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Percutaneous Ablation Therapy Guided by Contrast-Enhanced Sonography for Patients with Hepatocellular Carcinoma

Kazushi Numata1, Tetsuo Isozaki2, Yutaka Ozawa2, Takashi Sakaguchi2, Takayoshi Kiba2, Toru Kubota3, Akira Ito1, Kazuya Sugimori4, Kazuhito Shirato4, Manabu Morimoto4 and Katsuaki Tanaka4

1 Clinical Laboratory, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
2 Third Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama 236-0004, Japan.
3 Second Department of Surgery, Yokohama City University School of Medicine, Yokohama 236-0004, Japan.
4 Gastroenterological Center, Yokohama City University Medical Center, Yokohama, 232-0024, Japan.



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  		Fig. 1B. —65-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 14 mm) in superior anterior segment of right lobe of liver. Conventional sonogram does not show tumor.

 


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  		Fig. 2A. —59-year-old man with Child's [15] class B cirrhosis and hepatocellular carcinoma (maximal diameter, 18 mm) in inferior posterior segment of right lobe of liver. Conventional sonogram does not show tumor clearly.

 


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  		Fig. 3A. —73-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 8 mm) in inferior anterior segment of right lobe of liver. Conventional sonogram does not show tumor.

 


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  		Fig. 1C. —65-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 14 mm) in superior anterior segment of right lobe of liver. Arterial phase real-time contrast-enhanced harmonic gray-scale sonogram shows hypervascular enhancement. Arrowheads point to tumor margin.

 


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  		Fig. 2B. —59-year-old man with Child's [15] class B cirrhosis and hepatocellular carcinoma (maximal diameter, 18 mm) in inferior posterior segment of right lobe of liver. Arterial phase real-time contrast-enhanced harmonic gray-scale sonogram shows tumor with homogeneous enhancement. Arrowheads point to margin of tumor.

 


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  		Fig. 3C. —73-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 8 mm) in inferior anterior segment of right lobe of liver. Arterial phase real-time contrast-enhanced harmonic gray-scale sonogram shows tumor and tumor margin (arrowheads). Homogeneous tumor enhancement can be seen.

 


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  		Fig. 2C. —59-year-old man with Child's [15] class B cirrhosis and hepatocellular carcinoma (maximal diameter, 18 mm) in inferior posterior segment of right lobe of liver. Arterial phase real-time contrast-enhanced harmonic gray-scale sonogram shows tip of radiofrequency ablation electrode (arrow) in tumor.

 


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  		Fig. 1D. —65-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 14 mm) in superior anterior segment of right lobe of liver. Real-time contrast-enhanced harmonic gray-scale sonogram obtained after injection of 1 mL ethanol shows treated hyperechoic area in tumor. Acoustic shadow is seen behind this area. Arrowheads point to tumor margin.

 


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  		Fig. 2D. —59-year-old man with Child's [15] class B cirrhosis and hepatocellular carcinoma (maximal diameter, 18 mm) in inferior posterior segment of right lobe of liver. Portal phase real-time contrast-enhanced harmonic gray-scale sonogram obtained immediately after radiofrequency ablation guided by real-time contrast-enhanced harmonic gray-scale sonography shows tumor (arrowheads) as nonenhancing area. Note that this nonenhancing area covers more than area of tumor enhancement seen in B. Enhancement of normal liver parenchyma is seen.

 


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  		Fig. 3D. —73-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 8 mm) in inferior anterior segment of right lobe of liver. Portal phase real-time contrast-enhanced harmonic gray-scale sonogram obtained immediately after percutaneous ethanol injection guided by real-time contrast-enhanced harmonic gray-scale sonography shows tumor (arrowheads) as nonenhancing area. Note that this nonenhancing area covers more than homogeneous enhancement seen in B. Enhancement of normal liver parenchyma is seen.

 


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  		Fig. 3E. —73-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 8 mm) in inferior anterior segment of right lobe of liver. Portal phase real-time contrast-enhanced harmonic gray-scale sonogram obtained 1 week after percutaneous ethanol injection guided by real-time contrast-enhanced harmonic gray-scale sonography shows tumor (arrowheads) as perfusion defect with oval shape and distinct margins. Enhancement of normal liver parenchyma is seen.

 


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  		Fig. 3B. —73-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 8 mm) in inferior anterior segment of right lobe of liver. Late phase real-time contrast-enhanced harmonic gray-scale sonogram shows tumor (arrowheads) as perfusion defect. Enhancement of normal liver parenchyma is seen.

 


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  		Fig. 1A. —65-year-old woman with Child's [15] class B cirrhosis and recurrent hepatocellular carcinoma (maximal diameter, 14 mm) in superior anterior segment of right lobe of liver. Contrast-enhanced CT scan obtained before treatment shows high-attenuation area. Arrowheads point to tumor margin.

 

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