Department of Diagnostic Radiology, College of Medicine, Korea University, Korea.
Published online: January 1, 2001.
ABSTRACT
PURPOSE: To analyze the therapeutic results of nodular hepatocellualr carcinomas (HCCs) managed by ultrasonography (US) guided percutaneous ethanol injection (PEI) after transcatheter arterial chemoembolization(TACE). MATERIALS & METHODS: Subjects consisted of 39 nodular HCC lesions in 32 patients, in which US-guided PEI was done from August, 1993 to November, 1997. Maximal diameters of te lesions were 1.0-7.0cm. Duration of PEI was 1-4 weeks and number of procedures was 1-10 times. The total amount of 99% ethanol used in PEI was 8-210cc. Follow-up after the procedure was done with CT within 1 month after PEI and then further follow-up was performed with CT or sonogram at variable intervals. Therapeutic results were evaluated by CT density, enhancement, and change in size of the lesions. The duration of follow-up varied from 1 to 48 months. RESULTS: Out of the 39 lesions, five(12%) which had undergone surgical resection after PEI showed complete necrosis by pathology. Twenty-four lesions (62%) showed Lipiodol uptake, decrease in size, no enhancement, and low density which presenting tissue necrosis within the center and periphery of the tumor on follow-up CT scans. Ten lesions (26%) had enhancement or increase in size ; out of these, the two subcapsular lesions had intraperitoneal spread and two had abdominal wall seeding. CONCLUSION: PEI under sonographic guidance after TACE in the treatment of nodular HCCs brings effective therapeutic results even in lesions with diameters greater than 3cm. However, PEI in subcapsular lesions can accompany severe complications, such as rupture or abdominal wall seeding, so intensive care must be taken in performing PEI in such cases.
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