Treatment of unresectable hepatocellular carcinoma with radiolabelled lipiodol.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common solid organ tumours, with approximately 500,000 new cases being reported each year. It has a very high prevalence in Asia, and almost two-thirds of all cases occur in this region. The incidence of this tumour in Australia has nearly doubled in the past decade. Surgical resection is the mainstay of treatment, but only 10-30% of HCC are amenable to surgical resection at the time of diagnosis. The prognosis for patients with unresectable HCC remains dismal. Internal radiotherapy with radiolabelled lipiodol has been used with some success in treatment of HCC. Several studies have validated its usefulness in an adjuvant setting, but it also appears to have a role in treating unresectable tumours. METHODS: Twenty-two patients with proven HCC, not amenable to or having failed surgical treatment, were evaluated for radiolabelled lipiodol treatment. Of these, 10 patients were excluded after initial evaluation and 12 patients underwent treatment. Patients were followed up every 3 months with physical examination, computed tomography scan and alpha-fetoprotein levels. Overall survival, change in tumour size and alpha-fetoprotein levels were used to evaluate the efficacy of treatment. RESULTS: The median overall survival in patients undergoing lipiodol therapy was 15 months. Tumour size was stabilized in most patients and very few side-effects of the treatment were observed. CONCLUSION: This study has shown that radiolabelled lipiodol is an effective method for the treatment of unresectable locally advanced HCC.

Assessment of radionuclide arthrography in the evaluation of loosening of knee prostheses.

BACKGROUND: Radionuclide arthrography (RNA) is an established technique in the evaluation of hip prostheses but there is scant literature on its role in knee prostheses and no data specifically related to unicompartmental knee prostheses. We reviewed our experience with radionuclide arthrography in total (TKRs) and unicompartmental (UKRs) knee arthroplasties. METHODS: A retrospective review of 66 consecutive RNA studies that either had direct surgical correlation or arthroscopic assessment in conjunction with at least 12 months of clinical and radiological follow-up. These formed the basis of our case note review. 26 studies had a confirmed diagnosis of prosthetic loosening. RESULTS: By using standardised criteria for diagnosis and an early and late imaging protocol at 30 min and 4 h, RNA had an overall sensitivity of 88% and a specificity of 88% for the diagnosis of prosthetic loosening. The individual sensitivities and specificities were 93% and 86% for TKRs and 82% and 92% for UKRs. The technique was unable to detect femoral component loosening unless a long femoral stem was present, although only 8% of episodes of prosthetic loosening did not involve the tibial component. CONCLUSION: Radionuclide arthrography should be considered as a useful diagnostic test for the evaluation of loosening of the tibial component of knee prostheses but requires early and late imaging and close attention to detail to achieve optimal results.