Percutaneous intravascular ethanol injection of the supplying tumor vessel in the treatment of hepatocellular carcinoma larger than 3 cm

Acoustic radiation force impulse imaging of thermally- and chemically-induced lesions in soft tissues: preliminary ex vivo results

The ability of acoustic radiation force impulse (ARFI) imaging to visualize thermally- and chemically-induced lesions in soft tissues was investigated. Lesions were induced in freshly excised bovine liver samples. Chemical lesions were induced via the injection of formaldehyde and thermal lesions were created using a radiofrequency (RF) ablation system. Although conventional sonography was unable to visualize induced lesions, ARFI imaging was capable of monitoring lesion size and boundaries. Agreement was observed between lesion size in ARFI images and in results from pathology. The fact that ARFI imaging requires no additional equipment aside from that needed for conventional ultrasonic imaging makes it a promising modality for monitoring lesion development in situations where sonography is already involved as a guiding mechanism, such as in procedures requiring precise catheter placement.

Percutaneous ethanol injection of the supplying artery to hepatocellular carcinoma that is not amenable to conventional treatment

The purpose of this study was to evaluate the clinical usefulness of ultrasound-guided percutaneous ethanol injection of the supplying artery (PEISA) to the tumour in the palliative management of hepatocellular carcinoma (HCC) that is not amenable to conventional treatments. A total of 23 cases of HCC, measuring from 3.1 cm to larger than 15 cm (median 5.4 cm) in 17 cirrhotic patients, were treated by PEISA. PEISA was used to control rapid growth of the tumour in seven patients and to reduce abdominal discomfort caused by rapid expansion of the tumour in 10 patients. Tumours with arterial Doppler signals persisting after PEISA underwent repeated treatment. The follow-up period ranged from 2-48 months. PEISA was achieved in 69 out of 76 attempts (90.8%). The amount of ethanol injected on each occasion ranged from 2.5-33 ml. Follow-up colour Doppler scanning showed complete elimination of tumour Doppler signals in 22 out of 23 lesions (95.7%). Following treatment, one tumour disappeared, 13 tumours shrank and nine tumours were unchanged in size. All patients with abdominal discomfort had relief after treatment. The common complications of PEISA were local pain and fever. In conclusion, PEISA is effective at treating painful HCC unsuitable for conventional treatment.

Correlation between hepatic tumor index on color Doppler sonography and tumor vessels on arteriography in large hepatocellular carcinomas

We assessed a possible correlation between the hepatic tumor index (as the ratio of the tumoral peak systolic velocity to the peak systolic velocity of the right or left hepatic artery) and grade of tumor vessel in large hepatocellular carcinomas (HCCs). Color Doppler sonographic findings were evaluated and compared with selective hepatic arteriographic findings in 78 patients with 93 hepatocellular carcinomas larger than 2.0 cm in diameter. Pulsatile color flow images were obtained in 78 of 93 lesions. The hepatic tumor index was equal to or greater than 1.0 in 57 of 78 lesions. These lesions were revealed arteriographically to have distinct tumor vessels and/or arteriovenous shunting. When this index was 1.0 or greater, we calculated 90% accuracy in distinguishing HCCs with distinct tumor vessels from those without distinct tumor vessels. The hepatic tumor index correlated with the grade of tumor vessels and the presence of arteriovenous shunting.

Improved investigation of portal-hepatic veins by echo-enhanced Doppler sonography

Microbubbles of air released from a galactose vehicle (Levovist) amplify the intensity of Doppler signals. They survive both pulmonary and systemic capillary passage, leading to echo enhancement in the entire vascular system. The aim of this study was to investigate this agent in patients with liver disease and insufficient Doppler signals. A total of 275 Doppler examinations were performed in 176 patients; 20 of these patients could not be studied conventionally due to bowel gas, obesity or noncompliance. They received Levovist to examine portal or hepatic veins or TIPS patency. Angiography, computed tomography (CT) scan or magnetic resonance tomographic angiography (MRTA) was performed subsequently as a control. After administration of Levovist, portal or hepatic veins and TIPS patency could be unequivocally assessed in 18 of the 20 patients. In two patients, suspected occlusion of the portal vein was disproved because the diagnosis was not confirmed later. Only minor adverse effects were encountered. Echo-enhanced Doppler sonography with Levovist is well tolerated. Further study of the value of Levovist for the assessment of portal-hepatic vessels not amenable to conventional Doppler sonography is justified.

Percutaneous hepatic infarction therapy for hepatocellular carcinoma

OBJECTIVE

We percutaneously injected ethanol into small vessels afferent to tumor nodules to induce hepatic infarction in areas of tumor caused by hepatocellular carcinoma.

CONCLUSION

Percutaneous hepatic infarction therapy holds promise as a new method of treating large hepatocellular carcinoma.

Hepatocellular carcinoma

BACKGROUND

Hepatocellular carcinoma is one of the world's most common malignancies. The aims of the present paper are to review data on (1) epidemiology and screening programmes for the early detection of the tumour and (2) advances in the diagnostic imaging and management.

METHODS

Relevant English language articles, published between January 1985 and December 1997, were reviewed. Articles were identified through Medline search, using the key words 'hepatocellular carcinoma'. Articles cited in the bibliographies of these articles were searched manually.

RESULTS

Hepatocellular carcinoma has a heterogeneous geographical distribution. Although its risk factors have been identified, the efficacy of screening programmes remains uncertain. Imaging has improved substantially with the recent application of dual-phase helical computed tomography and magnetic resonance imaging employing specific contrast agents. The comparative efficacy of conservative therapy and surgical resection is uncertain, since well controlled trials are lacking.

CONCLUSION

Hepatocellular carcinoma is commonly a problem of two diseases, the malignancy itself and cirrhosis. This renders treatment rarely curative, even when surgical resection can be applied in a technically successful sense. Liver transplantation could be a definitive treatment but this is plagued by limited donor resources.

Current and future treatment modalities for hepatocellular carcinoma

This article reviews recent innovations in the treatment of Hepatocellular carcinoma (HCC), which, although a common malignancy, has often proved difficult to diagnose and treat effectively. The epidemiology and natural history of HCC are discussed, as well as treatments such as hepatic resection, liver transplantation, and cryosurgery, among others.