐DWI for all qualitative scores and had the worst diagnostic performance (sensitivity of 57.0% and accuracy of 87.3%, with 36 undiagnosable cases due to severe artifacts). MUSE‐DWI showed significantly higher sensitivity (97.5% vs. 86.1%) and accuracy (98.9% vs. 95.1%) than ssDWI for detecting bowel inflammation.
Data Conclusion
MUSE‐DWI was advantageous in assessing bowel inflammation in CD, resulting in improved spatial resolution and image quality.
Level of Evidence
2
Technical Efficacy Stage
2
Objectives
Assessing the efficacy of single high-intensity focused ultrasound (HIFU) ablation in benign thyroid nodules beyond 12 months.
Methods
One hundred and eight patients underwent single HIFU ...treatment. Extent of nodule shrinkage by volume reduction ratio (VRR) and obstructive symptom score by 0-10 visual analogue scale (VAS) were evaluated for 24 months after treatment. VRR (%) was calculated based on the formula: baseline volume – volume at visit / baseline volume × 100. Binary logistic regression was performed to evaluate factors associated with 24-month treatment success (VRR ≥ 50%).
Results
After treatment, the mean (± SD) VRR at 3, 6, 12 ,18 and 24 months were 51.32 ± 20.71%, 62.99 ± 22.05%, 68.66 ± 18.48%, 69.76 ± 17.88% and 70.41 ± 17.39%, respectively, while the median (IQR) VAS at baseline, 6, 12 and 24 months was gradually lowered from 4.0 (2.0), 2.0 (1.0), 2.0 (1.0) to 1.0 (2.0), respectively. Sixty-three (58.3%) nodules had a further volume reduction (i.e. > 4.5%) from 12 to 24 months, while 22 (20.4%) nodules had a volume increase of > 4.5% from 12 to 24 months. Small pre-ablation nodule volume was a significant determinant for treatment success at 24 months (OR=1.045, 95% CI=1.021–1.092,
p
= 0.038).
Conclusions
A majority of nodules had further volume reduction beyond 12 months after single HIFU ablation, but since one-fifth of nodules had a notable volume increase beyond 12 months, a longer period of surveillance would be necessary. Small pre-ablation nodule volume was a significant factor determining 24-month treatment success.
Key Points
• Small but significant nodule shrinkage continues beyond 12 months after single treatment.
• Obstructive symptom continues to improve beyond 12 months after single treatment
• Smaller-sized nodules have a greater chance of treatment success at 24 months
Objective
High-intensity focused ultrasound (HIFU) ablation is a promising treatment for benign thyroid nodules but single application is less effective in larger-sized nodules. We aimed to assess ...the efficacy and safety of two sequential applications in larger-sized nodules.
Methods
Fifty patients underwent ablation of a large-sized nodule (baseline volume ≥ 20 mL and diameter ≤ 50 mm). Thirty-one (62.0%) patients underwent single application (group I) while 19 (38.0%) underwent two sequential applications (group II). Nodule shrinkage (by volume reduction ratio or VRR), pain scores during and after ablation, and rate of vocal cord palsy (VCP), skin burn, and nausea/vomiting were compared between the two groups.
t
test or the Mann-Whitney
U
test was used for continuous variables while chi-square test was used for categorical variables. To determine factors for VRR, multivariate analysis was done by logistic regression analysis.
Results
Total energy delivered and treatment time were significantly more in group II (
p
< 0.001 and
p
= 0.001, respectively). Total energy per nodule volume (kJ/mL) was also significantly greater in group II (1.01 kJ/mL vs. 0.57 kJ/mL,
p
< 0.001). The 6-month VRR was significantly greater in group II (56.74 ± 11.47% vs. 43.49 ± 12.03%,
p
= 0.004). Pain severity and rates of VCP, skin burn, and nausea/vomiting were comparable between the two groups (
p
> 0.05). Sequential application was an independent determinant of 6-month VRR (OR = 13.936, 95% CI = 1.738–197.399,
p
= 0.036).
Conclusions
Sequential application led to better 6-month treatment efficacy than single application in large-sized nodules. Patients undergoing sequential application are not at greater risks of treatment-related side effects afterwards.
Key Points
• Sequential application produces better 6-month efficacy over single application for large-sized nodules.
• Sequential HIFU application is well-tolerated and safe in patients with large-sized nodules.
• Sequential application takes longer and requires larger amount of pethidine and diazepam.
Background
We aimed to assess the efficacy and safety of second high-intensity focused ultrasound (HIFU) ablation treatment in benign thyroid nodules that had failed to shrink by > 50% 6 months after ...the first treatment.
Methods
Twenty-eight patients who did not achieve 50% volume reduction at 6 months after the first HIFU treatment underwent a second HIFU treatment. Nodule volume was measured on ultrasound at baseline, 3 months and 6 months. Extent of nodule shrinkage (by volume reduction ratio) (VRR) = Baseline volume – volume at 6 months/Baseline volume * 100. Treatment success was defined as VRR > 50%. Obstructive symptom score (by 0–10 visual analogue scale, VAS) was evaluated for 6 months after treatment.
Results
No complications occurred after the second treatment. The mean 6-month VRR was 21.78 ± 16.87% with a median (range) of 16.16 (1.63–54.07)%. At 6 months, only two (7.1%) patients achieved treatment success, while nine (32.1%) patients had VRR < 10%. However, relative to baseline (3.96 ± 1.04), the mean VAS significantly improved at 3 and 6 months (2.96 ± 1.43,
p
<0.001 and 2.58 ± 1.39,
p
<0.001, respectively). There was a significant correlation between VRR and improvement in VAS score at 6 months (
ρ
=0.438,
p
=0.025). Greater nodule volume before the second treatment (OR=1.169, 95% CI=1.004–1.361,
p
=0.045) was a significant factor for greater VRR after the second treatment.
Conclusions
Although subjective obstructive symptoms continued to improve after the second treatment, the actual extent of nodule shrinkage was small. Larger-volume nodules tended to shrink more significantly than smaller-volume nodules in the second treatment.
Key Points
•
Second treatment resulted in small shrinkage in unsatisfactory nodules after first treatment.
• Obstructive symptoms tended to continue to improve after second treatment.
• Larger-size nodules tended to respond better in the second treatment.
Objective
To evaluate the longer-term disease relapse of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation as a treatment for persistent/relapsed Graves’ disease (GD).
Methods
...After ethics approval, consecutive patients with persistent or relapsed GD who underwent bilateral US-guided HIFU ablation from 2016 to 2017 were retrospectively analyzed. Altogether, 75 patients received HIFU ablation of the central portion of the right and left thyroid lobes with areas near the trachea–esophageal groove and common carotid artery un-ablated. They were followed for 24 months or longer. Baseline thyrotropin (TSH), free T4, anti-thyroid autoantibodies, and TSH receptor (TSHR) antibody were checked. Primary outcome was the 24-month relapse rate. Relapse referred to hyperthyroidism (free T4 (FT4) > 23 pmol/L) afterwards. Variables associated with relapse were analyzed by binary logistic regression.
Results
The cohort comprised mostly females (84.0%) with a mean age of 42.05 ± 10.74 years. The 24-month relapse rate was 41.3% with 31 patients suffering a relapse. No patient suffered from hypothyroidism. Three patients (4.0%) suffered from temporary vocal cord palsy but these injuries recovered spontaneously after 2 months. In univariate analysis, higher daily dose of carbimazole (OR = 1.125, 95% CI = 1.023–1.237,
p
= 0.015) and higher baseline TSHR level (OR = 1.085, 95% CI = 1.022–1.152,
p
= 0.007) were significant factors for disease relapse. In the multivariate analysis, higher baseline TSHR level was a significant independent factor for disease relapse within 24 months (OR = 1.079, 95% CI = 1.014–1.148,
p
= 0.016).
Conclusions
US-guided HIFU of the thyroid gland was a safe and relatively efficacious treatment in the longer term for patients with persistent or relapsed GD.
Key Points
•
US-guided HIFU ablation is relatively efficacious in the longer term.
•
US-guided HIFU ablation of the thyroid is safe.
•
Higher TSHR level may lead to higher disease relapse after treatment
.
Objectives
Assessing the efficacy and safety of sequential high-intensity focused ultrasound (HIFU) ablation in a multinodular goitre (MNG) by comparing them with single HIFU ablation.
Methods
One ...hundred and four (84.6%) patients underwent single ablation of a single nodule (group I), while 19 (15.4%) underwent sequential ablation of two relatively-dominant nodules in a MNG (group II). Extent of shrinkage per nodule by volume reduction ratio (VRR), pain scores (by 0-10 visual analogue scale) during and after ablation, and rate of vocal cord palsy (VCP), skin burn and nausea/vomiting were compared between the two groups.
Results
All 19 (100%) sequential ablations completed successfully. The 3- and 6-month VRR of each nodule were comparable between the two groups (
p
> 0.05) and in group II, the 3- and 6-month VRR between the first and second nodules were comparable (
p
= 0.710 and
p
= 0.548, respectively). Pain score was significantly higher in group II in the morning after ablation (2.29 vs 1.15,
p
= 0.047) and nausea/vomiting occurred significantly more frequently in group II (15.8% vs 0.0%,
p
= 0.012). However, VCP and skin burn were comparable (
p
> 0.05).
Conclusions
Sequential ablation had comparable efficacy and safety as single ablation. However, patients undergoing sequential ablation are at higher likelihood of pain in the following morning and nausea/vomiting after ablation.
Key Points
• Sequential HIFU ablation is well-tolerated in patients with two dominant thyroid nodules
• More pain is experienced in the morning following sequential HIFU ablation
• More nausea/vomiting is experienced following sequential HIFU ablation
Objective
To assess severity and factors of pain during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules.
Methods
128 patients who underwent a HIFU ablation for a benign ...thyroid nodule were analysed. All patients received a bolus of intravenous pethidine and diazepam before treatment. After treatment, patients were asked to rate their overall pain experience on a visual analogue scale (0–100) (0 = no pain; 100 = worse possible pain) during treatment, 2 h after treatment and the following morning. Binary logistic regression was performed to evaluate associated factors for pain including patient demographics, nodule size, body mass index (BMI) and treatment parameters.
Results
At T1, median (range) pain score was 65.0 (0.00–100.00). Only 16 (12.5 %) patients had a pain score of zero. In multivariate analysis, only lower BMI (OR 1.265, 95 % CI 1.102–1.452,
p
=0.001) and longer nodule diameter (OR 1.462, 95 % CI 1.071–1.996,
p
=0.017) were independent factors for pain score at T1 ≤ 65.0.
Conclusions
A moderate to severe amount of pain was reported during ablation of benign thyroid nodules in over 50 % of patients. Patients’ BMI and length of nodule diameter were independent variables for pain during HIFU ablation.
Key Points
•
Pain was moderate to severe during HIFU ablation of thyroid nodules.
•
Only one in eight patients reported no pain during ablation.
•
Level of energy per pulse did not affect pain.
•
Patients with lower BMI and larger nodules had less pain.
Objective
To assess whether perithyroidal lignocaine infusion (PLI) could provide additional analgesia in high-intensity focused ultrasound (HIFU) treatment of benign thyroid nodules for patients ...already receiving their usual intravenous doses of Pethidine and Diazemuls.
Methods
Two hundred and five patients who underwent HIFU ablation for a benign thyroid nodule were analyzed. Among them, 104 (50.7%) patients received PLI in addition to their boluses of Pethidine and Diazemuls before treatment (group I), while the rest (
n
= 101, 49.3%) received intravenous Pethidine and Diazemuls only (group II). After treatment, patients were asked to rate their overall pain experience on a visual analogue scale (VAS) (0–100) (0, no pain; 100, worse possible pain) during treatment. Binary logistic regression was performed to evaluate significant determinants for treatment pain including demographics, doses of medications, and treatment parameters.
Results
VAS was significantly lower in group I (51.30 vs. 63.79,
p
= 0.002). In the multivariate analysis, older age at treatment (OR = 1.036, 95%CI = 1.008–1.065,
p
= 0.011), lower BMI (OR = 1.202, 95%CI = 1.083–1.334,
p
= 0.001), higher Diazemuls dose (OR = 1.066, 95%CI = 1.018–1.114,
p
= 0.006), and use of PLI (OR = 2.096, 95%CI = 1.121–3.922,
p
= 0.020) were independent determinants of less treatment pain.
Conclusions
PLI can provide additional analgesia in patients already receiving their usual intravenous doses of Pethidine and Diazemuls during HIFU ablation of benign thyroid nodules. Older age, lower body mass index, and greater Diazemuls (i.e., a sedative) dose are significantly associated with less treatment pain.
Key Points
• PLI provided an additional analgesic effect in HIFU ablation of thyroid nodules.
• Older age and lower BMI were significantly associated with less pain.
• Higher doses of Diazemuls lessened pain during HIFU ablation.
PDF
