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Percutaneous Acetic Acid Injection for Hepatocellular Carcinoma: Using CT Fluoroscopy to Evaluate Distribution of Acetic Acid Mixed with an Iodinated Contrast Agent

¹ Service de Radiologie, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75012 Paris Cedex, France.
² Service d'Hépato-Gastro-Entérologie, Hôpital Saint-Antoine, 75012 Paris Cedex, France.

View larger version (174K): [in a new window]   Fig. 1A. —85-year-old woman with hepatocellular carcinoma. CT fluoroscopy image shows homogeneous distribution of acetic acid in lesion at first positioning and injection. Despite peripheral location of lesion and presence of perihepatic ascites, no extrahepatic leak was observed.

View larger version (145K): [in a new window]   Fig. 2. —67-year-old woman with hepatocellular carcinoma. CT fluoroscopy image obtained with three repositionings shows near homogeneous distribution (>75%) of acetic acid in lesion. At first needle positioning, tip of needle was pushed outside deeper border of lesion, and peritumoral leak (arrow) was observed. Needle was pulled back, but leak persisted. No further leak was observed after needle was repositioned.

View larger version (148K): [in a new window]   Fig. 3. —60-year-old woman with hepatocellular carcinoma. CT fluoroscopy image shows inhomogeneous distribution (<75%) of acetic acid in lesion despite seven repositionings. Leak of acetic acid into peritoneum (arrow) at periphery of lesion is shown.

View larger version (151K): [in a new window]   Fig. 4. —67-year-old woman with hepatocellular carcinoma. CT fluoroscopy image shows heterogeneous distribution of acetic acid in semilunar left part of lesion. Repositioning of needle tip centered in right untreated part of lesion was performed to obtain homogeneous distribution.

View larger version (168K): [in a new window]   Fig. 1B. —85-year-old woman with hepatocellular carcinoma. CT fluoroscopy image obtained at end of procedure shows peritumoral leak (arrow). Injection was discontinued.

View larger version (153K): [in a new window]   Fig. 5. —76-year-old man with hepatocellular carcinoma. CT fluoroscopy image at end of procedure shows small leak of acetic acid into hepatic vein. Homogeneous enhancement of lesion is shown.

View larger version (128K): [in a new window]   Fig. 6. —74-year-old woman with hepatocellular carcinoma. CT fluoroscopy image shows acetic acid leak in right bile duct (arrow). Repositioning was performed to avoid further leak.

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