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Virtual Sonographic Radiofrequency Ablation of Hepatocellular Carcinoma Visualized on CT but Not on Conventional Sonography

Masashi Hirooka1, Hidehito Iuchi1, Teru Kumagi1, Shuichiro Shigematsu1, Atsushi Hiraoka1, Takahide Uehara1, Kiyotaka Kurose1, Norio Horiike1 and Morikazu Onji1

1 All authors: Third Department of Internal Medicine, Ehime University, Sigenobutyo Sizukawa, Ehime, Japan.


Figure 1
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  		Fig. 1A —Puncture procedure used for virtual sonography in gelatin gel. MDCT image of gelatin gel shows small ball of contrast medium (arrow) and 4-French catheters (arrowheads) placed in phantom in such a way as to imitate tumor and vessels.

 

Figure 2
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  		Fig. 1B —Puncture procedure used for virtual sonography in gelatin gel. Virtual sonographic image is then reconstructed. Arrow indicates contrast medium; arrowheads indicate catheters.

 

Figure 3
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  		Fig. 1C —Puncture procedure used for virtual sonography in gelatin gel. Conventional sonographic image is depicted in same slice as that shown by virtual sonography. Arrowheads indicate catheters.

 

Figure 4
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  		Fig. 1D —Puncture procedure used for virtual sonography in gelatin gel. Image confirms that puncture is appropriate.

 

Figure 5
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  		Fig. 2A —72-year-old man with hepatocellular carcinoma. Construction of virtual image of hepatocellular nodule. CT scan shows hepatocellular nodule (arrowheads).

 

Figure 6
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  		Fig. 2B —72-year-old man with hepatocellular carcinoma. Construction of virtual image of hepatocellular nodule. Virtual sonographic image shows same nodule (white arrowheads).

 

Figure 7
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  		Fig. 2C —72-year-old man with hepatocellular carcinoma. Construction of virtual image of hepatocellular nodule. Conventional sonographic image of B. Black arrowhead indicates cancer nodule; black and white arrows indicate previously treated areas.

 

Figure 8
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  		Fig. 3A —61-year-old man with hepatocellular carcinoma (maximum diameter, 6 mm) in superior anterior segment who received initial treatment. Contrast-enhanced CT scan obtained before treatment shows low-attenuation area (arrow).

 

Figure 9
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  		Fig. 3B —61-year-old man with hepatocellular carcinoma (maximum diameter, 6 mm) in superior anterior segment who received initial treatment. Reconstructed virtual sonographic image shows branches of portal vein (black arrow) and hepatic vein (black arrowheads), in addition to low-attenuation area (white arrow) seen in A.

 

Figure 10
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  		Fig. 3C —61-year-old man with hepatocellular carcinoma (maximum diameter, 6 mm) in superior anterior segment who received initial treatment. Nodule was not visualized clearly on conventional sonography; thus, same slice as in B is revisualized on conventional sonography and nodule is punctured. Arrow indicates portal vein; arrowheads indicate hepatic vein.

 

Figure 11
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  		Fig. 3D —61-year-old man with hepatocellular carcinoma (maximum diameter, 6 mm) in superior anterior segment who received initial treatment. After puncture, CT scan shows that needle accurately hits target nodule.

 

Figure 12
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  		Fig. 3E —61-year-old man with hepatocellular carcinoma (maximum diameter, 6 mm) in superior anterior segment who received initial treatment. After treatment, dynamic CT scan reveals completely necrotic area.

 

Figure 13
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  		Fig. 4A —71-year-old man with hepatocellular carcinoma who received additional treatment. Contrast-enhanced CT scan obtained before treatment showed high-attenuation area in lateral segment (black arrow). This nodule was adjacent to necrotic area (white arrows), which had previously undergone percutaneous ethanol injection.

 

Figure 14
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  		Fig. 4B —71-year-old man with hepatocellular carcinoma who received additional treatment. Necrotic area is seen before treatment (white arrows), but pulsation of heart prevents clear visualization of nodule.

 

Figure 15
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  		Fig. 4C —71-year-old man with hepatocellular carcinoma who received additional treatment. Reconstructed virtual sonographic image shows necrotic area as hypoattenuating (white arrows) and target nodule as hyperattenuating (black arrow). Puncture is performed at area of hyperattenuation.

 

Figure 16
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  		Fig. 4D —71-year-old man with hepatocellular carcinoma who received additional treatment. After treatment, dynamic CT scan reveals completely necrotic area.

 

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