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[(log)5.4(i)-.4(cal)-236.6(e)-1.5(v)5.4(a)-1.5(lu)5.4(at)5.3(io)5.4(n,)-238.8(gr)5.5(owth)-242.2(p)5.4(a)-1.5(t)5.3(t)-.4(ern,)-238.8(n)5.4(u)-.3(cl)5.3(ear)-242.2(a)4.3(nd)-242.2(cyt)5.3(o)-.3(p)5.4(l)-.4(as)5.6(mi)5.3(c)]TJ
0 -1.1116 TD
[(featu)5.2(r)-.5(es,)-740.1(c)-1.7(o)5.2(llo)5.2(id)-737.8(ch)5.2(aract)5.1(e)-1.7(r)5.3(i)-.6(st)5.1(ics,)-740.1(b)5.2(ros)5.4(is)5.4(,)-745.8(i)5.1(n)5.4(ammato)5.2(ry)]TJ
T*
.0124 Tc
[(co)5.5(mp)5.5(onent)5.4(s,)-313.6(an)5.5(d)-317(i)-.3(mmun)5.5(oph)5.5(en)5.5(ot)5.4(ypi)5.4(c)-318.2(p)5.5(ro)5.7(le)-312.4(of)-317(t)5.4(h)-.2(y)5.5(rocyt)5.4(es)5.7(.)]TJ
0 -1.1174 TD
.0123 Tc
[(Th)5.4(e)-295.2(t)-.4(hr)5.5(ee)-295.2(mai)5.3(n)-294.1(comp)5.4(onent)5.3(s)-293.9(o)-.3(f)-294(t)-.4(h)5.4(e)-295.2(co)5.4(re)-295.2(\(cel)5.3(ls,)-290.6(c)-1.5(o)5.4(llo)5.4(id)5.4(,)-296.4(a)4.3(nd)]TJ
0 -1.1116 TD
.0111 Tc
[(br)4.3(o)-1.5(u)4.2(s)-249(t)4.1(i)-1.6(s)4.4(s)-1.3(ue\))-243.4(w)-2.4(ere)-244.6(r)-1.5(epor)4.3(ted)-243.4(i)]TJ
12.2048 0 TD
.0098 Tc
[(n)-244.7(p)-2.8(erce)-4(nta)-4(g)2.9(e)-4(s)-244.5(of)-244.7(the)-245.9(s)-2.6(am)-4(ples)]TJ
-12.2048 -1.1116 TD
.0072 Tc
[(c)-6.6(o).3(m)-6.6(p).3(o)-5.4(s)-5.2(it)-5.5(io)-5.4(n.)-330.3(Th)-5.4(is)-327.8(e)-6.6(v).3(a)-6.6(l)-5.5(ua)-6.6(ti)-5.5(on)-328(w)-6.3(a)-.8(s)-327.8(p)-5.4(er)-5.4(fo)-5.4(r)-5.4(m)-.9(ed)-328(u)-5.4(n).3(d)-5.4(e)-.8(r)-327.9(m)-6.6(ic)-6.6(ro)-5.4(-)]TJ
T*
.0129 Tc
[(sco)6(p).3(i)5.9(c)-726.6(exa)4.9(m)4.8(ina)4.9(t).2(i)5.9(o).3(n)-725.4(a)-.9(t)-725.6(m)4.8(ed)6(iu)6(m)-726.7(pow)5.2(er)-725.4(e)4.9(ld)-725.4(\()6.1(u).3(si)5.9(ng)-725.4(a)]TJ
0 -1.1174 TD
.0126 Tc
(20)Tj
/F6 1 Tf
1.1865 0 TD
0 Tc
()Tj
/F5 1 Tf
.7315 0 TD
.013 Tc
[(ob)6.1(je)5(ct)6(iv)6.1(e\).)-278.4(T)-.8(h)6.1(e)-283(n)6.1(al)-282(va)5(lu)6.1(e)-283(w)-.5(a)5(s)-287.4(t)6(h).4(e)-283(m)4.9(ea)5(n)-281.8(o).4(f)-281.8(t).3(h)6.1(e)-283(va)5(lu)6.1(es)]TJ
-1.918 -1.1116 TD
.0116 Tc
[(rep)4.7(o)-1(r)4.8(t)-1.1(ed)-300.5(b)4.7(y)-300.5(t)4.6(h)-1(e)-295.9(p)-1(ath)4.7(o)-1(lo)4.7(gi)4.6(st)4.6(s.)-297.1(When)-294.8(t)4.6(h)-1(e)-295.9(d)-1(if)4.8(ference)-301.7(b)4.7(et)4.6(ween)]TJ
T*
.0072 Tc
[(t)-5.5(h)-5.4(e)-427(p)-5.4(at)-5.5(ho)-5.4(lo)-5.4(g)-5.4(i).2(s)-5.2(t).2(s)-5.2()-431.6(va)-6.6(lu)-5.4(es)-431.4(w)-6.3(a)-.8(s)-431.4(h).3(i)-5.5(g)-5.4(he)-6.6(r)-425.8(t)-5.5(ha)-6.6(n)-431.6(1).3(0)-5.4(%)-.7(,)-428.2(t)-5.5(h)-5.4(e)-427(s)-5.2(l).2(i)-5.5(d).3(e)-6.6(s)]TJ
0 -1.1174 TD
.0119 Tc
[(were)-215(r)5.1(e)-1.9(-r)5.1(ev)5(iewed)-213.8(b)-.7(y)-213.8(b)5(ot)4.9(h)-213.8(p)-.7(ath)5(o)-.7(l)4.9(o)-.7(g)5(i)-.8(st)4.9(s)-213.6(t)-.8(o)-213.8(r)5.1(each)-213.8(a)-209.2(c)-1.9(o)5(n)-.7(sens)5.2(us.)]TJ
0 -1.1116 TD
.0115 Tc
[(Co)4.6(llect)4.5(ed)-294.9(dat)4.5(a)-301.8(wer)4.7(e)-301.8(repo)4.6(rted)-300.6(i)4.5(n)-300.6(th)4.6(e)-301.8(d)-1.1(atabase.)-303(Onl)4.5(y)-300.6(on)4.6(e)-301.8(i)4.5(n-)]TJ
T*
.012 Tc
[(vesti)5(g)-.6(ato)5.1(r)-357.7(\(V.P.)-354.3(w)-1.5(i)5(t)-.7(h)-357.7()5.3(ve)-353.1(years)5.3()-357.7(ex)5.1(peri)5(en)5.1(ce)-358.9(i)5(n)-357.7(t)5(h)-.6(y)5.1(roi)5(d)-357.7(b)5.1(i-)]TJ
0 -1.1174 TD
.0122 Tc
[(ops)5.5(y\))-276.9(perf)5.4(or)5.4(med)-282.6(t)5.2(hi)5.2(s)-276.7(pro)5.3(cedu)5.3(re.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 69.7323 330.5763 Tm
0 Tc
[(Minimally)-865.8(invasive)-859.3(image-guided)-861.4(thermal)-858.5(techniques.)]TJ
/F5 1 Tf
9.843 0 0 9.843 59.7543 319.6346 Tm
[(Laryngoscopy)-264.2(was)-258.6(performed)-261(in)-255.8(the)-258(study)-258.9(population)-260.2(before)]TJ
0 -1.1116 TD
[(intervention)-309.8(to)-301.8(assess)-301.9(vocal)-307.5(cord)-299.3(mobility.)-307.7(The)-299.4(same)-307.3(opera-)]TJ
0 -1.1174 TD
[(tor,)-283.3(an)-279.8(experience)-11.2(d)-277.6(interventional)-284.5(radiologist)-284.3(who)-286.4(had)-280.9(regu-)]TJ
0 -1.1116 TD
[(larly)-277.6(performed)-278.3(RFA)-281.5(\(in)]TJ
/F3 1 Tf
10.1774 0 TD
(*)Tj
/F5 1 Tf
1.0022 0 TD
[(200)-274(nodules\))-274.8(and)-275.2(LA)-280.7(for)-273.9(several)]TJ
-11.1796 -1.1116 TD
[(years)-243.8(\()]TJ
/F3 1 Tf
2.6898 0 TD
(*)Tj
/F5 1 Tf
.9964 0 TD
[(150\),)-238.2(carried)-241.6(out)-239.6(all)-240.9(procedures)-244.6(including)-236.1(the)-240.7(initial)]TJ
-3.6862 -1.1116 TD
[(diagnostic)-359.1(evaluation)-360.5(by)-353.5(using)-356.8(the)-355.9(same)-359.1(US)-354.3(equipment)-359.3(for)]TJ
0 -1.1174 TD
[(guidance.)-384.5(Patients)-379.8(were)-382(placed)-384.6(in)-376.7(the)-379(supine)-382.1(position)-383.4(with)]TJ
0 -1.1116 TD
[(their)-410.1(neck)-409.9(fully)-403.1(extended.)-413.3(Perithyroidal)-408.6(injection)-410.2(of)-405.3(mepi-)]TJ
T*
[(vacaine)-363.8(\(25)-165.6(mL)-361.7(of)-359.3(2%,)-358(Carbosen\))-364.4(and)-355.8(ropivacaine)-362.6(\(3)-169.2(mL,)]TJ
0 -1.1174 TD
[(Naropine\))-283.9(was)-287.4(used)-281.8(for)-279.7(pain)-282.2(control.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 69.7323 199.0488 Tm
[(Radiofrequency)-482.4(ablation.)]TJ
/F5 1 Tf
9.843 0 0 9.843 180.17 199.0488 Tm
[(The)-414.6(procedure)-416.5(was)-414.1(based)-416.6(on)]TJ
-12.2336 -1.1116 TD
[(the)-217.7()50.8(moving-shot)47.8()-214.2(techn)-8(ique)-213(as)-216.3(described)-220.7(elsewhere)-222.7(\(19\))-211.7(by)]TJ
T*
[(using)-316.5(a)-313.3(trans-isthmic)-323.2(approach)-311.8(with)-316.6(direct)-320.2(nodule)-313.2(puncture.)]TJ
0 -1.1174 TD
[(In)-198(det)12.7(ail)12.6(,)-199.3(a)-198.1(rad)12.8(iof)13.9(req)12.8(uen)12.8(cy)-193.4(gen)12.8(era)11.7(tor)-193.5(wit)12.8(h)-196.9(a)0(n)-199.2(18-)14(ga)13.9(uge)12.8(,)-199.3(10-)14(cm)]TJ
0 -1.1116 TD
[(ele)11.5(ctr)12.7(ode)-246.4(wit)12.8(h)-254.5(a)-255.7(1-c)12.8(m)-255.7(a)0(c)12.8(tiv)13.7(e)-255.7(tip)-245.5(\(RF)-246(Med)11.9(ica)11.5(l)-254.7(Co,)-242.8(Ltd)12.7(.,)-248.8(Sou)14.1(th)]TJ
T*
[(Korea\))-361.1(was)-350.7(applied)-355.9(by)-353.5(using)-356.8(55)-353.5(W)-348.9(o)0(f)-353.5(power)-358.9(and)-350(adequate)]TJ
0 -1.1174 TD
[(exposure)-206.7(time)-208.6(to)-203.9(induce)-204.9(transient)-208.2(multiple)-207.6(hyperechoic)-206.9(zones)]TJ
0 -1.1116 TD
[(as)-302.7(a)-301.8(sign)-303.8(of)-301.7(the)-298.3(effectiveness)-313.7(of)-295.9(the)-304.1(ablation.)-302.9(We)-305.1(calculated)]TJ
T*
[(the)-419.3(treatment)-412.4(time)-416(for)-412.2(every)-416.7(RFA)-414(session)-417.4(from)-414.5(the)-413.5(initial)]TJ
0 -1.1174 TD
[(insertion)-207.1(of)-198(the)-200.4(radiofrequency)-210.2(needle)-200.3(into)-200.5(the)-200.4(thyroid)-203.8(nodule)]TJ
0 -1.1116 TD
[(to)-284.6(the)-281.1(nal)-282(assessment)-285.8(of)-278.6(the)-281.1(treatment)-285.7(session.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 69.7323 67.5212 Tm
[(Laser)-419.6(ablation.)]TJ
/F5 1 Tf
9.843 0 0 9.843 139.4645 67.5212 Tm
[(For)-354.5(this)-355.8(technique,)-362.7(we)-355.6(followed)-356.7(the)-355.9(in-)]TJ
-8.0981 -1.1116 TD
[(dications)-484.7(published)-477.7(in)-480.4(a)-480.3(previous)-476.4(study)-477.7(\(7\).)-479(In)-480.2(brief,)-476.7(the)]TJ
25.5097 67.9242 TD
[(procedure)-445.3(was)-448.6(performed)-451.1(by)-439.9(using)-448.9(a)-445.8(commercially)-446.9(avail-)]TJ
0 -1.1174 TD
[(able)-392.8(US)-388.8(system)-394.6(\(EchoLaser;)-398(ELESTA)-392.2(srl,)-392.5(Florence,)-395.8(Italy\))]TJ
0 -1.1116 TD
[(equipped)-258.9(with)-253.2(a)-255.7(dedicated)-262.5(linear)-256.8(transducer)-256.3(operating)-260.1(at)-256.9(13)]TJ
T*
[(4)-168.1(MHz)-277(and)-275.2(with)-282(a)-273(needle-guided)-284.2(attachment)-282.2(with)-276.2(adjustable)]TJ
T*
[(angle)-468.7(selection.)-466.3(Under)-468.3(US)-463.7(guidance,)-470.9(21-gauge)-466.1(introducer)]TJ
0 -1.1174 TD
[(needles)-333.7(were)-335.9(inserted)-339.5(with)-333.8(direct)-337.5(nodule)-330.4(puncture)-339.5(along)-335.1(its)]TJ
0 -1.1116 TD
[(longest)-331.5(axis.)-325.7(Subsequently,)-335.7(a)-330.6(300-)]TJ
/F13 1 Tf
14.0018 0 TD
(l)Tj
/F5 1 Tf
.5529 0 TD
[(m)-324.9(at-ti)-8(pped)-328.1(quartz)-331.6(op-)]TJ
-14.5548 -1.1116 TD
[(tical)-278.9(ber)-281.8(was)-275.9(introduced)-284.3(and)-275.2(advanced)-284.2(up)-278.7(to)-273(the)-281.1(introducer)]TJ
0 -1.1174 TD
[(needle)-465.2(tip.)-462(The)-460.7(introducer)-468.6(needle)-465.2(was)-465.9(then)-460.7(withdrawn)-468.1(to)]TJ
0 -1.1116 TD
[(expose)-216.1(the)-217.7(ber)-218.5(tip)-216.7(by)-215.3(at)-216.6(least)-221(5)-168.1(m)0(m)-212(i)0(n)-215.4(direct)-222.3(contact)-218.8(with)-218.6(the)]TJ
T*
[(tissue.)-247.2(The)-247.6(bbers)-243.5(were)-249.5(then)-247.6(connected)-250.8(with)-247.4(the)-246.5(laser)-243.9(source)]TJ
0 -1.1174 TD
[(operating)-312(at)-314.5(1064)-165.7(nm)-308.7(with)-310.8(an)-314.4(optical)-315.7(beam-splitting)-313.1(device.)]TJ
0 -1.1116 TD
[(The)-310.9(number)-308.5(of)-313.2(21-gauge)-310.6(applicators)-315.3(\(introducer)-308.4(needle)-315.5(and)]TJ
T*
[(exible)-263.6(ber\))-259.9(to)-255.7(be)-262.6(inserted)-264.6(was)-258.6(based)-261.1(on)-261.4(the)-258(size)-265.8(and)-257.9(shape)]TJ
T*
[(of)-388.1(the)-384.7(nodule.)-385.7(Each)-393.8(treatment)-389.4(was)-385.3(performed)-393.5(with)-385.7(a)-388.2(xed)]TJ
0 -1.1174 TD
[(power)-209.1(protocol)-206(\(3)-203.8(W\),)-209.5(but)-205(the)-206.2(illumination)-212.2(time)-208.6(was)-206.7(different)]TJ
0 -1.1116 TD
[(on)-215.3(a)-221.1(case-by-case)-221.3(basis)-219.5(accor)-9(ding)-217.6(to)-215.4(the)-217.7(size)-219.8(and)-223.3(shape)-215(of)-221(the)]TJ
T*
[(target.)-490.6(After)-497.2(the)-488.4(rst)-493.7(illumination,)-492.1(the)-494.2(applicator\(s\))-496(were)]TJ
0 -1.1174 TD
[(withdrawn)-335.6(by)-336.3(2/3)-170.5(cm)-338.6(and)-332.8(subsequent)-341.4(illumination)-338.9(was)-339.2(per-)]TJ
0 -1.1116 TD
[(formed)-348.8(\(pull-back)-347.6(technique\))-348.8(until)-351.5(the)-344.4(whole)-347.5(target)-349(was)-350.7(il-)]TJ
T*
[(luminated.)-328.3(Each)-324.7(illumination)-327.4(time)-323.8(ranged)-325.7(from)-328.1(a)-324.8(minimum)]TJ
0 -1.1174 TD
[(of)-192.2(400)-187.6(seconds)-194(to)-192.4(a)-192.3(maximum)-191.2(of)-192.2(600)-193.4(seconds)-194(to)-186.6(keep)-196.8(the)-188.9(total)]TJ
0 -1.1116 TD
[(energy)-187.5(applied)-188.8(between)-190.8(1200)-188.7(and)-188.8(1800)-165.7(J)-191(per)-188.7(ber.)-187.4(Depending)]TJ
T*
[(on)-393.9(the)-402(size)-398.3(of)-393.8(the)-402(nodule,)-397.2(one)-396.1(to)-399.7(three)-393.8(illuminations)-403.2(were)]TJ
0 -1.1174 TD
[(applied)-315.6(in)-313.4(each)-313.2(session.)-317.1(LA)-315.3(was)-316.2(used)-316.4(on)-313.2(an)-314.4(average)-317.6(of)-313.2(two)]TJ
0 -1.1116 TD
[(bbers)-232(by)-232.6(employing)-231.4(the)-235(pull-back)-237.1(technique.)-236(We)-230.3(calculated)]TJ
T*
[(the)-321.4(treatment)-326(time)-318.1(for)-325.8(every)-318.8(LA)-326.8(session)-319.4(from)-322.3(the)-321.4(initial)-326.3(in-)]TJ
T*
[(sertion)-302.6(of)-307.4(the)-304.1(LA)-303.8(needle)-304(into)-304.2(the)-304.1(thyroid)-301.7(nodule)-307.4(to)-301.8(the)-304.1(nal)]TJ
0 -1.1174 TD
[(assessment)-285.8(of)-278.6(the)-281.1(treatment)-285.7(session.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 320.8251 393.6188 Tm
[(Contrast-enhanced)-613.7(ultrasonography.)]TJ
/F5 1 Tf
9.843 0 0 9.843 478.7148 393.6188 Tm
[(Extrapolating)-542.5(the)]TJ
-17.0545 -1.1174 TD
[(data)-507.9(obtained)-506.7(in)-503.4(other)-507.9(organs,)-506.3(contrast-enhanced)-509.5(ultraso-)]TJ
0 -1.1116 TD
[(nography)-361.3(\(CEUS\))-366.6(is)-365(considered)-365.8(a)-365.1(useful)-364.8(and)-367.3(reliable)-364(tech-)]TJ
T*
[(nique)-646.1(to)-647.4(evaluate)-653.1(the)-649.7(actual)-649.7(coagulation)-649.6(zone)-651.8(induced)]TJ
0 -1.1174 TD
[(immediately)-220.2(after)-221(the)-223.5(ablation)-218.9(maneuver)-220.9(\(20,21\).)-220.8(The)-218.8(double)]TJ
0 -1.1116 TD
[(contrast-imaging)-552.5(model)-543.7(was)-546.6(adopted)-551.6(with)-546.9(contrast-tuned)]TJ
T*
[(imaging.)-595.5(The)-593.2(mechanical)-594.3(index)-594.3(was)-592.6(0.03.)-591.9(The)-593.2(second-)]TJ
0 -1.1174 TD
[(generation)-314.2(contrast)-310.7(agent)-313.2(SonoView)-311.2(was)-310.4(used)-310.6(\(Bracco,)-315.1(Mi-)]TJ
0 -1.1116 TD
[(lan,)-249.9(Italy\).)-247.5(Twenty-ve)-251.5(milligrams)-256.8(of)-244.1(SonoView)-253.6(was)-252.8(diluted)]TJ
T*
[(with)-201.4(5)-168.1(m)0(L)-206.2(saline)-204.8(\(0.9%)-210.5(NaCl\),)-202.2(and)-206.1(a)-203.8(microbubbl)-7.9(e)-203.8(suspension)]TJ
T*
[(was)-235.5(created)-242.8(by)-232.6(vibrating)-241.8(for)-233.6(30)-238.3(seconds.)-237.7(The)-236(suspension)-242.1(was)]TJ
0 -1.1174 TD
[(injected)-548.3(as)-550.3(a)-549.4(bolus)-552.6(through)-549.2(the)-546(antecubita)-10.3(l)-548.4(vein)-547.1(with)-546.9(a)]TJ
0 -1.1116 TD
[(0.812)-163.3(mm)-344.5(\(20G\))-340.4(needle;)-345.5(2.4)-166.9(mL)-344.4(of)-336.2(each)-347.7(injection)-341.1(was)-345(then)]TJ
T*
[(ushed)-191.7(with)-189.8(5)-168.1(m)0(L)-188.9(saline.)-191(The)-190(dynamic)-195.7(perfusion)-189.5(of)-192.2(the)-188.9(lesion)]TJ
0 -1.1174 TD
[(was)-356.5(continuously)-360.2(observed)-356.5(for)-354.6(90)-353.5(seconds,)-358.7(and)-355.8(the)-355.9(images)]TJ
0 -1.1116 TD
[(were)-220.7(stored.)-224.2(Residual)-219.6(viable)-222.3(tissue)-226.5(was)-218.3(determined)-229.1(by)-215.3(means)]TJ
T*
[(of)-272.9(signal)-272.8(enhancement)-278.5(within)-278.6(the)-269.5(ablated)-276.4(lesion.)-276.2(The)-276.4(size)-277.4(of)]TJ
0 -1.1174 TD
[(the)-482.6(non-enhanced)-490.1(area)-491.7(on)-486(CEUS)-485.4(was)-489(measured,)-489(and)-488.3(the)]TJ
0 -1.1116 TD
[(volume)-199.2(was)-206.7(calculated)-207.3(by)-203.8(the)-200.4(ellipsoid)-207.2(formula)-200.2(stated)-204.8(earlier.)]TJ
T*
[(CEUS)-422(evaluation)-423.8(was)-419.8(performed)-422.3(three)-422.6(days)-420.1(after)-422.6(LA)-419(and)]TJ
T*
[(RFA)-281.5(treatments)-286.6(to)-278.8(calculate)-286.8(the)-281.1(necrosis)-281.6(volume.)]TJ
/F12 1 Tf
8.9663 0 0 8.9663 310.8472 149.726 Tm
(Outcomes)Tj
/F5 1 Tf
9.843 0 0 9.843 320.8251 133.285 Tm
[(This)-345.4(trial)-352.6(compared)-347.6(the)-350.2(following)-351(primary)-350(endpoints)-351(be-)]TJ
-1.0137 -1.1116 TD
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