Korean J Radiol.  2013 Apr;14(2):240-247. 10.3348/kjr.2013.14.2.240.

Therapeutic Efficacy and Safety of Percutaneous Ethanol Injection with or without Combined Radiofrequency Ablation for Hepatocellular Carcinomas in High Risk Locations

• Cha DI
• Lee MW
• Rhim H
• Choi D
• Kim YS
• Lim HK

• KMID: 1482783
• DOI: http://doi.org/10.3348/kjr.2013.14.2.240

Abstract

OBJECTIVE
To evaluate the therapeutic efficacy and safety of percutaneous ethanol injection (PEI) alone and combined with radiofrequency ablation (RFA) for hepatocellular carcinomas (HCCs) in high risk locations.
MATERIALS AND METHODS
We performed PEI for HCCs in RFA-high risk locations, either alone or in combination with RFA. There were 20 HCCs (1.7 +/- 0.9 cm) in 20 patients (PEI group: n = 12; PEI + RFA group: n = 8). We evaluated technical success, local tumor progression and complications in both groups.
RESULTS
Technical success was achieved in all HCCs in both groups. During follow-up, local tumor progression was found in 41.7% (5/12) in the PEI group, whereas 12.5% (1/8) for the PEI + RFA group (p = 0.32). Bile duct dilatation was the most common complication, especially when the tumors were in periportal locations; 55% (5/9) in the PEI group and 50% (2/4) in the PEI + RFA group (p = 1.00). One patient in the PEI group developed severe biliary stricture and upstream dilatation that resulted in atrophy of the left hepatic lobe. One patient treated with PEI + RFA developed cholangitis and an abscess.
CONCLUSION
Combined PEI and RFA treatment has a tendency to be more effective than PEI alone for managing HCCs in high risk locations, although the difference is not statistically significant. Even though PEI is generally accepted as a safe procedure, it may cause major biliary complications for managing HCCs adjacent to the portal vein.

Keyword

Radiofrequency ablation; Percutaneous ethanol injection; Hepatocellular carcinoma; Liver imaging; Complication

MeSH Terms

Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*drug therapy/*surgery
Catheter Ablation/*methods
Chemoembolization, Therapeutic/*methods
Disease Progression
Ethanol/administration & dosage
Female
Humans
Liver Neoplasms/*drug therapy/*surgery
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Statistics, Nonparametric
Tomography, X-Ray Computed
Ethanol

Figure

• 

  Fig. 1 1.8 cm sized hepatocellular carcinoma (HCC) in 47-year-old man with liver cirrhosis due to chronic hepatitis B viral infection. He had no previous treatment history for HCC. A. Axial hepatobiliary phase MRI image (repetition time/echo time, 4.4/2.1 ms) obtained 20 minutes after administration of gadoxetic acid shows 1.8 cm sized HCC lesion in hepatic segment 4, as low signal intensity (arrowheads). Tumor is in contact with hilar bile ducts shown as high signal intensity (arrows). B. On ultrasonogram, tumor in hepatic segment 4 is seen as low echogenecity (arrowheads), in contact with left portal vein at hilar level. Although bile duct is not delineated on this image, it is highly likely that this tumor is contacting left hilar bile duct, as well. C. Axial portal phase CT image obtained immediately after percutaneous ethanol injection (PEI) shows complete ablation of HCC (arrowheads) with no residual tumor. D. Although not shown here, liver CT taken 1 month after PEI demonstrated dilatation of left intrahepatic bile duct. Axial portal phase image of dynamic liver CT obtained 10 months after PEI shows progression of bile duct dilatation, which resulted in atrophy of left hepatic lobe.

• 

  Fig. 2 61-year-old man with underlying liver cirrhosis due to chronic hepatitis B viral infection who had previous treatment history of right hemihepatectomy followed by multiple episodes of transcatheter arterial chemoembilization and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). A. Axial arterial phase image of dynamic liver CT shows accumulated iodized oil (black arrowhead) in left lateral segment. Anterior to accumulated iodized oil there is ill-defined enhancing area with maximum diameter of 1.5 cm, suggesting viable HCC (white arrowheads). This enhancing lesion is contacting left portal vein (arrows). Combined percutaneous ethanol injection (PEI) and RFA was conducted with technical success. B. Patient complained of abdominal pain and fever about 40 days after combined PEI and RFA. Axial arterial phase image of dynamic liver CT taken for evaluation demonstrates no evidence of local tumor progression, but abscess demonstrates formation in ablated zone (black arrowheads). Dilatation of intrahepatic bile ducts with wall enhancement is also seen (white arrowheads), suggesting cholangitis.

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