Preoperative endovascular embolization of craniospinal hemangioblastomas.

PURPOSETo determine whether hemangioblastomas, highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding, can be embolized safely by using interventional techniques that furnish a more avascular surgical field.METHODSNine hemangioblastomas involving either the cerebellum or the spinal cord were embolized preoperatively. In each case the feeding artery was selectively catheterized with a microcatheter and the hypervascular tumor nidus was devascularized with polyvinyl alcohol particles.RESULTSTwo patients who had undergone recent attempts as surgical resection at another institution had repeat surgery after endovascular embolization rendered the tumor nidus avascular. At surgery, the tumor was completely removed in one case and markedly debulked in the other. In all nine cases, blood loss after embolization was reported to be less than expected by experienced surgeons. In addition, manipulation and removal of the tumor was reported to be subjectively easier in these embolized tumors. The embolization procedure caused no permanent complications; however, one patient with a posterior fossa hemangioblastoma and hydrocephalus worsened clinically within 12 hours of embolization. This event was thought to be caused by obstructive hydrocephalus resulting from tumor swelling. Emergency craniotomy, ventricular decompression, and surgical resection of the tumor produced complete resolution of the signs and symptoms.CONCLUSIONSOur results indicate that preoperative embolization of hemangioblastomas is a safe procedure that is useful in aiding surgical resection of these highly vascular tumors.     

Hemangioblastomas of the lower spinal region: report of four cases with preoperative embolization and review of the literature

BACKGROUND AND PURPOSE: Hemangioblastomas (HBs) are rare lesions accounting for 1-5% of all spinal cord tumors. Seventy-five percent of spinal HBs are intramedullary. Lesions of the conus medullaris and the cauda equina are uncommon, and the filum terminale location is very rare. HBs of the lower spinal region are highly vascular tumors requiring surgery that is potentially complicated by excessive bleeding. In the literature, there are few reports concerning preoperative embolization of HBs, and only few cases are reported in spinal location. Presurgical embolization of HBs located in the lower spinal region has not been described. Although lower spinal HBs are predominantly fed by the anterior spinal artery (ASA), embolization of these lesions is possible and can reduce tumor vascular supply, thus facilitating surgery. We report our experience in four rare cases of solitary HBs occurring in the lower spinal region. METHODS: Clinical charts and radiologic studies of four patients with a preoperatively embolized HB of the lower spinal region were retrospectively reviewed. The lesions were located in the conus medullaris in one case, at the level of the cauda equina in another, and in the filum terminale in two. In the conus medullaris case, the neoplasm was associated with a syrinx. In three patients, the HB was sporadic, while the patient with the HB of the cauda equina had Von Hippel-Lindau disease. Devascularization of the tumor was performed through the ASA in all cases and also through the posterior spinal artery in one by using non reabsorbable calibrated microspheres in three cases and polyvinyl alcohol particles in the other one. RESULTS: Embolization caused no permanent complications, although one patient with a cauda equina HB mildly worsened after the endovascular procedure but recovered before surgery. At surgery, the tumor was completely removed in all cases. Blood loss was reported to be less than usually observed (100, 200, 200, and 400 mL). In addition, manipulation and removal of the tumor was reported to be easy in three of four tumors. Histologic examination confirmed the diagnosis. At 1-year postsurgical follow-up, two patient recovered completely from neurologic deficits, and two showed significant recovery. No tumor recurred during a follow-up period of 1-6 years (mean, 3.5 years). CONCLUSION: Our results indicate that preoperative embolization of HBs of the lower spinal region is an useful procedure in aiding surgical resection of these highly vascular tumors. With a meticulous technique, embolization can be performed through the ASA.     

巨型富血供脑膜瘤术前栓塞的临床应用

目的 探讨巨型富血供脑膜瘤术前栓塞的的临床应用价值.方法 选择2013年4月至2014年8月收治的71例巨大脑膜瘤(最大径＞5 cm)患者,术前MRI提示均强化明显,血供丰富,分成术前栓塞组(研究组)38例和未栓塞(对照组)33例,术前DSA造影确定血供分型为Ⅰ及Ⅱ型脑膜瘤,研究组予以PAV颗粒(200～300μm)栓塞,对照组仅行脑血管造影,未予以栓塞,观察两组术中出血、肿瘤切除时间及栓塞并发症情况;术后复查MRI观察切除程度.结果 研究组及对照组术中出血量(ml)(562±178)比(833±234)、肿瘤切除时间(h)(5.45±2.13)比(7.23±2.45)、肿瘤切除程度Simpson分级(Ⅲ及Ⅲ以下)27例(27/38,71％)比19例(19/33,57.6％),P＜0.05,差异均有统计学意义,7例出现栓塞后脑水肿加重,2例出现头皮缺血性坏死,1例出现术中癫痫发作,对症治疗后均缓解.结论 巨型富血供脑膜瘤术前栓塞可以明显减少术中出血、缩短手术时间,提高脑膜瘤的切除程度,值得在临床推广及应用.     

中枢神经系统血管母细胞瘤术前栓塞

目的 探讨术前栓塞对中枢神经系统血管母细胞瘤手术切除的作用。方法 11例经CT、MRI及DSA检查诊断为中枢神经系统血管母细胞瘤患者，8例病变位于小脑，1例位于延髓，2例位于脊髓胸段内。手术切除前均在局麻下经微导管行供血动脉PVA颗粒栓塞。栓塞后均行手术切除肿瘤。结果 微导管均到达供血动脉，注入适量直径为250～350μmPVA颗粒后，6例完全栓塞，肿瘤血管和肿瘤染色完全消失；5例大部栓塞，肿瘤血管和肿瘤染色仅存小部分。11例栓塞后均顺利实施肿瘤手术切除。与既往未栓塞的病例相比较，行术前栓塞的病例手术时肿瘤界限清楚，术中出血减少，手术视野清晰，不易误伤邻近正常结构，容易分块切除，手术时间缩短，6例完全栓塞者表现尤为显著。11例手术均未出现并发症。结论 术前栓塞对血管母细胞瘤手术切除可使肿瘤切除更为容易，临近正常结构不易损伤，手术时间缩短，术中出血明显减少，手术并发症及病死率降低。     

脊柱肿瘤术前选择性动脉栓塞术的临床价值

目的探讨脊柱肿瘤术前选择性动脉栓塞术的临床应用价值。方法回顾性分析2017年1月至2018年12月于中国医科大学附属盛京医院骨科行脊柱肿瘤切除手术的42例患者的临床资料,依据肿瘤切除术前是否行动脉栓塞治疗,将患者分为栓塞组(20例)和未栓塞组(22例),再根据手术方式分为椎体切除亚组和椎板切除亚组。栓塞组椎体切除12例、椎板切除8例;未栓塞组椎体切除13例、椎板切除9例。采用独立样本t检验比较各组间术中失血量、红细胞输入量、校准失血量、手术时间和住院时间的差异。结果栓塞组20例患者均成功实施了脊柱肿瘤动脉栓塞术,无严重并发症发生。栓塞组与未栓塞组患者术中失血量、红细胞输入量、校准失血量、手术时间和住院时间,差异均无统计学意义(P>0.05)。栓塞组椎体切除患者,术中失血量、红细胞输入量和校准失血量分别为(1966.7±898.8)ml、(7.42±3.27)U和(91.3±39.2)g/L,未栓塞组椎体切除患者分别为(2838.5±1143.5)ml、(11.04±4.08)U和(133.0±46.4)g/L,差异均有统计学意义(t值分别为-2.107、-2.436、-2.419,P<0.05);而2组手术时间和住院时间差异均无统计学意义(t值分别为-0.780、-0.549,P>0.05)。栓塞组与未栓塞组椎板切除患者的上述各指标差异均无统计学意义(P>0.05)。结论脊柱肿瘤术前选择性动脉栓塞术相对安全。脊柱肿瘤术前动脉栓塞不能减少外科切除手术的失血量,但对外科术式加以区分后,术前栓塞可显著减少接受椎体切除手术患者的失血量,而椎板切除手术的患者无明显受益。     

脊柱肿瘤术前栓塞疗效的影响因素分析

目的评价外科术前介入栓塞技术的安全性和对脊柱肿瘤切除术中出血量的影响。 方法回顾北京大学人民医院2003年3月至2011年5月90例行术前栓塞的脊柱肿瘤患者的临床资料,分析患者性别、病理类型、栓塞颗粒直径、栓塞与手术的时间间隔、是否为初次手术及肿瘤侵犯范围等因素对栓塞疗效的影响。 结果对于所有肿瘤和颈胸腰椎肿瘤,接受二次或多次手术的患者术中出血量大于首次接受栓塞及手术治疗的患者（P=0.023、0.044）;骨巨细胞瘤（GCT）患者术中出血量大于其他原发肿瘤（P=0.013、0.006）。患者性别、栓塞颗粒直径、栓塞与手术的时间间隔及肿瘤侵犯范围等因素对栓塞后肿瘤切除术中出血量无影响。 结论术前栓塞对减少脊柱富血供肿瘤的术中出血量、提高肿瘤的可切除性是安全、有效的。     

Preoperative embolization of primary bone tumors:A case control study

AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss,intraoperative blood transfusion volume and surgical time.METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities,hip or vertebrae before resection and stabilization.The primary osseous tumors included giant cell tumors,aneurysmal bone cyst,osteoblastoma,chondroblastoma and chondrosarcoma.Twenty-six patients were included for the statistical analysis(embolization group)as they were operated within 0-48 h within preoperative embolization.A control group(non-embolization group,n = 28)with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.RESULTS:The mean intraoperative blood loss was 1300 mL(250-2900 mL),the mean intraoperative blood transfusion was 700 m L(0-1400 m L)and the mean surgical time was 221 ± 76.7 min for embolization group(group Ⅰ,n = 26).Non-embolization group(group Ⅱ,n = 28),the mean intraoperative blood loss was 1800 m L(800-6000 m L),the mean intraoperative blood transfusion was 1400 mL(700-8400 mL)and the meansurgical time was 250 ± 69.7 min.On comparison,statistically significant(P < 0.001)difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion.There was no statistical difference between the two groups for the surgical time.No patients developed any angiography or embolization related complications.CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.     

Embolization of cranial/spinal tumours and vascular malformations with hydrogel microspheres. An experience of 69 cases

Objective: To evaluate polymethyl methacrylate hydrogel microspheres (HMs) as an embolization material in the management of hypervascular craniofacial and spinal lesions.Material and Methods: Sixty-nine patients with vascular lesions of the craniofacial and spinal regions underwent embolization with HM. The pathologies included craniofacial tumours (n=38), cranial arteriovenous malformations (AVMs) (n=7), dural AVM (n=1), cavernous carotid fistula (n=1), spinal tumours (n=7), spinal AVMs (n=6), orbital lesions (n=4) and scalp AVMs (n=5). Surgery was done in 56 patients. The blood loss at surgery, tumour shrinkage, surgical cleavage and ease of removal of tumour was noted from the records. Histopathology was available in 39 patients. A follow-up of 3 months to 6 years was available in 13 patients in whom embolization was the sole treatment. Surgical and histopathological findings were correlated with angio-embolization findings.Results: HMs were easy to inject through the microcatheter with good control. Good devascularization was obtained in 61 patients and partial in 8 patients. Two patients developed complications due to presence of anastomoses between intra- and extracranial circulation and 1 patient due to tumor swelling. Histopathology showed presence of HMs in all the lesions, with minimal inflammatory reaction in 2 patients. Patients with spinal lesions treated with embolization only stabilised in neurologic deficits.Conclusion: HMs are highly suitable as embolization agents in the management of craniofacial and spinal hypervascular lesions.     

Preoperative embolization of hypervascular head and neck tumours

The embolization of vascular tumours of the head and neck has become an important adjunct to the surgical treatment of these tumours. A vascular tumour in the head and neck region in a surgically treatable patient may be a candidate for embolization. Palliative embolization may be the sole treatment for high risk patients. Reducing intraoperative bleeding may shorten surgery time thus decreasing morbidity and mortality. The purpose of this study is to assess the efficacy of embolization as an adjunct to surgery or as a curative measure in the management of hypervascular head and neck tumours. We retrospectively reviewed the records of 46 consecutive patients (27 men and 16 women; mean age, 37.8 years) with 48 hypervascular head and neck tumours that had undergone preoperative transarterial, direct puncture or combined mode of embolization. Diagnosis of tumours was made on the basis of findings of imaging studies. The 46 patients underwent embolization either through transarterial route, by direct puncture technique or both direct puncture and arterial route. The devascularization reached 90-95% with the use of NBCA. The amount of devascularization reached by transarterial particle embolization is a little lesser. One patient (carotid body tumour) developed mild unilateral seventh, ninth and 10th cranial nerve palsy after transarterial embolization, transient hemiparesis was seen in another patient (nasopharyngeal angiofibroma). Both patients improved completely with steroids and had no deficit on follow up. One patient developed delayed glue migration into the middle cerebral artery territory 6 h after the procedure with no reported increase in size of the lesion in the following 5 years. Preoperative embolization of hypervascular tumour of head and neck region appears to be safe and improves the chance of complete removal during surgery with minimal blood loss.     

Preoperative embolization of primary spinal aneurysmal bone cysts by direct percutaneous intralesional injection of n-butyl-2-cyanoacrylate

Aneurysmal bone cysts (ABCs) are highly vascular lesions often referred for preoperative transarterial embolization. However, accessible arterial pedicles do not always exist. Two cases are presented of pediatric patients with spinal ABCs in which preoperative embolization was performed by percutaneous injection of up to 31 mL of liquid embolic agent (1:7 ratio, n-butyl-2-cyanoacrylate [n-BCA] to ethiodized oil). Total estimated surgical blood loss was 1,000 mL in one case and 3,650 mL in the other case, which occurred during the extensive anterior and posterior approaches required to remove the massive ABCs. Direct percutaneous injection of n-BCA is a technically simple and efficient adjunct to surgical resection with the aim to reduce intraoperative blood loss.     

术前肿瘤动脉栓塞联合术中腹主动脉球囊阻断在骶骨肿瘤切除术中的应用

目的 探讨术前肿瘤动脉栓塞联合术中腹主动脉球囊阻断在骶骨肿瘤切除术中的应用价值.方法 本研究纳入56例患者.对照组(24例)行常规外科切除骶骨肿瘤;试验组(32例)行术前骶骨肿瘤动脉栓塞联合术中腹主动脉球囊阻断.计算两组的手术时间、术中出血量、术后1年肿瘤复发率,并进行统计学分析.结果 试验组患者造影显示骶骨肿瘤由多支血管供血,分别给予栓塞后在球囊阻断腹主动脉的辅助下成功切除肿瘤.试验组术中手术视野清晰,骶骨肿瘤切除时出血明显减少,术后未出现异位栓塞、肾缺血和肢体缺血等并发症.两组手术时间、术中出血量、术后1年肿瘤复发率差异均有统计学意义(P ＜ 0.05).结论 术前肿瘤动脉栓塞联合腹主动脉球囊阻断能有效缩短手术时间、减少术中出血,使肿瘤切除术中的手术视野更加清晰,明显提高了手术的安全性.     

Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage.

BACKGROUND AND PURPOSE: Corporectomy is an effective treatment for vertebral metastases; however, massive perioperative hemorrhage is often associated with this procedure. We compared preoperative particle, particle-coil, and coil embolizations of hypervascular spinal tumors prior to vertebral body replacement to determine which prevented perioperative hemorrhage most effectively. METHODS: The vertebral tumors of 59 patients were embolized prior to corporectomy. In 26 cases, only coils were used for the proximal occlusion of feeding segmental arteries. Twenty-four patients received a combination of polyvinyl alcohol (PVA) particles and coils, and nine tumors were embolized with particles alone. We compared intraoperative blood loss between the three groups and 10 other patients who did not undergo embolization prior to corporectomy. RESULTS: Estimation of intraoperative hemorrhage showed a median value of 4350 mL in patients without embolization, 2650 mL in cases of coil embolization, 1850 mL in cases of particle-coil embolization, and 1800 mL in cases of particle embolization. The difference between unembolized patients and those who underwent coil embolization was not statistically significant. Particle and particle-coil embolizations showed very similar results, and reduced hemorrhage significantly as compared to unembolized and proximal coil occlusion cases. Residual bleeding came from the venous system and the neighborhood of the embolized region. CONCLUSION: Particle embolization prior to corporectomy can reduce perioperative hemorrhage. The additional benefit of proximal coil occlusion of arterial feeders is questionable.     

Preoperative embolization of cervical spine osteoblastomas: report of three cases

Our aim was to describe the technique and clinical results of preoperative embolization of cervical spine osteoblastomas. We treated 3 patients with these tumors with transarterial embolization and subsequent surgical excision. In all 3 patients, distal access to the tumor-supplying vessels was gained with a microcatheter and embolization was performed with polyvinyl alcohol particles. No complications occurred. Surgical resection was performed in all patients without relevant bleeding. The postoperative course was uneventful in all patients. Preoperative embolization is a valuable adjunct to the surgical treatment of osteoblastomas of the cervical spine.     

Arterial embolization of unresectable hepatocellular carcinoma with use of cyanoacrylate and lipiodol.

PURPOSE: To assess the potential of transarterial permanent embolization with use of a mixture of cyanoacrylate and lipiodol for treatment of unresectable primary hepatocellular carcinoma (HCC). MATERIALS AND METHODS: In a retrospective study, 36 patients with histologically proven HCC were treated with transarterial embolization (TAE) of the hepatic arteries. None of these patients were candidates for surgical resection and some had advanced disease with multinodular disease or bulky tumor, thrombosis of a segmental branch of the portal vein, and/or extrahepatic spread. To induce permanent and more peripheral embolization, cyanoacrylate, an adhesive polymerizing on contact with blood, was used in TAE. From 1990 to 1998, a total of 76 embolization procedures were performed. Cumulative survival rates were calculated. RESULTS: Most of the patients presented with a self-limited postembolization syndrome. Severe procedure-related complications were found after four treatment sessions (5.2%). The 30-day perioperative mortality rate was 2.7%. The mean follow-up period was 20.3 months (range, 1-68 mo), with a median survival of 26 months. The median survival was also estimated for different Okuda stages of disease: stage II (n = 26) versus stage III (n = 5) disease (32 vs 9 months; P <.05); patients with (n = 9) or without (n = 27) extrahepatic metastasis (10 vs 26 months; P <.05); and patients with (n = 10) or without (n = 26) thrombosis of a segmental branch of the portal vein (7 versus 34 months [P <.005]). CONCLUSION: TAE with use of cyanoacrylate and lipiodol for unresectable HCC is a feasible treatment modality. This retrospective report indicates beneficial effects on survival even in patients with advanced disease.     

Preoperative embolization of intracranial meningiomas with a fibrin glue preparation.

BACKGROUND AND PURPOSE: Preoperative embolization expands the spectrum of meningioma that can be operated on safely. Our goal was to achieve the distalmost loading of the vascular bed and confluent tumor necrosis with a fibrin glue preparation in the preoperative embolization of meningiomas. METHODS: Between 1992 and 1997, 80 patients with a meningioma had diagnostic angiography with a standard transfemoral Seldinger technique, performed with a 6F guiding catheter and digital subtraction angiography. Preoperative embolization was carried out in the same session with an additional microcatheter system. Fibrin glue was the only component used. In all cases, CT was performed immediately after embolization; in nine patients, MR imaging was also performed. RESULTS: Angiography verified the elimination of tumor blush in all patients. The high-density areas seen on postembolization CT scans, caused by the fibrin glue dispersed in the embolized supply area, were found to be necrotic at surgery and were easily removed by suction. Two (2.5%) of the 80 patients had complications associated with embolization that resulted in neurologic deficits. CONCLUSION: The most effective preoperative embolization of tumors requires a distalmost loading of the vascular bed. Fibrin glue, which is easy to use and safe to handle, causes confluent tumor necrosis within the injected vascular territory.     

Preoperative Embolization of Cervical Spine Tumors

Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery. Received: 0/00/00/Accepted: 0/00/00     

富血供巨大脑膜瘤术前栓塞的临床应用

目的评价经动脉栓塞术（TAE）对巨大富血供脑膜瘤术前栓塞的临床意义。方法 32例巨大富血供脑膜瘤患者（男性18例,女性14例,年龄38～65岁,平均56.5岁）为确认肿瘤供血动脉,先经选择性血管造影（DSA）,随后又经术前TAE。全部TAE操作是采用Seldinger技术将150～300μm的聚乙烯醇（PVA）微粒或海藻酸钠（KMG）微球超选择地注入病灶血管床及供血动脉完成。对全部患者获自DSA与TAE的资料进行了回顾性分析。结果 DSA证实,在32例脑膜瘤患者的肿瘤供血动脉中,主要为颈外动脉分支供血者见于22例,颈内、外动脉供血各占50%者6例,颈内动脉供血者占90%以上者4例;脑膜瘤供血动脉大部分栓塞者15例,部分栓塞10例,未栓塞7例。在肿瘤大部分栓塞患者的切除术中,出血量明显减少,手术时间显著缩短,肿瘤易被彻底切除。未发生与栓塞操作有关的严重并发症。结论脑膜瘤术前介入栓塞能减少术中出血,降低手术难度,可作为富血供脑膜瘤切除术前的一项重要的、常规性辅助措施。     

Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32–82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.     

Outcomes of embolization of bone tumors in the pelvic and shoulder girdles: Initial experience

Purpose

To assess the effectiveness of transarterial embolization of bone tumors as preoperative technique to reduce blood loss or as a curative method in bone tumors of shoulder and pelvic girdles.

Power Doppler sonography: evaluation of hepatocellular carcinoma after treatment with transarterial embolization or percutaneous ethanol injection therapy

OBJECTIVE: The aim of this study was to compare tumor detectability by assessing the vascularity on power and color Doppler sonography and CT after transarterial embolization or percutaneous ethanol injection therapy or both in hepatocellular carcinoma. SUBJECTS AND METHODS: Forty-seven nodules of hepatocellular carcinoma (size, 28 +/- 7 mm [mean +/- standard deviation]; range, 20-40 mm) in 38 patients were treated with transarterial embolization (n = 6), percutaneous ethanol injection therapy (n = 23), and transarterial embolization plus percutaneous ethanol injection therapy (n = 9). Power Doppler sonography, color Doppler sonography, and CT were performed before and 2 weeks, 3 months, and 6 months after the treatments. The existence of hepatocellular carcinoma was confirmed by positive findings for color signals on both Doppler sonography techniques and for tumor stains on CT. All the tumors were determined to be malignant by microscopic examination of biopsy specimens. RESULTS: Before the treatments, power Doppler sonography (100%) and CT (100%) were significantly more effective than color Doppler sonography (61.7%) (p < 0.001, for both). Six months after the treatments, the sensitivity of power Doppler sonography (87.5%) was significantly better than that of color Doppler sonography (12.5%) but was not significant in comparison with CT (66.6%). However, power Doppler sonography detected color signals in two of three tumors in which iodized oil was accumulated and no tumor stain appeared on CT, and the two lesions detected with power Doppler sonography were carcinomas. CONCLUSION: Power Doppler sonography can be considered the most sensitive technique in assessing the viability of hepatocellular carcinoma treated with transarterial embolization or percutaneous ethanol injection therapy or both.