Experimental Studies and Clinical Experiences on Treatment of Secondary Hypersplenism with Extracorporeal High-Intensity Focused Ultrasound

Shi, Bing; Zhu, Hui; Liu, Yongjun; Lin, Li; Chen, Jin; Ran, Lifeng; Zhou, Kun; Yang, Wei; Wang, Zhibiao; Mei, Zhechuan

doi:10.1016/j.ultrasmedbio.2012.07.010

Cited by 7 publications

(10 citation statements)

References 27 publications

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“…They also reported no deleterious effects from applying high‐intensity focused ultrasound to the spleen, which was consistent with results of high‐intensity focused ultrasound treatment in other organs 7 – 9 . A previous experimental study showed that high‐intensity focused ultrasound is feasible and effective for splenomegaly and hypersplenism 10 . However, from the literature, it is noted that no study of high‐intensity focused ultrasound treatment of both the liver and spleen has been reported before.…”

supporting

confidence: 76%

“…[7][8][9] A previous experimental study showed that high-intensity focused ultrasound is feasible and effective for splenomegaly and hypersplenism. 10 However, from the literature, it is noted that no study of high-intensity focused ultrasound treatment of both the liver and spleen has been reported before. This study evaluated whether patients with hepatocellular carcinoma and hypersplenism who undergo high-intensity focused ultrasound ablation benefited in terms of their prognosis and quality of life.…”

mentioning

confidence: 99%

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High‐Intensity Focused Ultrasound Ablation for Treatment of Hepatocellular Carcinoma and Hypersplenism

Zhu

Mei

Chen

et al. 2013

J of Ultrasound Medicine

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The purpose of this work was to preliminarily investigate the efficacy and safety of high-intensity focused ultrasound treatment of hepatocellular carcinoma and hypersplenism. Nine patients with hepatocellular carcinoma complicated by hypersplenism (5 male and 4 female; median age, 56 years; range, 51-66 years) were treated with ultrasound-guided high-intensity focused ultrasound. Complications were recorded. Laboratory examination and magnetic resonance imaging were used to evaluate the efficacy. After high-intensity focused ultrasound treatment, mean spleen ablation ± SD of 28.76% ± 6.1% was discovered; meanwhile, the white blood cell count, platelet count, and liver function of the patients were substantially improved during the follow-up period. In addition, symptoms such as epistaxis and gingival bleeding were ameliorated or even eliminated, and the quality of life was improved. Follow-up imaging showed a nonperfused volume in the spleen and an absence of a tumor blood supply at the treated lesions in the liver. For the first time to our knowledge, high-intensity focused ultrasound ablation was used to treat hepatocellular carcinoma complicated by hypersplenism. High-intensity focused ultrasound may be an effective and safe alternative for treatment of hepatocellular carcinoma complicated by hypersplenism, but further studies are necessary to clarify the mechanisms.

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confidence: 76%

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confidence: 99%

High‐Intensity Focused Ultrasound Ablation for Treatment of Hepatocellular Carcinoma and Hypersplenism

Zhu

Mei

Chen

et al. 2013

J of Ultrasound Medicine

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“…These results were consistent with the pathological results. 5,27 The results may explain that the coagulative necrosis in spleen parenchyma that was caused by HIFU is just like PSE, which may impair the splenic ability to phagocytize blood cells, weaken the function and capacity of the spleen and produce the effect of splenectomy. The thermal effect induced by HIFU ablation leads to the temperature of the splenic increasing to 65-100°C within seconds, resulting in coagulation necrosis of the tissue and the occlusion of sinusoids and small vessels.…”

Section: Discussionmentioning

confidence: 99%

“…7,21,22 Another study has shown that HIFU is feasible and effective in the treatment of experimental splenomegaly and hypersplenism. 5 We reported that HIFU may be an effective and safe alternative for treatment of HCC that is complicated by hypersplenism, 23 However, no clinical results of HIFU for secondary hypersplenism have been reported. Because of the particularities of secondary hypersplenism, such as abundant blood sinus and vessels in spleen tissues, hyperkinesis of portal vein, fragile spleen tissues and poor liver function, leucopenia and/or thrombocytopaenia and depressed immune function, it is important to investigate the safety and efficiency of HIFU treatment for patients with secondary hypersplenism.…”

Section: Discussionmentioning

confidence: 99%

“…An experimental study on HIFU ablation of the porcine spleen for the treatment of hypersplenism has also shown that HIFU is feasible and effective in treating animal splenomegaly and hypersplenism. 5 However, to the best of our knowledge, no clinical study on HIFU ablation of secondary hypersplenism has been reported before. In this present study, patients with secondary hypersplenism were treated by splenic HIFU ablation.…”

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confidence: 96%

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High-intensity focused ultrasound ablation: an effective and safe treatment for secondary hypersplenism

Zhu¹,

Mei²,

L³

et al. 2014

BJR

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Objective: Hypersplenism is a common disease. The conventional treatment is splenectomy and partial splenic embolization; however, both of them have high complication rates and technical defects. Therefore, safer and more effective techniques should be considered for the treatment of hypersplenism. High-intensity focused ultrasound (HIFU) may provide an effective and safe way for treatment of hypersplenism. Therefore, we conducted this study to assess the safety and efficacy of HIFU in treatment of secondary hypersplenism. Methods: A total of 28 patients who suffered from secondary hypersplenism were treated with HIFU ablation. All patients who underwent HIFU were closely followedup over a year. MRI scan was performed, and the spleens were observed. Blood counts and liver function tests were also carried out.Results: In the follow-up process, the levels of white blood cells and platelets in the blood after HIFU were significantly higher than those before HIFU, liver function also improved after HIFU treatment. In addition, the symptoms were ameliorated significantly or even disappeared. The MRI showed that the ablation area had turned into a non-perfused volume, and after 12 months of HIFU ablation, the ablated area shrank evidently; the sunken spleen formed a lobulated shape and the splenic volume decreased. Conclusion: HIFU ablation is a safe, effective and noninvasive approach for secondary hypersplenism. Advances in knowledge: For the first time we used HIFU ablation to treat secondary hypersplenism. It not only expands indications of HIFU but also provides better choice for the treatment of secondary hypersplenism.Hypersplenism is a common manifestation in cirrhotic patients with portal hypertension. Liangpunsakul et al 1 reported that 70-80% of cirrhotic patients with portal hypertension have different degrees of splenomegaly and hypersplenism. Hypersplenism is a clinical syndrome characterized by splenomegaly, a variable combination of anaemia, leucopenia and/or thrombocytopaenia, compensatory bone marrow hyperplasia, reduced immunity and improvement after splenectomy. 1 The conventional treatment for patients with hypersplenism is splenectomy. However, after the first report of overwhelming post-splenectomy infection, clinical practitioners started realizing the important immunological function of the spleen. What is more, splenectomy is associated with increased risk of splenic vein thrombosis, secondary thrombocythemia and infection, particularly with encapsulated micro-organisms. 2 Several studies have shown that the spleen is an organ with a variety of important functions such as anti-infection and antitumour immunity. Therefore, it is important to retain the splenic function as much as possible when using splenomegaly treatment. Recently, partial splenic embolization (PSE) has been used in the treatment of splenomegaly and hypersplenism, but it has high incidence of complications. Local ablation therapies, such as radiofrequency ablation (RFA) and microwave ablation, also have marked improvement for...

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Microwave Ablation on Spleen

Cheng

Liang

2014

Microwave Ablation Treatment of Solid Tumors

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Experimental Studies and Clinical Experiences on Treatment of Secondary Hypersplenism with Extracorporeal High-Intensity Focused Ultrasound

Cited by 7 publications

References 27 publications

High‐Intensity Focused Ultrasound Ablation for Treatment of Hepatocellular Carcinoma and Hypersplenism

High‐Intensity Focused Ultrasound Ablation for Treatment of Hepatocellular Carcinoma and Hypersplenism

High-intensity focused ultrasound ablation: an effective and safe treatment for secondary hypersplenism

Microwave Ablation on Spleen

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