The aim of this study was to investigate the use of time to maximum enhancement (t(max)) for each voxel in contrast-enhanced MRI (CE-MRI) as a non-invasive tool to determine areas of necrosis following treatment of liver tumours with high-intensity focused ultrasound (HIFU) and, having established the utility of t(max) maps, to develop a three-dimensional (3-D) representation to display this information concisely. 3-D T(1) weighted fast spoiled gradient echo images of the liver were acquired before and after administration of contrast agent. The CE-MR images were aligned to the pre-contrast volume and an estimate of t(max) was obtained for each voxel. Such pre- and post-contrast image sets were acquired before and after ablation. The t(max) maps before and after HIFU treatment were correlated with the procedure notes, radiological reports and gross histological specimen. Finally, 3-D t(max) maps of the whole liver were reconstructed to show all areas of abnormal tissue perfusion. Normal, healthy liver tissue uniformly enhances maximally after approximately 1 min. The computed t(max) maps accurately delineated areas of abnormal contrast agent uptake, corresponding to tumour deposits. Changes in t(max) and non-enhancing voxels after treatment correlate well with volumes targeted during ablation and the necrotic regions seen on gross histological specimens. Alignment of the contrast-enhanced images with the pre-contrast volume greatly improved the conspicuity of the t(max) maps. We conclude that t(max) maps and their 3-D views can be used as a non-invasive tool to assess and potentially to quantify the success of HIFU ablation, and concisely represent the large number of CE-MRI data.

Cancer therapies usually depend on cross-sectional imaging for the assessment of treatment response. This study was designed to evaluate the ability of MRI to predict zones of necrosis following the use of high-intensity focused ultrasound (HIFU) to treat liver metastases. Patients with liver metastases, who had been scheduled for elective surgical resection of their tumours, were recruited to this non-randomized Phase II study. In each case, a proportion of an index liver tumour target was ablated. The response to HIFU was assessed after 12 days using contrast-enhanced MRI and compared directly with histological analysis at the time of surgery. Eight patients were treated, of whom six were subsequently assessed with both MRI and histology. There were no major complications. MRI predicted complete ablation in three cases. In each case, histological analysis confirmed complete ablation. In one case, the region of ablation observed on MRI appeared smaller than predicted at the time of HIFU, but histology revealed complete ablation of the target region. The predominant characteristic of HIFU-ablated tissue was coagulative necrosis but heat fixation was evident in some areas. Heat-fixed cells appeared normal under haematoxylin and eosin staining, indicating that this is unreliable as an indicator of HIFU-induced cell death. This study demonstrates that HIFU is capable of achieving selective ablation of pre-defined regions of liver tumour targets, and that MRI evidence of complete ablation of the target region can be taken to infer histological success.

Human immunodeficiency virus (HIV) infection, haematological malignancy, and immunosuppression for transplantation and autoimmune disorders have led to a large increase in immunocompromised patients. Neck masses are relatively common in this patient group and include both opportunistic and severe manifestations of common infections, benign hyperplasia, and primary or secondary malignancies. Although biopsy may be necessary for definitive diagnosis, features on cross-sectional imaging may suggest a specific diagnosis or limit the differential diagnosis and facilitate optimal patient management. This article will review critical aspects of neck anatomy, illustrate the spectrum of imaging features, and discuss the interpretative pearls and pitfalls when evaluating neck masses in immunocompromised patients.

14645 Background: High-intensity focused ultrasound (HIFU) provides a potential non-invasive alternative to conventional therapies. We have been using the extracorporeal ultrasound-guided Model-JC Tumor Therapy System (HAIFU Technology Company, China) in clinical trials to evaluate the safety and feasibility of treating small renal tumours. Methods: Patients with renal tumours less than 4cm diameter and unsuitable for surgery were treated with HIFU were enrolled into this phase II prospective trial. Treatment was delivered under general anaesthesia in a single session using the Model-JC Tumor Therapy System. Magnetic resonance imaging (MRI) 12 days after treatment provided an initial assessment of response (technical success). Patients are followed-up with further MR imaging at 6 months and one year to gauge technique effectiveness. A total of 14 patients will be included in the trial. Results: Eight patients with kidney tumours have been treated to date. All eight have had pre- and 12-day post-treatment MR imaging. One patient was not included in the analysis as treatment was suspended due bowel interposition in the treatment field during therapy. MRI changes suggestive of kidney tumour response have been seen in 4/7 (57%) cases. Complete ablation has been seen in two cases and partial ablation in two cases. One patient remains disease free 12 months after HIFU. Mild transient discomfort was reported by 4/8 patients (50%), and moderate discomfort in 3/8 (38%) but more severe pain needing opiate analgesia has not been encountered in this series. Minor skin toxicity (1mm blister at the treatment site) was seen in two patients. All patients were discharged the day after the procedure. There have been no adverse effects on renal, haematological or hepatic function. Conclusions: Extracorporeal HIFU has the ability to completely ablate small renal tumours. Our early clinical experience suggests that HIFU treatment of kidney tumours is safe and extremely well tolerated. The reasons for the variability in observed response remain obscure, and reliability of tumour ablation will need to improve before extracorporeal HIFU can be proposed for wider clinical use. [Table: see text]

High-intensity focused ultrasound (HIFU) provides a potential non-invasive alternative to conventional therapies. We have been using the extracorporeal ultrasound-guided Model-JC Tumor Therapy System (HAIFU™ Technology Company, China) in clinical trials to evaluate the safety and feasibility of treating small renal tumours.

High-intensity focused ultrasound (HIFU) provides a potentially non-invasive alternative to conventional therapies. We have been using the extracorporeal ultrasound-guided Model-JC Tumor Therapy System (HAIFU (TM) Technology Co, China) in clinical trials to evaluate the safety and feasibility of treating renal and liver tumours. 30 patients have been treated (22 liver and 8 kidney tumours), all of whom were available for adverse event reporting. Of the 22 liver tumours, 20 are evaluable for response to treatment; 14 were followed up with magnetic resonance imaging (MRI) alone, and 6 with both MRI and histological resection. Evidence of ablation was seen in 20/20 (100%) cases radiologically, and 6/6 (100%) cases histologically. Of the 8 kidney tumours treated, 7 are evaluable; 2 were followed up with MRI alone, and 5 with both MRI and histological resection. Evidence of ablation was seen in 4/7 (57%) radiologically and 1/5 (20%) histologically. Mild, moderate or severe transient pain was reported by 16 (53%), 7 (23%) and 1 (3%) patients, respectively. Superficial skin toxicity was seen in 7 patients (23%). Renal function was unaffected, and all patients were fit for discharge from hospital the day after treatment. Early results show that this technique is feasible, and carries a low morbidity.

The disorder usuallypresents with chronic localized back pain often ofseveral months’ duration. We report an unusualcase in which a non-obese person, without any ofthe above risk factors, presented acutely withsevere back pain following a lumbar puncture forsuspected subarachnoid haemorrhage. The symp-toms were subsequently found to be due to spinalepidural lipomatosis. A brief review of the relevantliterature is also presented.

You have accessJournal of UrologyPodium, Tuesday, May 24, 2005, 3:30 - 5:30 pm1 Apr 20051400: Early Clinical Experience Using High-Intensity Focused Ultrasound for the Treatment of Renal Tumours James E. Kennedy, Rowland O. Illing, Feng Wu, Gail R. ter Haar, Rachel R. Phillips, Andrew S. Protheroe, and David W. Cranston James E. KennedyJames E. Kennedy More articles by this author , Rowland O. IllingRowland O. Illing More articles by this author , Feng WuFeng Wu More articles by this author , Gail R. ter HaarGail R. ter Haar More articles by this author , Rachel R. PhillipsRachel R. Phillips More articles by this author , Andrew S. ProtheroeAndrew S. Protheroe More articles by this author , and David W. CranstonDavid W. Cranston More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35534-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1400: Early Clinical Experience Using High-Intensity Focused Ultrasound for the Treatment of Renal Tumours." The Journal of Urology, 173(4S), pp. 379–380 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 379-380 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information James E. Kennedy More articles by this author Rowland O. Illing More articles by this author Feng Wu More articles by this author Gail R. ter Haar More articles by this author Rachel R. Phillips More articles by this author Andrew S. Protheroe More articles by this author David W. Cranston More articles by this author Expand All Advertisement PDF downloadLoading ...

Angiomyolipomas (AMLs) are benign tumours containing smooth muscle, fat and abnormal blood vessels. They have recently been recognized as clonal neoplasms rather than hamartomas, with a significant proportion containing clonal chromosomal aberrations. An epithelioid variant of AML has been identified. The majority of conventional and epithelioid AMLs have an entirely benign course, although there is a risk of catastrophic haemorrhage. However, several cases of AMLs with malignant potential have been reported. The first described case was a patient with sarcomatous degeneration of a renal AML with pulmonary metastases. The tumour cells in such cases stain strongly for melanoma-associated markers, and are thought to be derived from perivascular epithelioid cells (PECs). Malignant epithelioid AML arising in the kidney is a distinct disease entity, separate from renal cell carcinoma (RCC). We report on a case of a patient with a malignant epithelioid AML of the kidney with an adjacent conventional AML. The ultrasound and computed tomography (CT) appearances of the tumour are described. The patient also had multiple hepatic lesions, with the typical imaging characteristics of haemangiomas.