Use of Epinephrine Infusion During CT Hepatic Arteriography (Pharmaco-CTHA):Clinical Application in Patients with Hepatocellular Carcinoma

PURPOSE: To evaluate the usefulness of epinephrine infusion (Pharmaco-CTHA) prior to liver to liver spiral CT during hepatic arteriography in patients with hepatocellular carcinoma. MATERIALS AND METHODS: Twenty-two patients in whom hepatocellular carcinoma had been diagnosed underwent three types of liver spiral CT during hepatic arteriography. In the first method, spiral CT scanning was started 5 seconds after injecting 8cc of contrast media at a rate of 0.3cc/sec. In the second, 10 microgram of epinephrine was slowly injected for 1 minute via the catheter and subsequent spiral CT scanning began 11 seconds after injecting 8cc of contrast media at a rate of 0.3cc/sec. In the third method, spiral CT scanning was started 5 seconds after injecting 25cc of contrast media at a rate of 1cc/sec. The following were evaluated and compared with the results of follow-up lipiodol CT: 1) the incidence of false positive lesions; 2) the incidence of false negative lesions; 3) portal enhancement; and 4) lesion conspicuity. RESULTS: Follow-up lipiodol CT of 22 patients showed 16 masses. In 12 patients there was no lipiodol uptake, and in five, four and one patient(s), uptake occurred once, twice, and three times, respectively. With method 1there were nine false-positive lesions, with method 2 there were 13, and with method 3, there were 49. The use of method 2(Pharmaco-CTNA) led to less false-positives than did method 3 (conventional CTHA)(p=0.000). Method 1 showed the lowest false positive rate (nine lesions), but its false-negative rate was two and four times higher than with method 2 (four lesions) and with method 3 (two lesions), respectively. Portal enhancement was observed four times using method 3 and once with method 1, but was absent with method 2. As regards the conspicuity of 16 masses, "good" and "excellent" lesions were seen four times with method 1(25%), ten times with method 2 (62.5%) and thirteen times with method 3 (81.3%). CONCLUSION: The infusion of epinephrine (Pharmaco-CTHA) prior to spiral CT during hepatic arteriography has the advantage of reducing the amount of contrast media required as well as the number of cases which are false positive and show no portal enhancement.

Microwave Tissue Coagulation: Effects of Power and Treatment Time on Coagulation size

PURPOSE: To determine the effects of power and coagulation time on lesion size of ex-vivo bovine liver using microwaves. MATERIALS AND METHODS: Six bovine livers were divided into two groups(first group: 30W output, secondgroup: 60W output) and microwave coagulation was performed for 30, 60, and 120 sec. thermal injury site was thenobserved by means of sonography, and the maximal transverse diameter of the echo-change portion after microwave coagulation was measured. On the section of specimen, maximal transverse diameters of the thermal injury site weremeasured by gross inspection and compared with the result of sonographic measurement. RESULTS: Maximal transversediameters of hyperechoic lesions of the first group, as seen on sonography were 8.3 mm, 12.2mm, and 15.6mm, andthe maximal transverse diameters of thermal injury sites on gross specimens were 9.1mm, 12.0mm, and 15.1mm,respectively. Maximal transverse diameters of hyperechoic lesions of the second group, as seen on sonography, were12.1 mm, 17.4 mm, and 21.2 mm and maximal transverse diameters of thermal injury sites on gross specimens were13.2 mm, 16.0 mm, and 20.0 mm, respectively. Statistically maximal transverse diameters of hyperechoic lesions, asseen on sonography, correlated closely with the gross findings of maximal transverse diameters of thermal injurysites(p<0.05). CONCLUSION: Maximal transverse diameters of thermal injury sites were significantly increased asthe output of the microwave coagulator and the duration of coagulation time increased(p<0.05).