Percutaneous ethanol injection under CT fluoroscopy for hypervascular hepatocellular carcinoma following transcatheter arterial embolization.
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.
Hamuro
Masao
M
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
Kaminou
Toshio
T
Nakamura
Kenji
K
Matsuoka
Toshiyuki
T
Sakai
Yukimasa
Y
Morimoto
Akira
A
Hayashi
Seisyou
S
Nakamura
Atsushi
A
Hatagawa
Masakatsu
M
Yamada
Ryusaku
R
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
D000431:Ethanol