Percutaneous ethanol lipiodol injection therapy of
recurred hepatocellular carcinoma after trans-arterial
chemoembolization in high-risk locations
Poster No.:
C-540
Congress:
ECR 2009
Type:
Scientific Exhibit
Topic:
Interventional Radiology
Authors:
H.-K. Ko, L. Jong Tae, J. Y. Won, S. Choi; Seoul/
Keywords:
hepatocellular carcinoma, percutaneous ethanol lipiodol Injection
therapy
DOI:
10.1594/ecr2009/C-540
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Page 1 of 14
Purpose
The purpose of this study is to evaluate the safety andeffectiveness of percutaneous
ethanol lipiodol injection therapy (PELIT) of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) in high-risklocations.
Methods and Materials
1. From April 2006 to March 2008,
Total 22 patients with 22 recurred HCC nodules after repeated TACE were included in
this study.
2. Repeated TACE was impossible due to
•
•
hypovascularity (n=12) and
rudimentary chnage of feeding arteries after repeated embolization (n=10).
3. Included lesions in all patients have High-risk location for RFA
4. PELIT was performed
-under real time fluoroscopy guidance
-Alternative injection of lipiodol and pure ethanol
-During and immediate after the procedure: cone-beam CT scan (Dyna-CT; Siemens
Medical Solution, Forchheim, Germany).
5. 1,3,6 month F/U with MDCT 6. Complications, effectiveness of PELIT, and prognosis
of the patients were evaluated.
Images for this section:
Page 2 of 14
Fig. 1: Before CBCT guidance as a main procedure, Dyna CT supplied fluoroscopic
image that was helpful that the author inserted the needle.
Page 3 of 14
Fig. 2: Using DYNA CT (Siemens), after single breath hold with 8 sec, non contrast CT
image can be obtained. With this CBCT image, we confirm the needle targeting. And
after PELIT, the author could evaluate the immediate result.
Page 4 of 14
Fig. 3: The lesion was close attached to main portal vein and GB. Not only dangerous
but also heat cooling effect is suspected.
Page 5 of 14
Fig. 4: The lesion is located to subphrenic area where the targeting is difficult. And also
heat damage to diaphragm and pleura are guessed when RFA.
Page 6 of 14
Fig. 5: For PELIT, We used all kind of radiologic device. This is a US guidance for real
time monitoring.
Page 7 of 14
Results
1.Follow-up: mean-14 months
2. 31 PELIT sessions /22 nodules.
-Mean: 1.41/nodule
3. Primary success rate with first PELIT
-15/22 nodules (68.2%).
4. Secondary success rate
-17/22 nodules (77.3 %)
5. local recurrence: 7/22 nodules (31.8%).
-Repeated PELIT: 4/7
- 2/4 nodules: complete necrosis
- Planning repeated PELIT: 5 patients
6. All of patients survived during follow up period.
7. No major complication.
Images for this section:
Page 8 of 14
Fig. 1: Under fluoroscopy and CBCT guidance, PELIT was done. Immediate after CBCT
and 3 month F/U CT scan showed complete resolution without evidence of viablie tumor.
Page 9 of 14
Fig. 2: After repeated TACE, due to arterial damage and hypovascularity, additional
TACE was impossible to treat residual HCC.
Fig. 3: Residual tumor with arterial enhancement and delayed washout was seen in prePELIT CT scan.
Page 10 of 14
Fig. 4: Fluoroscopy image during the PELIT. Under fluoroscopic guidance, with Chiba
needle, alternative injection of lipiodol and ethanol
Page 11 of 14
Fig. 5: Immediate F/U CBCT (cone beam CT, Dyna CT) after PELIT showed complete
impaction and deposition of lipoidol which was injected percutaneously. With this CBCT,
immediate result could be evaluated.
Fig. 6: After 3 month F/U CT scan showed complete lipiodol impaction without viable
HCC in treated HCC with PELIT.
Page 12 of 14
Fig. 7: Small HCC nodule in seg 7 showed still viablity after initial TACE.
Page 13 of 14
Conclusion
PELIT under fluoroscopy and cone-beam CT guidance is safe and effective for the
treatment of recurred HCC afterTACE in high-risk locations.
Page 14 of 14