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Fig. 4D. —Percutaneous ethanol injection guided by CO₂-enhanced sonography in 67-year-old man with Child's class B cirrhosis [9] and large hepatocellular carcinoma (maximum diameter, 100 mm) in residual tumor after initial treatment. CO₂-enhanced sonogram with direct injection of carbon dioxide into right inferior phrenic artery shows 30-mm area of positive enhancement (arrows) that was seen in B in inferior posterior segment. In this residual lesion, viable portion could not be differentiated from nonviable portion on conventional sonography. Injections of 1.0 and 6.0 mL of iodized oil-ethanol mixture (1:1 and 1:2, respectively) into tumor in superior anterior and inferior posterior segments were guided by CO₂-enhanced sonography.

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