title: Recurrent hepatocellular carcinoma after transcatheter arterial chemoembolization: planning sonography for radio frequency ablation.
abstract: OBJECTIVE
  The purposes of this study were to evaluate the sonographic findings of recurrent hepatocellular carcinoma after transcatheter arterial chemoembolization and to determine how often the lesion conspicuity of the recurrent hepatocellular carcinoma makes it suitable for percutaneous sonographically guided radio frequency ablation.
  
  
  METHODS
  A radiologist prospectively classified the echogenicity of recurrent hepatocellular carcinomas compared to that of the surrounding liver. In addition, the margin of the tumor was classified as follows: grade 1, absolutely indistinguishable; grade 2, less than 50%; grade 3, greater than 50%; and grade 4, clearly demarcated. The lesion conspicuity was also classified as follows: grade 1, absolutely invisible, thus ineligible for percutaneous sonographically guided radio frequency ablation; grade 2, poorly visible, thus unsuitable for ablation; and grade 3, visible and conspicuous, thus suitable for ablation.
  
  
  RESULTS
  A total of 37 consecutive patients (31 men and 6 women; mean age, 59.4 years) with 38 hepatocellular carcinomas were enrolled. The echogenicity of the recurrent hepatocellular carcinomas varied, with the most common finding being a heterogeneous hypoechoic lesion (31.6%), followed by an isoechoic lesion (23.7%), a heterogeneous hyperechoic lesion (18.4%), a homogeneous hypoechoic lesion (13.2%), a lesion with a hypoechoic halo (10.5%), and a homogeneous hyperechoic lesion (2.7%). The margin of the recurrent hepatocellular carcinomas was clearly demarcated in only 28.9% of tumors, whereas 23.7% of the tumors were absolutely indistinguishable from the surrounding liver. The lesion conspicuity was classified as grade 3 in only 60.5% of the recurrent hepatocellular carcinomas.
  
  
  CONCLUSIONS
  The echogenicity and margins of recurrent hepatocellular carcinomas after transcatheter arterial chemoembolization varied. The lesion conspicuity was suitable for sonographically guided radio frequency ablation in only 60.5% of cases.
authors.affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Min
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Lee
authors.forename: Hyunchul
authors.initials: H
authors.lastname: Rhim
authors.forename: Dongil
authors.initials: D
authors.lastname: Choi
authors.forename: Young-Sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Cha
authors.forename: Hyo K
authors.initials: HK
authors.lastname: Lim
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D002406:Catheterization, Peripheral; D016461:Chemoembolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods
chemical_list: D000970:Antineoplastic Agents