IOUS and CE-IOUS during hepatic resection for patients with hepatocellular carcinoma in liver cirrhosis1.

PURPOSE: To retrospectively evaluate the role of intraoperative ultrasonography (IOUS) and contrast-enhanced IOUS (CE-IOUS) for the patients with hepatocellular carcinoma (HCC) undergoing hepatic resection (HR). METHODS: Twenty-one consecutive patients who had undergone HR for HCC were included in this study. The patients were subject to preoperative imaging modalities including preoperative ultrasonography (Pre-US) and preoperative contrast-enhanced ultrasonography (Pre-CEUS). All the patients then underwent intraoperative ultrasonography (IOUS) and contrast-enhanced intraoperative ultrasonography (CE-IOUS) during surgery. The visualization of primary HCC and additional lesions of all patients were analyzed. RESULTS: Twenty-one HCCs were detected during Pre-US and the remaining six lesions (28.6%) were detected during IOUS and CE-IOUS. Thus the treatment plan was changed in 28.6% of patients. Twenty-one HCCs (diameter, 0.6-3.0 cm; mean±SD, 1.98±0.85 cm) were measured on Pre-US and remeasured on IOUS (diameter, 0.9-3.3 cm; mean±SD, 2.19±0.84 cm) (p < 0.001). The 6 additional lesions consisted of three moderately differentiated HCCs, one cholangiocarcinoma (ICC), and two high-grade dysplastic nodules (DNs). The mean maximal diameter of the 6 additional lesions was 0.83 cm (range: 0.6-1.1 cm). The malignancy associated features such as capsule interruption, echo heterogeneity, hypo-echoic rim, and a nodule in nodule pattern were more often depicted on IOUS than on Pre-US (all p < 0.01). On CEUS, 19 (90.5%) of 21 HCCs were hyper-enhanced in the arterial phase and washed out from the portal phase to the late phase; the remaining two (9.5%) were hypoenhanced. On CE-IOUS, tumor vasculatures were classified as four patterns: 11 (52.4%) exhibited netlike pattern, 7 (33.3%) annular pattern, 2 (9.5%) mixed pattern, and 1 (4.8%) radial pattern. 3 mHCCs and 2 DNs of six additional nodules had similar greyscale imagining features on IOUS, but they showed different enhancement patterns on CE-IOUS. The ICC showed slightly heterogeneous enhancement during the arterial phase and hypo-enhancement during the portal phase. CONCLUSIONS: IOUS detects more lesions and the treatment plan is changed in 28.6% of patients. HCCs were larger on IOUS than on Pre-US. The typical imaging features of HCCs were better depicted on IOUS in comparison with Pre-US. CE-IOUS can catch the details of microcirculation perfusion of HCCs more sensitively than CEUS. Both IOUS and CE-IOUS were able to provide more decision information during surgery.

Comparison of the effectiveness and safety of ultrasound- and CT-guided percutaneous radiofrequency ablation of non-operation hepatocellular carcinoma.

To retrospectively compare the effectiveness and safety of ultrasound (US)- and computer tomography (CT)-guided percutaneous radiofrequency ablation (PRFA) in treating patients with non-operation hepatocellular carcinoma (HCC). Forty patients with non-operation HCC who were treated with US-guided PRFA (20 patients with 24 HCC lesions) or CT-guided PRFA (20 patients with 27 HCC lesions) were enrolled in this study. Follow-up was performed with US and CT/MRI. Complete ablation rate, local recurrence rate, and overall survival rate were used to evaluate the efficacy of the two therapeutic choices. The PRFA-related complications including hilar bile duct injury, sepsis, liver failure, renal dysfunction, peritoneal hemorrhage, and skin burn were assessed. The operation time of CT-guided group was significantly longer than that of the US-guided group (P < 0.05). The single ablation times for tumors with similar size showed no significant difference between the two groups (P > 0.05). The differences in complete ablation rate (79.2 vs. 88.9 %, P > 0.05) and local recurrence rate (16.7 vs. 14.8 %, P > 0.05) between US- and CT-guided groups were not statistically significant. In the US-guided group, the 1-, 2-, and 3-year overall survival rates were 85, 74, and 68 %, respectively, while they were 84, 72, and 58 % in the CT-guided group. The differences were not statistically significant (P > 0.05). No severe complications were found in the two groups. Both US- and CT-guided PRFA are safe and effective therapies for patients with HCC when surgical options are precluded.