title: MR-guided percutaneous ethanol ablation of hepatocellular carcinomas before liver transplantation.
abstract: It was the objective of this study to evaluate MR-guided, percutaneous ethanol injection of hepatocellular carcinoma in ten patients scheduled for liver transplantation. Using a 0.2 T open MR scanner (Magnetom Open, Siemens Medical Systems, Erlangen, Germany) and percutaneous instillation of ethanol, 12 liver tumors (median tumor volume, 6.3; range, 0.6-43.2 ccm) were treated. Coagulation necrosis, morbidity, and post-transplant histology were assessed. No major complications were observed. A mean of 16.4+/-11.4 ml ethanol was injected for each tumor. The median volume of the ablation necrosis was 12.3 (range, 0.3-48.3) ccm. Three tumors were retreated and complete radiological necrosis before liver transplantation was found in eight of 12 tumors (67%). One patient developed multifocal disease and was excluded from transplantation; thus nine of ten patients underwent liver transplantation within 3.9+/-3.1 months. In the explants, satellite nodules (n = 2), new liver tumors (n = 2) and a complete necrosis were found in five of 12 treated tumors (42%). During follow-up (median 41.3; range, 0.4-86.1 months), three patients died, but no tumor-seeding or post-transplantation recurrence occurred. MR-guided ethanol injection is feasible, and may delay tumor progression. However, the local recurrence rate is high, and the spatial resolution of a low-field MR scanner limits the detection of small tumors.
authors.affiliation: Cardiovascular and Interventional Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Melanie
authors.initials: M
authors.lastname: Blum
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Markus
authors.initials: M
authors.lastname: Peck-Radosavljevic
authors.forename: Friedrich
authors.initials: F
authors.lastname: Wrba
authors.forename: Gabriela
authors.initials: G
authors.lastname: Berlakovich
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mühlbacher
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steiniger
authors.forename: Maria
authors.initials: M
authors.lastname: Speiser
authors.forename: Mario
authors.initials: M
authors.lastname: Pones
authors.forename: Michael
authors.initials: M
authors.lastname: Hüpfl
authors.forename: Johannes
authors.initials: J
authors.lastname: Lammer
authors.forename: Joachim
authors.initials: J
authors.lastname: Kettenbach
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local
chemical_list: D000431:Ethanol