Nonresectable Hepatocellular Carcinoma

Abstract

OBJECTIVE. The purpose of our study was to evaluate the usefulness of percutaneous ethanol installation using CO₂-enhanced sonography for patients with nonresectable hepatocellular carcinoma (HCC). SUBJECTS AND METHODS. Forty-six patients with 65 HCC lesions were examined with contrast-enhanced sonography with direct injection of CO₂ into the proper hepatic artery during arteriography. We performed percutaneous ethanol injection guided by CO₂-enhanced sonography for the treatment of hypervascular HCC lesions that could not be treated with conventional percutaneous ethanol injection or with transcatheter arterial embolization. RESULTS. CO₂-enhanced sonography detected five additional small HCC lesions before treatment (pp2-enhanced sonography showed positive enhancement of residual lesions after initial treatment (n = 3) and incomplete local treatment (n = 5) that were not detected on conventional sonography. These 27 lesions were successfully treated with percutaneous ethanol injection using a mixture of iodized oil and ethanol and guided by CO₂-enhanced sonography. CONCLUSION. CO₂-enhanced sonography is a sensitive method for detecting residual viable lesions and small new HCC lesions that cannot be detected with conventional sonography. Percutaneous ethanol injection guided by CO₂-enhanced sonography can treat hypervascular HCC lesions that cannot be treated with conventional percutaneous ethanol injection or transcatheter arterial embolization.