title: CT fluoroscopy-assisted needle puncture and ethanol injection for hepatocellular carcinoma: a preliminary study.
abstract: OBJECTIVE
  We assessed the usefulness of real-time CT fluoroscopy for needle guidance and evaluated the clinical usefulness of a unified CT fluoroscopy and angiography system in the treatment of hepatocellular carcinoma.
  
  
  METHODS
  A single-session percutaneous ethanol injection was performed with CT fluoroscopy guidance and monitoring for 15 hepatocellular carcinomas with an average size of 2.5 cm (range, 0.7-4.7 cm) in 10 consecutive patients. Of these, seven lesions were not seen on sonography. To mark the lesion for puncture, we performed CT arteriography or arterial injection of iodized oil. A puncture guide was applied to 12 lesions.
  
  
  RESULTS
  The average depth from the skin's surface to the lesion was 9.3 cm (range, 4.5-11.5 cm), and the puncture route was transthoracic in five lesions and transabdominal in 13. The overall success rate in puncturing the lesions was 94.4% (17/18 sessions). The average number of punctures was 3.3, and it significantly decreased after introduction of a puncture guide compared with freehand puncture (p < .01). The average amount of injected ethanol was 12.7 ml (range, 4-27 ml). The ratio of injected ethanol dose to calculated ethanol dose was 0.6. Local recurrence occurred in four (26.7%) of 15 lesions after an average of 5 months.
  
  
  CONCLUSIONS
  Using CT fluoroscopy for guidance of the needle and for monitoring ethanol infusion in the target lesion, we have found single-session percutaneous ethanol injection to be possible for hepatocellular carcinomas smaller than 5 cm or not revealed by sonography. The puncture guidance equipment was helpful for accurate insertion of the needle into the lesion, allowing a minimum number of punctures and minimal radiation exposure.
authors.affiliation: Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takayasu
authors.forename: Y
authors.initials: Y
authors.lastname: Muramatsu
authors.forename: S
authors.initials: S
authors.lastname: Asai
authors.forename: Y
authors.initials: Y
authors.lastname: Muramatsu
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009339:Needles; D011677:Punctures / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D000431:Ethanol