Hepatocellular Carcinoma Ablation By Combining Percutaneous Microwave Coagulation And Ethanol Injection And Role Of Contrast-enhanced Ultrasound In Combining Treatment

Part one Value of contrast-enhanced ultrasonography in detection of feeding artery of hepatocellular carcinomaObjective To evaluate value of contrast-enhanced ultrasonography(CEUS) in detection of feeding artery of hepatocellular carcinoma(HCC).Methods CEUS were performed on 72 patients with HCC to detect feeding artery. The blood flow image of feeding artery was observed and was compared with color Doppler sonography.And the type and diameter of feeding artery were also observed with CEUS.Results A feeding artery was detected in 68 HCCs(94.4%) with CEUS,A feeding artery was detected in 38 HCCs(52.8%) with color Doppler sonography(P＜0.05). The feeding artery of HCCs could be classified into surrounding artery pattern or branching artery pattern.Compared with DSA, the accuracy of CEUS was 93.3% for detecting the feeding artery patterns. Kappa value was 0.86. The diameter of feeding artery in 1～3cm HCCs was smaller than in～5cm HCCs(P＜0.05), the diameter of feeding artery in the～5cm groups was smaller than in the～8cm HCCs (p＜0.05). Conclusion CEUS can image the feeding artery very well,and is a very sensitive technique of detecting micro-vessel, has very important clinical value. Part two Hepatocellular carcinoma ablation by combining percutaneous microwave coagulation therapy and ethanol injectionObjective We sought to determine if larger hepatocellular carcinoma(HCC) ablative volumes could be obtained by combining percutaneous microwave coagulation therapy(PMCT) and ethanol injection(PEI), by PEI followed by PMCT with occlusion of the feeding artery.Methods Forty patients with 48 HCCs(diameter,2-5cm) were treated with (Ⅰ) percutaneous microwave coagulation therapy; (Ⅱ) combined therapy of PEI immediately followed by PMCT; (Ⅲ) combined therapy of PEI immediately followed by PMCT with occlusion of the feeding artery. The coagulated area was measured at the maximum diameter perpendicular to the needle tract on enhanced computed tomography (CT) performed immediately after therapy. The local effect of the treatment was evaluated by follow-up enhanced CT.and the rate of complete necrosis were compared with three treatment groups. Results The coagulation area in groupⅠwere 28±4.6mm, the rate of complete necrosis in groupⅠwere 58.8%(10/17); The coagulation area in groupⅡwere 36±8.3mm, the rate of complete necrosis in groupⅡwere 73.4%(11/15); the coagulation area in groupⅢwere 46±8.5mm, the rate of complete necrosis in groupⅢwere 93.8%(15/16). The difference in the coagulation area and the rate of necrosis were significantly larger in the groupⅡthan groupⅠ(p＜0.001,p＜0.05). Thedifference in the coagulation area and the rate of necrosis were significantly larger in groupⅢthan groupⅡ(p＜0.001,p＜0.05).Conclusions Combined therapy of PEI immediately followed by PMCT, especially combined therapy of PEI immediately followed by PMCT with occlusion of the feeding artery can significantly coagulate larger volumes of tumor and improve the rate of complete necrosis. Part three Evaluation of non-surgical treatment response in hepatocellular carcinomas using contrast-enhanced sonography: comparison with contrast-enhanced helical CTObjective: To compare the efficacy of contrast-enhanced sonography with contrast-enhanced helical CT for non-surgical treatment response in hepatocellular carcinomas.Materials and Methods: Non-surgical therapies were performed on 56 patients with 64 liver neoplasms. Including 4 patients performing TACE, eight patients performing PEI,eleven patients performing PMCT, five patients performing RFA, four patients performing TACE+PEI, three patients performing TACE+PMCT, eleven patients performing PEI+PMCT, ten patients performing PEI+occlusion of the feeding artery +PMCT, and diagnosies were made before non-surgical therapies by US-guided biopsy. Sono Vue enhanced ultrasonography and contrast-enhanced helical CT were performed to assessing the treatment response.Results: Forty-six of 64 lesions were not enhanced with contrast-enhanced sonography.Partial enhancement were demonstrated in 18 lesions. Forty-eight of 64 lesions were not enhanced with contrast- enhanced helical CT.Partial enhancement were demonstrated in 16 lesions.The sensitivity,specificity and accuracy were 94.4%,97.8%,96.9% for contrast-enhanced sonography and 83.3%,97.8%,93.8% for contrast-enhanced helical CT compared with clinic(P＞0.05). There were no significant differences between contrast-enhanced sonography and contrast-enhanced helical CT.Conclusion: Contrast-enhanced sonography is at least comparable with contrast-enhanced helical CT in assessing the non-surgical treatment response in hepatocellular carcinomas and is more sensitive and useful in assessing treatment response of TACE and some patents without residue tumors with contrast-enhanced helical CT.