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Abstracts
P109
Methods: Using an internet registry of 765 liver tumors by nine centers we performed a retrospective (1996 to 2005) observational study on consecutive nonsurgical LA-treated HCCs. Effectiveness was assessed by absence of enhancement on CT scans 30 d after LA. Complications were recorded (Goldberg, Radiology 2005) and related to patient/ nodule or LA characteristics using Fisher, Chi square or Mann-Whitney tests for statistical evaluation. Results: Five hundred twenty HCCs (353 M, 167 F, age 67.2 ⫾ 7.9 % yrs) with 652 nodules (mean Ø 32,3 ⫾ 16.9 mm range 6 to 99 mm) were treated by 1011 sessions. Complete necrosis of HCCs (⬍3 cm) was obtained in 291/387 (75.2%) after one and in 363/387 (93.8%) after two sessions. There were 4/520 (0.76%) deaths (three liver failure, one intestinal perforation, all with nodules ⬎3.3 cm, difficult approach and subcapsular/exophytic localization), 11/1011 (1.08%) major complications (five of D and six of C category, SIR classification) not associated with center, patient or LA characteristics. Minor complications were found in 69/1011 (6.8%) and adverse effects in 445/1011 (44%, of which 74% pleural effusions) sessions. Conclusions: LA is an effective and safe ablation method for small HCC with low incidence of major complications.
sive puncture metal attachment whose puncture-angle can be varied according to the depth of the lesion. Methods: Wide-band pulse inversion contrast harmonic imaging with Levovist was used with a frame rate fixed at six per s. When the lesion was in the blind spot, or comparison of ultrasound section and CT section was difficult, artificial pleural effusion technique or virtual sonography was used. Results: The lesions which can be depicted with contrast CT but not be visible with ultrasound, as well as the remains of a large-scale HCC and the area with insufficient margin could be successfully treated by RFA. RFA had to be abandoned due to the location of the tumor in only 1.4% of 145 HCC cases treated with RFA in our department. Conclusions: RFA treatment for HCC became easier and more accurate by this method using the exclusive puncture attachment.
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Objectives: To assess the value of ultrasound-guided percutaneous ablation for recurrent hepatocellular carcinoma. Methods: One hundred forty-one patients with recurrent hepatocellular carcinoma (628 lesions) were treated by percutaneous ablation, including microwave, radiofrequency, ethanol and hot distilled water ablation. Local efficacy, influence on liver function and long-term outcome were observed. Results: The complete ablation rate was 92% (578/628). The complete ablation rate of microwave, radiofrequency, ethanol and hot distilled water ablation were 96.3% (105/109), 92.9% (119/128), 91.5% (311/ 340 and 84.3% (43/51), respectively. The local recurrence rate was 13.5% (78/578). The local recurrence rate of microwave, radiofrequency, ethanol and hot distilled water ablation were 11.4% (12/105), 13.4% (16/119), 11.9% (37/311) and 30.2% (13/43), respectively. After a follow-up period of two to 66 months, influence on liver function was observed in 24 patients (19%). 1-, 3- and 5-y overall survival rate was 75%, 53% and 26%, respectively. Conclusions: According to local factors such as tumor size and tumor location, as well as other factors such as liver function, economic situation and vital organs conditions, repeated, individualized and combined interventional treatment for patients with recurrent hepatocellular carcinoma is safe and beneficial to liver function, and can improve the patient’s prognosis.
Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in hepatic dome: Initial experience Rhim H, Lim HK, Kim Y-S, Lee WJ, Kim MJ, Choi D, Lee EJ, Sungkyunwan University, School of Medicine, Samsung Medical Center, Korea Objectives: To assess the efficacy and safety of percutaneous radiofrequency (RF) ablation with artificial ascites for hepatocellular carcinoma (HCC) in hepatic dome. Methods: Percutaneous RF ablations with artificial ascites were performed in 24 patients with 31 HCCs. At least one tumor in each patient was considered difficult to be treated with conventional technique because it was partially visible with poor electrode path on planning ultrasonography (US). Artificial ascites was achieved by dripping of dextrose/water solution into the peri-hepatic space via 6 Fr angiosheath. RF ablations were performed using internally cooled electrodes and 200 W RF generator after induction of artificial ascites. We assessed the efficacy and safety of RF ablation with artificial ascites with at least one month follow-up. Results: Artificial ascites was successfully achieved in 21 (87.5 %) of 24 patients. The amount of artificial ascites ranged from 150 to 1000 ml (mean, 364 ml). There was substantial improvement in the tumor visibility on US in 11 (45.8%) of 24 cases. Twenty nine (94%) of 31 tumors appeared completely necrotic without any incidents at immediate CT. No delayed complication related to artificial ascites occurred. Conclusions: Percutaneous RF ablation with artificial ascites appears an effective and a safe technique in treating HCC of hepatic dome. 2113 Establishment of real-time contrast ultrasound guided radiofrequency ablation for hepatocellular carcinoma and development of exclusive variable-angle puncture attachment Tamai H, Shingaki N, Shiraki T, Yanaoka K, Arii K, Shimizu Y, Oka M, Ichinose M, Second Department of Internal Medicine, Wakayama Medical University, Japan Objectives: Percutaneous ultrasound-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a minimally invasive method with a high cure rate. However, RFA is difficult for lesions that cannot be visualized on ultrasound. In order to treat such lesions accurately we developed a real-time contrast ultrasound-guided RFA method using the Hitachi EUB-6500 and the newly developed exclu-
2114 Ultrasound-guided percutaneous ablation for recurrent hepatocellular carcinoma Xiaoyan X, First Affiliated Hospital, Sun Yat-sen University, China
2116 Sonography guided percutaneous radiofrequency ablation of hepatocellular carcinomas: Effect of cooperative training on pretreatment assessment of feasibility Kim MJ, Lim HK, Lee EJ, Choi D, Lee WJ, Rhim H-C, Park CK, Samsung Medical Center, Korea Objectives: The aim of the study was to investigate the effect of a cooperative training on the pretreatment assessment of feasibility of sonography guided percutaneous RF ablation for HCC. Methods: We prospectively enrolled 146 patients with 200 nodular HCCs for sonography guided percutaneous RF ablation. Three radiologists with differing levels of experience in RF ablation performed pretreatment sonography to evaluate whether RF ablation was feasible or not. They scanned 74 patients with 100 HCCs independently before a cooperative training and decided the feasibility. After a training, the 72 patients with 100 HCCs were examined by the same radiologists. They described the reasons of unfeasibility. We evaluated the feasibility rates. The reasons of unfeasibility were analyzed. The interobserver
P109
Methods: Using an internet registry of 765 liver tumors by nine centers we performed a retrospective (1996 to 2005) observational study on consecutive nonsurgical LA-treated HCCs. Effectiveness was assessed by absence of enhancement on CT scans 30 d after LA. Complications were recorded (Goldberg, Radiology 2005) and related to patient/ nodule or LA characteristics using Fisher, Chi square or Mann-Whitney tests for statistical evaluation. Results: Five hundred twenty HCCs (353 M, 167 F, age 67.2 ⫾ 7.9 % yrs) with 652 nodules (mean Ø 32,3 ⫾ 16.9 mm range 6 to 99 mm) were treated by 1011 sessions. Complete necrosis of HCCs (⬍3 cm) was obtained in 291/387 (75.2%) after one and in 363/387 (93.8%) after two sessions. There were 4/520 (0.76%) deaths (three liver failure, one intestinal perforation, all with nodules ⬎3.3 cm, difficult approach and subcapsular/exophytic localization), 11/1011 (1.08%) major complications (five of D and six of C category, SIR classification) not associated with center, patient or LA characteristics. Minor complications were found in 69/1011 (6.8%) and adverse effects in 445/1011 (44%, of which 74% pleural effusions) sessions. Conclusions: LA is an effective and safe ablation method for small HCC with low incidence of major complications.
sive puncture metal attachment whose puncture-angle can be varied according to the depth of the lesion. Methods: Wide-band pulse inversion contrast harmonic imaging with Levovist was used with a frame rate fixed at six per s. When the lesion was in the blind spot, or comparison of ultrasound section and CT section was difficult, artificial pleural effusion technique or virtual sonography was used. Results: The lesions which can be depicted with contrast CT but not be visible with ultrasound, as well as the remains of a large-scale HCC and the area with insufficient margin could be successfully treated by RFA. RFA had to be abandoned due to the location of the tumor in only 1.4% of 145 HCC cases treated with RFA in our department. Conclusions: RFA treatment for HCC became easier and more accurate by this method using the exclusive puncture attachment.
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Objectives: To assess the value of ultrasound-guided percutaneous ablation for recurrent hepatocellular carcinoma. Methods: One hundred forty-one patients with recurrent hepatocellular carcinoma (628 lesions) were treated by percutaneous ablation, including microwave, radiofrequency, ethanol and hot distilled water ablation. Local efficacy, influence on liver function and long-term outcome were observed. Results: The complete ablation rate was 92% (578/628). The complete ablation rate of microwave, radiofrequency, ethanol and hot distilled water ablation were 96.3% (105/109), 92.9% (119/128), 91.5% (311/ 340 and 84.3% (43/51), respectively. The local recurrence rate was 13.5% (78/578). The local recurrence rate of microwave, radiofrequency, ethanol and hot distilled water ablation were 11.4% (12/105), 13.4% (16/119), 11.9% (37/311) and 30.2% (13/43), respectively. After a follow-up period of two to 66 months, influence on liver function was observed in 24 patients (19%). 1-, 3- and 5-y overall survival rate was 75%, 53% and 26%, respectively. Conclusions: According to local factors such as tumor size and tumor location, as well as other factors such as liver function, economic situation and vital organs conditions, repeated, individualized and combined interventional treatment for patients with recurrent hepatocellular carcinoma is safe and beneficial to liver function, and can improve the patient’s prognosis.
Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in hepatic dome: Initial experience Rhim H, Lim HK, Kim Y-S, Lee WJ, Kim MJ, Choi D, Lee EJ, Sungkyunwan University, School of Medicine, Samsung Medical Center, Korea Objectives: To assess the efficacy and safety of percutaneous radiofrequency (RF) ablation with artificial ascites for hepatocellular carcinoma (HCC) in hepatic dome. Methods: Percutaneous RF ablations with artificial ascites were performed in 24 patients with 31 HCCs. At least one tumor in each patient was considered difficult to be treated with conventional technique because it was partially visible with poor electrode path on planning ultrasonography (US). Artificial ascites was achieved by dripping of dextrose/water solution into the peri-hepatic space via 6 Fr angiosheath. RF ablations were performed using internally cooled electrodes and 200 W RF generator after induction of artificial ascites. We assessed the efficacy and safety of RF ablation with artificial ascites with at least one month follow-up. Results: Artificial ascites was successfully achieved in 21 (87.5 %) of 24 patients. The amount of artificial ascites ranged from 150 to 1000 ml (mean, 364 ml). There was substantial improvement in the tumor visibility on US in 11 (45.8%) of 24 cases. Twenty nine (94%) of 31 tumors appeared completely necrotic without any incidents at immediate CT. No delayed complication related to artificial ascites occurred. Conclusions: Percutaneous RF ablation with artificial ascites appears an effective and a safe technique in treating HCC of hepatic dome. 2113 Establishment of real-time contrast ultrasound guided radiofrequency ablation for hepatocellular carcinoma and development of exclusive variable-angle puncture attachment Tamai H, Shingaki N, Shiraki T, Yanaoka K, Arii K, Shimizu Y, Oka M, Ichinose M, Second Department of Internal Medicine, Wakayama Medical University, Japan Objectives: Percutaneous ultrasound-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a minimally invasive method with a high cure rate. However, RFA is difficult for lesions that cannot be visualized on ultrasound. In order to treat such lesions accurately we developed a real-time contrast ultrasound-guided RFA method using the Hitachi EUB-6500 and the newly developed exclu-
2114 Ultrasound-guided percutaneous ablation for recurrent hepatocellular carcinoma Xiaoyan X, First Affiliated Hospital, Sun Yat-sen University, China
2116 Sonography guided percutaneous radiofrequency ablation of hepatocellular carcinomas: Effect of cooperative training on pretreatment assessment of feasibility Kim MJ, Lim HK, Lee EJ, Choi D, Lee WJ, Rhim H-C, Park CK, Samsung Medical Center, Korea Objectives: The aim of the study was to investigate the effect of a cooperative training on the pretreatment assessment of feasibility of sonography guided percutaneous RF ablation for HCC. Methods: We prospectively enrolled 146 patients with 200 nodular HCCs for sonography guided percutaneous RF ablation. Three radiologists with differing levels of experience in RF ablation performed pretreatment sonography to evaluate whether RF ablation was feasible or not. They scanned 74 patients with 100 HCCs independently before a cooperative training and decided the feasibility. After a training, the 72 patients with 100 HCCs were examined by the same radiologists. They described the reasons of unfeasibility. We evaluated the feasibility rates. The reasons of unfeasibility were analyzed. The interobserver