title: Computed tomography demonstration of immediate and delayed complications of computed tomography-guided transthoracic percutaneous ethanol injection of hepatocellular carcinoma at the liver dome.
abstract: OBJECTIVE
  We conducted this study to correlate computed tomography (CT) images with the complications induced by CT-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC).
  
  
  METHODS
  Twenty-two patients with ultrasonographically unreachable HCC were treated with CT-guided transthoracic PEI. The procedures and the CT findings were recorded to correlate with the various complications of PEI.
  
  
  RESULTS
  After the ethanol injection, 3 patterns of CT images were identified according to the distribution of ethanol (ie, intratumoral, extrahepatic, and intrahepatic patterns). The intrahepatic pattern was further classified as the branch, tubular, and infiltrative types. During the follow-up period, 3 patients developed biliary stricture, portal vein thrombosis, or tumor seeding. The tubular type was associated with the development of biliary stricture, whereas the branch type was related to the occurrence of portal vein thrombosis. These complications were considered to be caused by a greater amount of ethanol leakage into bile ducts or portal veins than in cases without complications (median = 17 mL vs. 0 mL, P = 0.002).
  
  
  CONCLUSIONS
  Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.
authors.affiliation: Department of Radiology, College of Medicine, University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan 704, Taiwan.
authors.forename: Hong-Ming
authors.initials: HM
authors.lastname: Tsai
authors.forename: Xi-Zhang
authors.initials: XZ
authors.lastname: Lin
authors.forename: Chiung-Yu
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D000431:Ethanol / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012997:Solvents / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000379:methods
chemical_list: D012997:Solvents; D000431:Ethanol