title: Percutaneous ethanol injection under CT fluoroscopy for hypervascular hepatocellular carcinoma following transcatheter arterial embolization.
abstract: OBJECTIVE
  The present study was conducted to accurately monitor the pattern of ethanol distribution during percutaneous ethanol injection by computed tomography fluoroscopy and to examine the relationship between the distribution pattern and therapeutic effect.
  
  
  METHODS
  Twenty-five hypervascular hepatocellular carcinomas were studied. Each was treated with transcatheter arterial embolization. However, as residual parts were detected, percutaneous ethanol injection under real-time computed tomography fluoroscopy was performed. For analysis, ethanol distribution and local recurrence rate were compared.
  
  
  RESULTS
  Ethanol distribution in a tumor was classifiable into 3 patterns. In pattern 1, ethanol solution was distributed spherically. In pattern 2, ethanol solution spread forming linear boundaries indicating interruption of distribution by septa. In pattern 3, ethanol spread circumferentially only along the periphery sparing the central part of a tumor. The 6-month recurrence rate of the tumors in which ethanol solution was distributed to the whole viable part was 25% (pattern 1), 100% (pattern 2) and 0% (pattern 3), respectively.
  
  
  CONCLUSIONS
  In the tumors showing distribution pattern 3 by computed tomography fluoroscopy, a combination therapy of transcatheter arterial embolization and percutaneous ethanol injection was more effective than in other patterns. Computed tomography fluoroscopy was useful for accurate monitoring and predicting the therapeutic effect of percutaneous ethanol injection.
authors.affiliation: Department of Pathology, Osaka City University Medical School, 1-5-7, Asahi-machi, Abeno-ku, Osaka 545-858, Japan. hamuro@msic.med.osaka-cu.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Hamuro
authors.forename: Toshio
authors.initials: T
authors.lastname: Kaminou
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakamura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Sakai
authors.forename: Akira
authors.initials: A
authors.lastname: Morimoto
authors.forename: Seisyou
authors.initials: S
authors.lastname: Hayashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamura
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Hatagawa
authors.forename: Ryusaku
authors.initials: R
authors.lastname: Yamada
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D000431:Ethanol