BACKGROUNDTriple-phase enhancement of multi-slice computed tomography (MSCT) has markedly improved the diagnostic accuracy of hepatocellular carcinoma (HCC), and MSCT angiography (MSCTA) has been proved useful in detecting vascular anatomy noninvasively. This study aimed to explore the value of MSCTA by triple-phase enhancement in preoperative evaluation of HCC.

METHODSFifty-six consecutive cases of primary HCC scheduled for resection were studied with MSCTA by triple-phase enhancement. The raw data images were processed on a workstation for multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction. The findings after processing of the data were compared with those after surgery or intraoperative sonography.

RESULTSThe false positive rate of MSCTA by triple-phase enhancement was 10.1% and its false negative rate was 4.3% in detecting HCC. No significant difference was observed in MSCTA and surgery or intraoperative sonography in detecting vascular anatomy anomalies and pathologic variations, whereas significant difference was found in detecting bile duct invasion with MSCT compared to intraoperative sonography.

CONCLUSIONSMSCTA by triple-phase enhancement not only improves the detection of HCC, but also provides valuable preoperative information about hepatic vascular architecture and parenchyma. MSCTA by triple-phase enhancement is worthy of application as a non-invasive method in preoperative evaluation of HCC.

Adult ; Angiography ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Female ; Hepatic Artery ; diagnostic imaging ; Hepatic Veins ; diagnostic imaging ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; Radiographic Image Enhancement ; Tomography, X-Ray Computed

Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC). Although radiofrequency (RF) ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety.
Carcinoma, Hepatocellular/diagnostic imaging/*surgery ; Catheter Ablation ; *Cryosurgery ; Humans ; Liver Neoplasms/diagnostic imaging/*surgery ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo investigate the therapeutic efficacy and its influencing factors of ultrasound-guided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma.

METHODSWith a temperature-controlled multi-electrode needle, ultrasound-guided PRFA was employed to treat forty-seven patients with 67 tumor nodules, with a diameter of 2.6 +/- 1.1 cm (1.0 - 5.5 cm).

RESULTSA complete ablation (CA) rate of 80.6% was achieved in the present series, with a CA rate of 91.7% in the tumors < or = 3 cm in diameter, 75.0% in tumors from 3.1 to 4.0 cm, and 14.3% in tumors > 4 cm. The CA rate was significantly greater in tumors with a temperature rising up to 70 degrees C within the initial 2 minutes at ablation as compared with that longer than 2 minutes (P < 0.05). A markedly higher CA rate was obtained in tumors with an ablation-maintaining temperature of over 80 degrees C than that between 70 degrees C and 80 degrees C (P < 0.01). All patients were followed up with a mean time of 11.3 months. The local recurrence rate was 9.3% (5/54), and 1-year survival rate was 82.1%. Eighteen patients (38.3%) had a distant recurrence.

CONCLUSIONSThe tumor size, temperature-rising time and ablation-maintaining temperature represented the important factors affecting the therapeutic efficacy of PRFA.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Liver Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Temperature ; Ultrasonography, Interventional

OBJECTIVETo investigate the clinical value of enhanced ultrasonography before and after ultrasound guided radiofrequency ablation (RFA) of hepatomas.

METHODSEighteen patients with 17 primary hepatocellular carcinoma and 1 hepatic metastasis were studied. Sixteen were confirmed by operation or needle puncture biopsy, 2 by clinical examinations including CT scanning, MRI etc. New contrast agent, SonoVue, Technos DU6 and Contrast Tuned Imaging (CnTI) technique were adopted. Enhanced ultrasonography was performed before or after the RFA procedure.

RESULTSTwenty-six lesions were observed with enhanced ultrasonography before RFA, 24 of which showed ball-carrying sign or diffuse enhancement at the early artery phase favoring the fast diagnosis; 9 lesions showed feeding vessels; twelve of the 26 lesions (46.2%) tended to be larger, especially those with unclear margins (78.6%, 11/14) and those without halo sign (68.8%, 11/16). Enhanced ultrasonography revealed 13 satellite foci in four cases which had been undetectable with routine ultrasound, CT scanning or MRI. The final diagnosis of either inactivation or residual disease would rely upon more than two kinds of images, levels of tumor marks, biopsy pathology and more than 7 months of follow-up. Twenty-two lesions were observed with enhanced ultrasonography after RFA, with an accuracy of 95.5% (21/22), being similar to the enhanced CT and was significantly superior to the routine color ultrasonography whose accuracy was only 63.6% (14/22).

CONCLUSIONEnhanced ultrasonography may provide more information on the characters, size, number and feeding vessels of the tumor before radiofrequency ablation, thus helping choose the indicator, establish and carry out the treatment protocol. This technique may also help to assess the therapeutic response to RFA.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Catheter Ablation ; Female ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Ultrasonography

Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo assess the value of application of percutaneous radiofrequency ablation (RFA) with artificial hydrothorax for liver cancer in the hepatic dome.

METHODSThirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed.

RESULTSIn the 32 patients with 43 lesions in the hepatic dome (4 tumors in segment IV 21 tumors in segment VII and 18 tumors in segment VIII), 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and (1606.3 ± 485.9) ml (1000 - 2500 ml) saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% (29/31).

CONCLUSIONSArtificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Catheter Ablation ; methods ; Female ; Follow-Up Studies ; Humans ; Hydrothorax ; Liver Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Sodium Chloride ; Ultrasonography, Interventional

BACKGROUNDFew reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT). The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.

METHODSThe clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed. The effects of BDT and re-operation on prognosis were retrospectively analyzed.

RESULTSThe 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P>0.05). Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P<0.05). Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05). Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P>0.05).

CONCLUSIONSHepatectomy plus BDT removal is an effective treatment option for HCC with BDT. Obstructive jaundice is not a contraindication for surgery. Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

Adult ; Bile Ducts ; pathology ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

Biopsy ; Carcinoma, Hepatocellular ; diagnosis ; Diagnostic Errors ; Fatal Outcome ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Neoplasms ; diagnosis ; Male ; Middle Aged ; Splenectomy ; Splenic Diseases ; diagnosis ; surgery ; Tomography, X-Ray Computed

No abstract available.
Adult ; Anterior Temporal Lobectomy ; Bile Duct Neoplasms/*diagnostic imaging/surgery ; *Bile Ducts, Intrahepatic/surgery ; Carcinoma, Hepatocellular/diagnostic imaging ; Cholangiocarcinoma/*diagnostic imaging/surgery ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis, Differential ; Humans ; Liver/diagnostic imaging/metabolism ; Liver Neoplasms/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo explore and evaluate the effect of radio frequency ablation (RFA) in treatment of hepatic VX(2) tumor in rabbits.

METHODSThe hepatoma was treated with RFA in rabbits. The complete necrotic rate of the tumors, pathological changes, CT images and the animals' survival time were observed.

RESULTS(1) ALT in serum increased significantly on the first day and decreased to the control level during 4th-7th day following RFA. (2) On the second week, CT scans showed that complete necrotic foci became larger, and the density of which was asymmetrical. Enhanced CT scans showed no obvious intensification inside; however, ringed intensification appeared along edges of the foci. Biopsy showed that the dark necrotic tissue was surrounded by ringed granulation tissue. Incomplete necrotic tumor foci resembled the complete necrotic foci in no enhanced CT images; however, asymmetrical intensification was observed in enhanced CT scans in the incomplete necrotic foci. Macroscopic observation showed irregular tumor tissue between the necrotic tissue and the peripheral normal tissue. Biopsy showed tumor recurrence in it. (3) Compared with the control, survival time of the animals was longer, and metastases rate in lungs and the fatality rate were lower in the treatment group.

CONCLUSIONSRFA, with little injury, is an effective method in the treatment of hepatoma. Enhanced CT scans are consistent with pathological morphometrics of the tumor foci after RFA. The enhanced CT scan is a valuable check-up, which could be used to observe the therapeutic effect after RFA.

Animals ; Carcinoma, Hepatocellular ; Catheter Ablation ; Liver Neoplasms ; diagnostic imaging ; surgery ; Necrosis ; Neoplasm Recurrence, Local ; Rabbits ; Radionuclide Imaging ; Tomography, X-Ray Computed