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AJR 2001; 177:789-798
© American Roentgen Ray Society

Nonresectable Hepatocellular Carcinoma

Improved Percutaneous Ethanol Injection Therapy Guided by CO2-Enhanced Sonography

Kazushi Numata1, Katsuaki Tanaka, Takayoshi Kiba, Shuhei Matsumoto, Shigeru Iwase, Koji Hara, Hiroyuki Kirikoshi, Katsumi Morita, Satoru Saito and Hisahiko Sekihara

1 All authors: Third Department of Internal Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.

OBJECTIVE. The purpose of our study was to evaluate the usefulness of percutaneous ethanol installation using CO2-enhanced sonography for patients with nonresectable hepatocellular carcinoma (HCC).

SUBJECTS AND METHODS. Forty-six patients with 65 HCC lesions were examined with contrast-enhanced sonography with direct injection of CO2 into the proper hepatic artery during arteriography. We performed percutaneous ethanol injection guided by CO2-enhanced sonography for the treatment of hypervascular HCC lesions that could not be treated with conventional percutaneous ethanol injection or with transcatheter arterial embolization.

RESULTS. CO2-enhanced sonography detected five additional small HCC lesions before treatment (p<0.05) and 14 new lesions during follow-up (p<0.01), than conventional sonography detected. CO2-enhanced sonography showed positive enhancement of residual lesions after initial treatment (n = 3) and incomplete local treatment (n = 5) that were not detected on conventional sonography. These 27 lesions were successfully treated with percutaneous ethanol injection using a mixture of iodized oil and ethanol and guided by CO2-enhanced sonography.

CONCLUSION. CO2-enhanced sonography is a sensitive method for detecting residual viable lesions and small new HCC lesions that cannot be detected with conventional sonography. Percutaneous ethanol injection guided by CO2-enhanced sonography can treat hypervascular HCC lesions that cannot be treated with conventional percutaneous ethanol injection or transcatheter arterial embolization.


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