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Power Doppler Sonography

Evaluation of Hepatocellular Carcinoma After Treatment with Transarterial Embolization or Percutaneous Ethanol Injection Therapy

Kazumitsu Koito1, Tsutomu Namieno2, Takeshi Ichimura1, Naoki Hirokawa1, Takaharu Syonai1, Masato Hareyama1, Tadashi Katsuramaki3, Koichi Hirata3 and Motoi Nishi4

1 Department of Radiology, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan.
2 First Department of Surgery, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo, 060, Japan.
3 Department of First Surgery, Sapporo Medical University, Sapporo, 060-8543, Japan.
4 Department of Public Health, Sapporo Medical University, Sapporo, 060-8543, Japan.



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  		Fig. 1A. —63-year-old man with hepatocellular carcinoma (25 mm in diameter) in anterior segment of right lobe (before treatment). Color Doppler sonogram fails to reveal color signal in tumor (arrows). Note that color signal adjacent to tumor does not reveal tumor vessels but, instead, portal (red) and hepatic (blue) veins.

 


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  		Fig. 1B. —63-year-old man with hepatocellular carcinoma (25 mm in diameter) in anterior segment of right lobe (before treatment).Power Doppler sonogram shows color signal in tumor (arrows).

 


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  		Fig. 2A. —58-year-old woman with small hepatocellular carcinoma (20 mm in diameter) in anterior segment of right lobe treated by percutaneous ethanol injection therapy. CT scan obtained 6 months after injection therapy reveals low-density nodule (arrows), showing peripheral stain that indicates viable portion of tumor.

 


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  		Fig. 2B. —58-year-old woman with small hepatocellular carcinoma (20 mm in diameter) in anterior segment of right lobe treated by percutaneous ethanol injection therapy. Power Doppler sonogram reveals color signal in peripheral portion of tumor (arrow) that was not shown on color Doppler sonography.

 


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  		Fig. 3A. —46-year-old man with hepatocellular carcinoma treated with transarterial embolization with iodized oil, epirubicin hydrochloride, and sliced particles of gelatin sponge. CT scan obtained before transarterial embolization shows tumor stain (arrows) in nodule in lateral segment of left lobe.

 


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  		Fig. 3B. —46-year-old man with hepatocellular carcinoma treated with transarterial embolization with iodized oil, epirubicin hydrochloride, and sliced particles of gelatin sponge. CT scan obtained 6 months after embolization therapy does not enable evaluation of tumor viability (arrows) because of accumulation of iodized oil in tumor.

 


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  		Fig. 3. —46-year-old man with hepatocellular carcinoma treated with transarterial embolization with iodized oil, epirubicin hydrochloride, and sliced particles of gelatin sponge. Power Doppler sonogram, however, shows color signal in both center and periphery of tumor (arrows). Additional ethanol was injected into color signal areas under power Doppler guidance.

 

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