Zhi Li

Background: Transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKIs) and programmed cell death protein-1 (PD-1) inhibitors is increasingly used for unresectable hepatocellular carcinoma (uHCC). This study evaluated whether the depth of early alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) response was associated with treatment outcomes in this setting. Methods: This single-center retrospective cohort study included consecutive patients with uHCC receiving TACE combined with TKIs and PD-1 inhibitors. Patients with baseline AFP ≥100 μg/L or DCP ≥100 mAU/mL were included in the corresponding biomarker-evaluable cohorts; patients with elevation of both markers contributed to both analyses. Week-8 biomarker response was categorized as deep (>80% decrease), intermediate (20–80% decrease), or limited (Results: Among 98 patients, 64 were included in the AFP-evaluable cohort and 87 in the DCP-evaluable cohort, with 53 included in both. ORR increased with response depth in both cohorts (AFP: 85.7%, 53.3% and 21.4%; DCP: 84.1%, 52.4% and 4.5% for deep, intermediate, and limited responses, respectively; both PConclusions: Week-8 AFP and DCP response depth was associated with radiological response and survival in biomarker-evaluable patients with uHCC receiving TACE, TKIs and PD-1 inhibitors. These biomarkers may provide complementary on-treatment information alongside imaging, pending prospective validation.

Background: Hepatitis B virus (HBV) has historically been the primary cause of hepatocellular carcinoma (HCC) in China; however, recent etiological shifts due to HBV vaccination and lifestyle changes have influenced HCC prevention and management. Given the scarcity of long-term data, this study examines the etiological evolution of HCC from 2009 to 2023 using data from the interventional radiology department of a tertiary hospital to reflect broader national epidemiological trends. Methods: A retrospective analysis was conducted on 1,233 HCC patients diagnosed between 2009 and 2023. Patients were categorized based on viral serological status into HBV-related HCC, non-HBV non-HCV HCC (NBNC-HCC), and HCV-related HCC. Temporal, gender-specific, and age-specific distributions were analyzed. Results: Overall, HBV-HCC accounted for 75.3% (928/1,233) of cases, though its proportion exhibited a significant downward trend, declining from 91.0% in 2009 to 57.3% in 2022. Notably, in the most recent 5-year period (2019–2023), HBV-HCC decreased further to an average of 65.7%. Conversely, the proportion of NBNC-HCC showed a consistent upward trajectory. The proportion of NBNC-HCC was significantly higher in female patients (35.7%) compared to males (20.0%). In terms of age distribution, HBV-HCC remained dominant among younger patients (65 years, 49.7%). Conclusions: The etiology of HCC in China is transitioning from HBV predominance toward a coexistence of HBV-related and rising NBNC-HCC, although HBV continues to dominate among younger patients.

Purpose: To analyze the efficacy and safety of the combination of transarterial chemoembolization (TACE) with percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) at high-risk areas. Materials and Methods: Data from cases involving TACE combined with PEI for HCC treatment in high-risk regions were analyzed from January 2016 to December 2023 at three medical centers. High-risk areas were defined as those less than 10 mm from the diaphragm, gallbladder, gastrointestinal tract, or secondary branches of the portal vein or bile duct. The guidance modalities for PEI were computed tomograph (CT) and cone beam computed tomograph (CBCT). Each lesion received only one session of TACE combined with PEI. Treatment efficacy was assessed by complete ablation rate of target lesions at the 2-month follow-up. Factors affecting the efficacy were determined by binary logistic regression analysis. The difference in efficacy between CT-guided and CBCT-guided PEI was analyzed by Chi-square test. Results: About 62 patients with 67 target lesions were included in the analysis. The overall complete ablation rate lesion-based was 80.6% (54/67). Lesion diameter was significantly associated with the probability of achieving complete ablation (OR = 6.89, 95% CI: 1.57–30.234, P = 0.011). There was no significant difference in the complete ablation rates between CT- and CBCT-guided approaches (83.3% vs. 80%, P = 0.867). No severe complications occurred during treatment or follow-up. Conclusion: The combination of TACE with a single PEI proves to be a safe and effective treatment for HCC in high-risk areas. There was no difference between CBCT-guided and CT-guided outcomes.

Cone-beam computed tomography (CBCT) is a widely used imaging technique in interventional radiology. Although CBCT offers great advantages in terms of improving comprehension of complex angioarchitectures and guiding therapeutic decisions, its additional degree of radiation exposure has also aroused considerable concern. In this study, we aimed to assess radiation exposure and its influential factors in patients undergoing CBCT scans of the head and abdomen during interventional procedures. A total of 752 patients were included in this retrospective study. Dose area product (DAP) and reference air kerma (RAK) were used as measures of patient dose. The results showed that the median values of DAP were 53.8 (50.5–64.4) Gy⋅cm² for head CBCT and 47.4 (39.6–54.3) Gy⋅cm² for that of the abdomen. Male gender and body mass index (BMI) were characterized by increased DAP and RAK values in both head and abdominal CBCT scans. Larger FOV size was associated with a higher DAP but a lower RAK value, especially in head CBCT scans. Exposure parameters under automatic exposure control (AEC) also varied according to patient BMI and gender. In conclusion, the patients received slightly higher radiation doses from head CBCT scans than from those applied to the abdomen. BMI, gender, and FOV size were the key factors that influenced the radiation dose administered to the patients during CBCT scans. Our results may help to define and minimize patients’ exposure to radiation.

Purpose To elucidate incidence rates of vascular lake phenomenon (VLP) in hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), hepatic metastasis (HMT) on transarterial angiography before chemoembolization, and to identity CT features predictive for it. Materials and Methods A comprehensive evaluation involved 665 subjects for incidence analysis, comprising 527 of HCC, 33 of ICC and 105 of HMT. VLP was characterized as intratumoral contrast material pool persisting late into venous phase. Incidences were cataloged on both super-selective and common hepatic artery angiography. For CT features analysis, a subset of 182 cases were analyzed. Enhancement ratio served as an index for comparative analysis of nodule enhancement degrees. Results In HCC, incidence of VLP ascertained via super-selective angiography was 13.5%, whereas it as 7.8% on common hepatic artery angiography. Remarkably, no incidences of VLP were recorded in either ICC or HMT cases. On pre-interventional CT, the prevalence of pseudocapsule was statistically greater in VLP group than Non-VLP group (66.6% vs. 37.6%, P = 0.015). The Houndsfield units (HU) of tumors in plain scan (P = 0.007), arterial phase (P = 0.001), venous phase (P = 0.041), arterial phase enhancement ratio (P < 0.001) were statistically higher in VLP group compared to Non-VLP group. Arterial phase enhancement ratio (P = 0.025), presence of pseudocapsule (P = 0.001), HU of tumor in plain scan (P = 0.035) serve as independent risk factors for VLP manifestation. Conclusion VLP is a distinct angiography phenomenon uniquely associated with HCC. High arterial phase enhancement ratio, presence of pseudocapsule, high HU of tumor in plain scan are independent risk factors for VLP.

Purpose To evaluate the efficiency of radiomics signatures in predicting the response of transarterial chemoembolization (TACE) therapy based on preoperative contrast-enhanced computed tomography (CECT). Materials This study consisted of 111 patients with intermediate-stage hepatocellular carcinoma who underwent CECT at both the arterial phase (AP) and venous phase (VP) before and after TACE. According to mRECIST 1.1, patients were divided into an objective-response group (n = 38) and a non-response group (n = 73). Among them, 79 patients were assigned as the training dataset, and the remaining 32 cases were assigned as the test dataset. Methods Radiomics features were extracted from CECT images. Two feature ranking methods and three classifiers were used to find the best single-phase radiomics signatures for both AP and VP on the training set. Meanwhile, multi-phase radiomics signatures were built upon integration of images from two CECT phases by decision-level fusion and feature-level fusion. Finally, multivariable logistic regression was used to develop a nomogram by combining radiomics signatures and clinic-radiologic characteristics. The prediction performance was evaluated by AUC on the test dataset. Results The multi-phase radiomics signature (AUC = 0.883) performed better in predicting TACE therapy response compared to the best single-phase radiomics signature (AUC = 0.861). The nomogram (AUC = 0.913) showed better performance than any radiomics signatures. Conclusion The radiomics signatures and nomogram were developed and validated for predicting responses to TACE therapy, and the radiomics model may play a positive role in identifying patients who may benefit from TACE therapy in clinical practice.

Hepatocellular carcinoma (HCC) is among the primary causes of cancer deaths globally. Despite efforts to understand liver cancer, its high morbidity and mortality remain high. Herein, we constructed two nomograms based on competing endogenous RNA (ceRNA) networks and invading immune cells to describe the molecular mechanisms along with the clinical prognosis of HCC patients. RNA maps of tumors and normal samples were downloaded from The Cancer Genome Atlas database. HTseq counts and fragments per megapons per thousand bases were read from 421 samples, including 371 tumor samples and 50 normal samples. We established a ceRNA network based on differential gene expression in normal versus tumor subjects. CIBERSORT was employed to differentiate 22 immune cell types according to tumor transcriptomes. Kaplan–Meier along with Cox proportional hazard analyses were employed to determine the prognosis-linked factors. Nomograms were constructed based on prognostic immune cells and ceRNAs. We employed Receiver operating characteristic (ROC) and calibration curve analyses to estimate these nomogram. The difference analysis found 2028 messenger RNAs (mRNAs), 128 micro RNAs (miRNAs), and 136 long non-coding RNAs (lncRNAs) to be significantly differentially expressed in tumor samples relative to normal samples. We set up a ceRNA network containing 21 protein-coding mRNAs, 12 miRNAs, and 3 lncRNAs. In Kaplan–Meier analysis, 21 of the 36 ceRNAs were considered significant. Of the 22 cell types, resting dendritic cell levels were markedly different in tumor samples versus normal controls. Calibration and ROC curve analysis of the ceRNA network, as well as immune infiltration of tumor showed restful accuracy (3-year survival area under curve (AUC): 0.691, 5-year survival AUC: 0.700; 3-year survival AUC: 0.674, 5-year survival AUC: 0.694). Our data suggest that Tregs, CD4 T cells, mast cells, SNHG1, HMMR and hsa-miR-421 are associated with HCC based on ceRNA immune cells co-expression patterns. On the basis of ceRNA network modeling and immune cell infiltration analysis, our study offers an effective bioinformatics strategy for studying HCC molecular mechanisms and prognosis.

μg/L to normal range. In addition, we reviewed 11 similar case reports published in recent 5 years. We find that the interval from diagnosis to the recognition of SR is very short (4 m, 1–14 m). Therefore, we speculate the mechanism of SR should be a severe systemic reaction, and immune activation is the most likely conjecture....

Aland White rabbits were used to establish a VX2 liver tumor model. Hepatic artery angiography and embolization were performed 3 weeks after inoculation. The rabbits were restrained in supine position under anesthesia. Intra-arterial access was accomplished with percutaneous Seldinger technique through the auricular artery using a PICC device. The hepatic artery catheterization was performed with a microcatheter and guide wire. The rate of technical success and procedure time was investigated. Results: Two rabbits failed initial percutaneous transauricular arterial access, with success in a contralateral attempt. Thus, percutaneous transauricular arterial access was achieved in 10 of 12 auricular arteries, with a technical success rate of 83.3%. The time needed to obtain intra-auricular access was 7.2 ± 3.1 min. Hepatic artery catheterization, angiography, and embolization were accomplished through the auricular approach in all 10 rabbits. Conclusion: Arterial access in rabbits can be achieved through the auricular artery. Hepatic artery catheterization, angiography, and embolization can be performed through auricular arterial access....