Combined TACE and PEI for palliative treatment of unresectable hepatocellular carcinoma.

AIM: To assess whether the effectiveness of a combination of transarterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of unresectable hepatocellular carcinoma (HCC) is superior to TACE alone a randomized controlled trial was performed. METHODS: The effect of combination therapy on long-term survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs, randomly allocated to TACE-PEI (27 pts) or TACE alone (25 pts). RESULTS: The cumulative survival rate of the TACE group was 75.8% at 6 mo, 62.9% at 12 mo, and 18.0% at 24 mo and of the TACE-PEI group 76.9%, 61.5%, and 38.7%, respectively. Comparison of overall survival in both groups showed no statistically significant difference. Regarding the patients with HCCs Okuda stage I (n = 26), the median survival of the TACE-PEI group was significantly longer (>24 mo, median not yet reached in the study period) compared to the TACE group (18.4 mo [range 11.6-21.7 mo]; P = 0.04). TACE-PEI reduced the relative risk for mortality to 0.4 (95%CI 0.15-0.96) compared to patients who received TACE alone. Median survival in patients with HCCs Okuda stage II or III was 5.0 mo in the TACE group (1.7 mo-not defined) compared to 10.4 mo in the TACE-PEI group. CONCLUSION: The combination TACE-PEI improved survival time compared to TACE alone. Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably.

Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection.

PURPOSE: To compare the effectiveness of radio-frequency (RF) thermal ablation with that of percutaneous ethanol injection (PEI) for the treatment of small hepatocellular carcinoma (HCC) in patients with cirrhosis. MATERIALS AND METHODS: A series of 102 patients with hepatic cirrhosis and either single HCC 5 cm in diameter or smaller or as many as three HCCs each 3 cm or smaller (overall number of lesions, 142) randomly received either RF ablation (n = 52) or PEI (n = 50) as the sole first-line anticancer treatment. Mean follow-up was 22.9 months +/- 9.4 (SD) in the RF group and 22.4 months +/- 8.6 in the PEI group. Prognostic value of treatment techniques was assessed with univariate and multivariate Cox proportional hazards regression models. RESULTS: One- and 2-year survival rates were 100% and 98% in the RF group and 96% and 88% in the PEI group, respectively (univariate relative risk [RR] = 0.20; 95% CI: 0.02, 1.69; P =.138). One- and 2-year local recurrence-free survival rates were 98% and 96% in the RF group and 83% and 62% in the PEI group, respectively (univariate RR = 0.17; 95% CI: 0.06, 0.51; P =.002). One- and 2-year event-free survival rates were 86% and 64% for the RF group and 77% and 43% for the PEI group, respectively (univariate RR = 0.48; 95% CI: 0.27, 0.85; P =.012). RF treatment was confirmed as an independent prognostic factor for local recurrence-free survival rates with multivariate analysis (adjusted RR = 0.20; 95% CI: 0.05, 0.73; P =.015). CONCLUSION: RF ablation is superior to PEI with respect to local recurrence-free survival rates.

Assessment of pulmonary perfusion with ultrafast projection magnetic resonance angiography in comparison with lung perfusion scintigraphy in patients with malignant stenosis.

RATIONALE AND OBJECTIVE: The aim of this study was to demonstrate and measure perfusion deficits caused by central bronchogenic carcinoma and to compare magnetic resonance angiography (MRA) perfusion data with data of perfusion scintigraphy. The diagnostic value of 2D MRA in detection of malignant pulmonary artery stenosis in comparison with conventional DSA was investigated. MATERIALS AND METHODS: Eighteen patients were included in the study. MRA, conventional pulmonary angiograms, and pulmonary perfusion scintigrams were performed. MRA and DSA were compared and MR pulmonary perfusion data were assessed and compared with scintigraphical data. RESULTS: Perfusion defect could be demonstrated and localized in all patients. A quantitative perfusion deficit and a side dependent perfusion ratio could be evaluated. There was statistically significant correlation between MR perfusion and scintigraphically acquired data. 2D MRA showed a high correlation for detection and grading of stenosis compared with angiograms. CONCLUSIONS: Pulmonary perfusion could be demonstrated by using an ultrafast 2D projection MR DSA sequence. This technique allows measurement and quantification of pulmonary perfusion abnormalities in patients with malignant stenosis with statistically significant correlation to perfusion scintigraphy. The diagnostic potency in the evaluation of malignant pulmonary artery stenosis compared with conventional DSA could be shown.

Pulmonary sequestration: demonstration of blood supply with 2D and 3D MR angiography.

Pulmonary sequestration is a relatively rare but clinically significant congenital anomaly. This disease is a spectrum of disorders involving the pulmonary airways, the arterial supply to the lungs, the lung parenchyma and its venous drainage. Traditionally, the diagnosis of pulmonary sequestration has been made definitively with arterial angiography. It is imperative for the preoperative evaluation that the arterial supply and venous drainage of the sequestered segment is identified. Several cases of MR diagnosis and preoperative evaluation of pulmonary sequestration and blood supply have been reported. In this case, MR imaging was able to provide important information about systemic blood supply via intercostal arteries and regular venous drainage. Furthermore this imaging technique revealed a second pulmonary sequestration in the dorsal phrenicocostal sinus that was not diagnosed before.