OBJECTIVETo explore the value of ultrasono-portography using SonoVue in selective portal vein embolization (SPVE).

METHODSTwenty-eight patients with malignant liver tumors underwent percutaneous ultrasound-guided SPVE. The procedure was performed under color Doppler ultrasound guidance in 11 cases (conventional group) and under guidance with ultrasono-portography using SonoVue in 17 cases (contrast group). Contrast-enhanced CT was performed 2-4 weeks after SPVE to evaluate the effect of embolization.

RESULTSThe procedure of SPVE was aborted in 3 cases in which ultrasono-portography showed contraindications. Postoperative contrast-enhanced CT showed ectopic embolization in 2 cases in the conventional group, and none of the cases in the contrast group showed ectopic embolization.

CONCLUSIONUltrasono-portography using SonoVue can provide important assistance for SPVE.

Carcinoma, Hepatocellular ; pathology ; therapy ; Embolization, Therapeutic ; methods ; Female ; Humans ; Liver Neoplasms ; pathology ; therapy ; Male ; Middle Aged ; Portal Vein ; Portography ; methods ; Ultrasonography, Doppler, Color

Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.
Carcinoembryonic Antigen/metabolism ; Carcinoma, Hepatocellular/*diagnosis/pathology/*secondary ; Chemoembolization, Therapeutic ; Humans ; Liver Neoplasms/*pathology/therapy ; Male ; Middle Aged ; Sigmoid Neoplasms/*diagnosis/*secondary/ultrasonography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: The predictive role of contrast-enhanced ultrasonography (CEUS) before performing transarterial chemoembolization (TACE) has not been determined. We assessed the possible predictive factors of CEUS for the response to TACE. METHODS: Seventeen patients with 18 hepatocellular carcinoma (HCC) underwent TACE. All of the tumors were studied with CEUS before TACE using a second-generation ultrasound contrast agent (SonoVue(R), Bracco, Milan, Italy). The tumor response to TACE was classified with a score between 1 and 4 according to the remaining enhancing-tumor percentage based on modified response evaluation criteria in solid tumors (mRECIST): 1, enhancing tumor <25%; 2, 25%< or =enhancing tumor<50%; 3, 50%< or =enhancing tumor<75%; and 4, enhancing tumor> or =75%). A score of 1 was defined as a "good response" to TACE. The predictive factors for the response to TACE were evaluated during CEUS based on the maximum tumor diameter, initial arterial enhancing time, arterial enhancing duration, intensity of arterial enhancement, presence of a hypoenhanced pattern, and the feeding artery to the tumor. RESULTS: The median tumor size was 3.1 cm. The distribution of tumor response scores after TACE in all tumors was as follows: 1, n=11; 2, n=4; 3, n=2; and 4, n=1. Fifteen tumors showed feeding arteries. The presence of a feeding artery and the tumor size (< or =5 cm) were the predictive factors for a good response (P=0.043 and P=0.047, respectively). CONCLUSIONS: The presence of a feeding artery and a tumor size of less than 5 cm were the predictive factors for a good response of HCC to TACE on CEUS.
Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/pathology/therapy/*ultrasonography ; Chemoembolization, Therapeutic ; Contrast Media/*chemistry ; Doxorubicin/administration & dosage ; Female ; Humans ; Liver Neoplasms/pathology/therapy/*ultrasonography ; Male ; Microspheres ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: Needle-track seeding is a rare but important complication of diagnostic and therapeutic ultrasound (US)-guided procedures in hepatocellular carcinoma (HCC). We examined the frequency of needle-track seeding after US-guided percutaneous ethanol injection (PEI), fine-needle aspiration biopsy (FNAB), and percutaneous transhepatic biliary drainage (PTBD) in order to determine the appropriate treatment for needle-track seeding and its clinical outcome. METHODS: We analyzed the clinical characteristics and treatment outcomes in eight patients who experienced needle-track seeding from HCC after an US-guided procedure (FNAB, PEI, or PTBD) between January 1990 and July 2004. RESULTS: Seven (0.14%) of 5,092 patients who experienced needle-track seeding (2 after PEI, 4 after FNAB, and 1 after PTBD) during the study period and 1 other patient who experienced needle-track seeding recently were recruited for this study. Two of the eight patients underwent mass excision and the other six patients underwent en-bloc wide excision for the needle-track seeding. Tumors recurred in the needle-tracks in both patients who underwent mass excision but not in the six patients who underwent en-bloc wide excision. Mortality occurred in three patients who experienced the recurrence and progression of intrahepatic HCC. CONCLUSIONS: The incidence of needle-track seeding after US-guided procedures in HCC was 0.14%. En-bloc wide excision seems to be the optimal treatment for minimizing the probability of tumor recurrence due to needle-track seeding.
Adult ; Biopsy, Fine-Needle/*adverse effects ; Carcinoma, Hepatocellular/*secondary/therapy/ultrasonography ; Female ; Humans ; Liver Neoplasms/*pathology/therapy/ultrasonography ; Male ; Middle Aged ; *Neoplasm Seeding ; Retrospective Studies ; Skin Neoplasms/secondary ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the effectiveness of ultrasound-guided radiofrequency (RF) ablation in patients with incompletely treated hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to evaluate possible prognostic factors for this therapy. SUBJECTS AND METHODS: Thirty nine patients with incompletely treated single HCC (< or = 5 cm) after TACE were treated with RF ablation. All patients were evaluated for complete tumor ablation rate, local recurrence-free rate, overall survival rate, and complications. Local recurrence-free rate and overall survival rate were calculated using the Kaplan-Meier method. The possible prognostic factors of local recurrence-free rate and survival rate were analyzed using Cox proportional-hazards regression model. RESULTS: The complete tumor ablation rate was 92.3%. Local recurrence-free rates for 1-, 2-, 3-, and 5-years were 81.7%, 63.1%, 53.6%, and 35.7%, respectively. One-, 2-, 3-, and 5-year overall survival rates were 96.9%, 82.9%, 67.8%, and 48.4%, respectively. Among prognostic factors included in the analysis, only tumor diameter (< or = 2 cm versus > 2 cm) was statistically significant in terms of predicting local recurrence. Complications were observed in two patients, one with liver abscess and the other with portal venous thrombosis. CONCLUSION: Ultrasound-guided RF ablation could be effective and safe in treating incompletely treated HCC after TACE. The diameter of HCC was a significant prognostic factor for local recurrence.
Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/pathology/*therapy/ultrasonography ; Catheter Ablation/*methods ; Chemoembolization, Therapeutic/*methods ; Combined Modality Therapy ; Female ; Humans ; Liver Neoplasms/pathology/*therapy/ultrasonography ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Postoperative Complications ; Prognosis ; Proportional Hazards Models ; Treatment Outcome ; *Ultrasonography, Interventional

BACKGROUND/AIMS: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT. METHODS: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks. RESULTS: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (kappa=1.00) and substantial agreement between MDCT and MRI (kappa=0.67). CONCLUSIONS: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.
Aged ; Aged, 80 and over ; Antineoplastic Agents/administration & dosage ; Carcinoma, Hepatocellular/pathology/therapy/*ultrasonography ; Chemoembolization, Therapeutic ; Contrast Media/*chemistry ; Female ; Gadolinium DTPA/chemistry ; Humans ; Liver Neoplasms/pathology/therapy/*ultrasonography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pilot Projects ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo investigate the image findings of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy.

METHODSDuring the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients (1.4%) developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and ultra-sonography, 14 MRI and 15 digital subtract angiography (DSA). The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury.

RESULTSTACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis (8.8%), 5 of 1092 patients with hepatocellular carcinoma (HCC) (0.5%). On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in non-cirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis (P < 0.01), and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents (P < 0.01). The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions (P < 0.05).

CONCLUSIONBiliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predisposing factors to the development of TACE-induced bile duct injury.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; Bile Ducts ; diagnostic imaging ; pathology ; Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; Cholangiography ; Cisplatin ; administration & dosage ; Dilatation, Pathologic ; etiology ; Epirubicin ; administration & dosage ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Iodized Oil ; administration & dosage ; Liver Neoplasms ; therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Ultrasonography