Percutaneous transhepatic portal vein embolization: effectiveness of absolute ethanol infusion with balloon catheter in a pig model

Purpose: To evaluate the effectiveness of portal vein embolization (PVE) with absolute ethanol using multidetector-row computed tomography (CT) angiography in a pig model.

Material and Methods: Percutaneous transhepatic PVE with 10 ml absolute ethanol was performed in liver segments (n = 5) or subsegments (n = 5) in 10 pigs. CT images and volumetric data were qualitatively and quantitatively assessed to determine future liver remnant (FLR) hypertrophy and to correlate with histopathologic changes 2-6 weeks after PVE. Effectiveness evaluation was based on changes in absolute FLR size and ratio of FLR to total estimated liver volume (TELV).

Results: Occlusion of the embolized vessel was achieved immediately after injecting absolute ethanol within a range of 0.25-0.33 ml/kg. The TELV prior to PVE was 660.49±103.66 cm³ (range 527.22 to 833.70 cm³) and after PVE 769.51±29.36 cm³ (range 685.95 to 887.34 cm³). The mean FLR/TELV ratio increase after PVE was 14.2%. No statistically significant difference was found in the increase of TELV between segmental or subsegmental PVE. On microscopic observation, atrophy of the embolized liver was noted in all animals and was seen distinctly at 3 weeks after PVE in 2 animals.

Conclusion: Both regenerative response and histopathologic changes of the liver were seen after PVE with absolute ethanol with a mean FLR/TELV ratio of 14.2%.     

Acceleration of primary liver tumor growth rate in embolized hepatic lobe after portal vein embolization

Background: Portal vein embolization (PVE) is now widely accepted as a useful preoperative procedure in selected patients undergoing extended hepatectomy. However, the effect of PVE on the growth of liver tumors has not been fully elucidated.

Purpose: To retrospectively evaluate the effects of PVE on the growth of liver tumors in the embolized lobes.

Material and Methods: Eight patients with a primary liver tumor, six hepatocellular carcinomas (HCC) and two cholangiocellular carcinomas (CCC), were studied. The growth rates of the tumors in the embolized lobes and non-embolized liver parenchyma were calculated using the computed tomography (CT) volume values at the time of tumor identification, and before and after PVE.

Result: The median tumor growth rate was 0.59 cm³/day (range 0.22-6.01 cm³/day) before PVE and 2.37 cm³/day (range 0.29-13.97 cm³/day) after PVE (P = 0.018). The tumor growth acceleration ratios ranged from 1.50 to 7.46 (median 2.65) in the six HCCs, and were 1.00 and 1.32 in the two CCCs. There was no apparent correlation between the tumor growth rate after PVE and the growth rate of non-embolized liver parenchyma (median 6.00 cm³/day, range 1.24-11.0 cm³/day).

Conclusion: Liver tumor growth in an embolized lobe accelerates after PVE, in patients with HCC.     

Portal vein embolization with polyvinyl alcohol particles and coils in preparation for major liver resection for hepatobiliary malignancy: safety and effectiveness--study in 26 patients

PURPOSE: To evaluate whether preoperative portal vein embolization (PVE) with polyvinyl alcohol (PVA) particles and coils is safe and effective for inducing lobar hypertrophy in patients with hepatobiliary malignancy. MATERIALS AND METHODS: PVE was performed in 26 patients. All patients had malignancy: metastases (n = 11), cholangiocarcinoma (n = 9), hepatocellular carcinoma (n = 5), and gallbladder carcinoma (n = 1). One patient had underlying liver disease caused by hepatitis. PVE was performed if the future liver remnant (FLR) was estimated to be less than 25% of the total liver volume. PVE was performed with a percutaneous transhepatic approach (right, 25 patients; left, one patient). PVA particles and coils were used to occlude the right portal system and veins supplying segment IV to promote FLR hypertrophy (segments I-III +/- IV). FLR hypertrophy was assessed with comparison of computed tomographic scans obtained before and 2-4 weeks after PVE. Effectiveness evaluation was based on changes in absolute FLR size and ratio of FLR to total estimated liver volume (TELV). Safety of PVE and hepatic resection was determined with postprocedure complication rate and median hospital stay. RESULTS: Sixteen patients underwent hepatic resection (right trisegmentectomy [n = 13], right lobectomy [n = 3]) without mortality. Ten patients did not undergo resection (complete remission after medical therapy [n = 1], lack of regeneration [n = 2], extrahepatic disease undetected prior to PVE [n = 7]). Six patients had biliary obstruction; five were treated percutaneously before PVE. No patient developed postembolization syndrome or signs of fulminant hepatic insufficiency after PVE or resection. Two patients had complications after PVE that did not preclude successful resection. Median hospital stays were 1 day (PVE) and 7 days (liver resection). Mean absolute FLR increased from 325.0 to 458.6 cm3 (increase, 41.1%). Mean TELV was 1,784.8 cm3. FLR/TELV ratio increase was 8%. CONCLUSION: Preoperative PVE with PVA particles and coils is safe and effective for inducing lobar hypertrophy in patients with advanced hepatobiliary malignancy.     

Massive postpartum hemorrhage treated with transcatheter arterial embolization: technical aspects and long-term effects on fertility and menstrual cycle

Background: Transcatheter arterial embolization (TAE) is considered a safe, life-saving procedure in postpartum hemorrhage (PPH), but its long-term effect on menstruation and fertility is unclear.

Purpose: To investigate technical aspects and the evaluation of complications, focused on menstrual cycle and fertility, using TAE in patients with PPH.

Material and Methods: A retrospective study including 20 patients (seven with vaginal and 13 with cesarean delivery) with severe PPH treated with bilateral TAE of the uterine artery was carried out. All patients were asked to answer a questionnaire regarding their post-embolization history. In six patients, the radiation dose was measured.

Results: All 20 cases underwent bilateral TAE of the uterine artery. Gelfoam was used as the embolic agent. However, after cesarean delivery in six patients who had clear contrast medium extravasation and/or pseudoaneurysm-like lesion, metallic coils had to be used in order to achieve hemostasis. No major short- or long-term complications were registered. Normal menses resumed in all patients. Four patients had a total of five full-term and two preterm pregnancies, and all delivered healthy infants by cesarean section with no recurrence of PPH. The mean radiation dose to the ovaries was 586 mGy (range 204-729 mGy).

Conclusion: TAE in patients with PPH is safe and has no major short- or long-term side effects. A patient managed with TAE can expect return of normal menses and preservation of future fertility and successful pregnancies. PPH after cesarean section might need to be embolized with metallic coils in addition to Gelfoam in order to achieve secure hemostasis.     

Safety and efficacy of preoperative portal vein embolization with polyvinyl alcohol in 58 patients with liver metastases

OBJECTIVE: The objective of our study was to evaluate the safety and efficacy of transhepatic lobar portal vein embolization (PVE) using polyvinyl alcohol (PVA) particles to induce contralateral lobar hypertrophy in patients with liver-only metastases and normal underlying liver function. MATERIALS AND METHODS: Fifty-eight consecutive patients with small predicted future liver remnants (FLRs) underwent PVE with PVA particles to induce hypertrophy of the contralateral hemi-liver before surgical resection of liver metastases. Total liver, right hemi-liver, and left hemi-liver volumes were calculated before and after embolization using a 3D workstation. RESULTS: Eight patients underwent left PVE; 47, right PVE; and three, right and segment IV PVE. There were no major complications of the procedure. The mean increases in the ratio of the FLR to the total estimated liver volume after right, right and segment IV, and left PVE were 9%, 10%, and 3%, respectively; the corresponding mean hypertrophy ratios were 24.3%, 31.9%, and 1.5%, respectively. CONCLUSION: Right PVE using PVA particles alone as the embolic agent is safe and effective in achieving left hemi-liver hypertrophy. In contrast, left PVE did not induce significant right hemi-liver hypertrophy in this patient population.     

Gadolinium contrast agent is of limited value for magnetic resonance imaging assessment of synovial hypertrophy in hemophiliacs

Purpose: To examine the influence of different doses of gadolinium contrast agent on synovial enhancement, to compare magnetic resonance imaging (MRI) findings of synovial hypertrophy and radiographic joint changes in hemophiliacs, and to investigate the value of gadolinium in MRI assessment of synovial hypertrophy in hemophiliacs using dynamic MRI and MRI scoring.

Material and Methods: Twenty-one hemophiliacs on prophylactic factor treatment without recent bleeds were subjected to radiography and gadolinium contrast-enhanced dynamic and static MRI of the knee using a standard dose of 0.1 mmol/kg b.w. gadoteridol. In 17 of the patients, the MRI procedure was repeated after a triple dose of gadoteridol.

Results: MRI findings of synovial hypertrophy were significantly correlated with Pettersson radiographic scores. In 19 of the 21 MRI investigated joints, administration of contrast agent did not alter the result of the evaluation of synovial hypertrophy.

Conclusion: The optimal time interval for volume assessment of synovial hypertrophy after injection of gadolinium contrast agent is dose dependent. Hemophiliacs without recent bleeds have minor to abundant synovial hypertrophy in joints with pronounced radiographic changes. Dynamic MRI is not useful for evaluating hemophilic arthropathy, and gadolinium contrast agent is not routinely indicated for MRI scoring of joints in hemophiliacs.     

Radiological evaluation of covered self-expandable metallic stents used for palliation in patients with malignant esophageal strictures

Purpose: To study the role of self-expandable metallic stents in malignant esophageal strictures in terms of patency, improved dysphagia score, and possible associated complications.

Material and Methods: Twenty-two patients with inoperable carcinoma of the esophagus underwent stent placement. Four different varieties of covered stents were used. Stenting was performed under fluoroscopic guidance and local pharyngeal anesthesia. During follow-up, patients were examined clinically and radiologically to assess the effectiveness of stents in relieving dysphagia, to check the stent position, patency, and possible complications.

Results: Fluoroscopic placement of the stent was successful and well tolerated in all patients without any serious complications. Accurate stent placement was possible in 95% of cases. The mean dysphagia score prior to stenting was 3.5 and poststent 1.2, with an improvement of 2.3 degrees. In two patients with associated fistulas, complete closure was seen after stent insertion. There was poor stent expansion in three patients. Significant tumor overgrowth occurred in two patients, and a second overlapping stent was deployed in one case. Three patients developed food impaction, which needed endoscopic removal of impacted food in two cases.

Conclusion: Fluoroscopic placement of self-expandable metallic stents is a safe and effective method of palliating severe dysphagia and fistulas in patients with inoperable esophageal carcinoma. However, complications such as tumor overgrowth and food impaction may require reintervention after stent placement.     

Ultrasound guidance for puncture and injection in the radiocarpal joint

Background: The use of intra-articular contrast agent has been shown to increase the diagnostic accuracy of wrist magnetic resonance (MR) in patients with suspected trauma of the wrist ligaments. Traditionally, the contrast agent has been applied under fluoroscopic guidance.

Purpose: To present a method based on ultrasound guidance for the injection of intra-articular contrast agent in wrist MR.

Material and Methods: One hundred eight patients (56 female and 52 male, mean age 36 years) referred for wrist MR arthrograms due to suspected ligament rupture were included in this retrospective study. The preferred injection point is about 1 cm distal to Lister's tubercle in the distal radius. A correct positioning of the injection needle can be ensured using ultrasound guidance.

Results: Using this technique, the injection was intra-articular in 93.5% of the 108 injections over a 2-year learning period.

Conclusion: Ultrasound guidance of the contrast injection in radiocarpal MR arthrograms is a cost-effective and safe alternative to fluoroscopically guided procedures. Furthermore, the use of ultrasound guidance provides clues about possible fluid collections within the joint.     

Preoperative portal vein embolization using an amplatzer vascular plug

The purpose was to evaluate the safety and efficacy of preoperative portal vein embolization (PVE) using an Amplatzer vascular plug (AVP). Forty-one patients who underwent PVE using gelatin sponge particles and the AVP were enrolled. The right portal branches were embolized using gelatin sponges (1–8 mm³) through a 5-F catheter, and the AVP was deployed at the first- or second-order right portal vein. Technical success and complications, recanalization, and changes of total estimated liver volumes (TELV), future liver remnant (FLR), and FLR/TELV were evaluated. Follow-up CT performed 6–43 days (median, 16 days) after PVE was used to evaluate volume parameters. PVE was technically successful in 40 of 41 patients. Major complications occurred in two patients, with one each having extensive portal vein thrombosis and liver abscess. Partial recanalization of the occluded portal vein was seen in one patient. The mean FLR volume (653 ± 174 ml vs. 532 ± 154 ml, p < 0.001) and mean FLR/TELV ratio (43 ± 8% vs 36 ± 7%, p < 0.001) were significantly higher after than before PVE. PVE using the AVP seems to be a relatively safe and effective technique for inducing hypertrophy of the FLR with minimal risk of recanalization.     

Percutaneous microductectomy with a directional vacuum-assisted system guided by ultrasonography for the treatment of breast discharge: experience in 63 cases

Background: Vacuum-assisted devices are becoming a useful tool in the diagnosis and treatment of breast pathology. Recent publications show good results in percutaneous removal of benign lesions.

Purpose: To discuss our experience in percutaneous excision of ductal lesions with a vacuum-assisted, ultrasound-guided directional system.

Material and Methods: From January 2003 to July 2006, 63 patients with pathological nipple discharge and intraductal lesion identifiable on imaging were studied at two reference centers. Percutaneous excision with a vacuum-assisted device was offered as an alternative to surgery.

Results: A total of 71 lesions were diagnosed in 63 patients with a mean age of 52 years. All the patients presented nipple discharge. Mammography was normal in 65 cases (92%). Galactography showed an intraductal lesion in 67 cases (94%). Mean lesion size on ultrasonography was 7.4 mm (2-26 mm). Percutaneous excision was performed in 45 lesions (63%), while surgical excision was indicated in 26 lesions. The histopathological results in the 45 lesions biopsied demonstrated intraductal papilloma in 30 cases, dilated duct with papillomatous projections in 11, ductal ectasia with no papillary lesion in three, and a nonspecific benign result in one. Excision was considered complete in 41 lesions (91%). Clinical signs of discharge were resolved in 39 patients (95% of cases treated percutaneously). Mild complications occurred in four cases.

Conclusion: Percutaneous excision of ductal lesions with an ultrasound-guided, vacuum-assisted device is a safe procedure with high diagnostic and therapeutic value for the management of breast discharge.     

The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience

Background: Percutaneous nephrostomy (PCN) has been established as an effective technique for urinary decompression or diversion. This procedure may be performed with the guidance of fluoroscopy, ultrasonography, a combination of fluoroscopy and ultrasonography, computed tomography (CT), or magnetic resonance imaging.

Purpose: To retrospectively review experience with CT-guided PCN over a 10-year period in a single center.

Material and Methods: All CT-guided PCN procedures performed in adults at our institution between 1995 and 2005 were evaluated. In 882 patients, 1113 nephrostomy catheters were inserted. Interventional radiologists or radiology residents under direct attending supervision inserted all catheters. During the PCN procedure, bleeding, sepsis, and injuries to adjacent organs were regarded as major complications. Clinical events requiring nominal therapy with no sequelae were regarded as minor complications.

Results: PCN procedures were performed via 1-3 punctures in patients with grades 0-1 and 2 hydronephrosis, and via 1-2 punctures in patients with grade 3 hydronephrosis. They were carried out with a procedure time ranging from 9 to 26 min. All PCNs were considered as technically successful, and no major complications were observed. There were minor complications including transient macroscopic hematuria (28.6%, 19.9%, and 4.9% in patients with hydronephrosis grades 0-1, 2, and 3, respectively) and perirenal hematomas in a total of eight patients. No patient required additional intervention secondary to complications of the PCN procedure.

Conclusion: CT-guided PCN is an efficient and safe procedure with major and minor complication rates below the accepted thresholds. It can be used for the management of patients requiring nephrostomy insertion in inpatient settings, and might be a preferable procedure in patients with minimal or no dilatation of the renal pelvis.     

Do contrast media (iomeprol, gadopentetate dimeglumine) deteriorate ischemia/reperfusion injury of the liver?

Background: Hepatic microcirculation is a main determinant of reperfusion injury and graft quality in liver transplantation. One of the important diagnostic procedures to recognize reperfusion failure is contrast-enhanced computed tomography or magnetic resonance imaging.

Purpose: To examine the additional effect of contrast media (iomeprol and gadopentetate dimeglumine) on hepatic microcirculation and hepatic cellular damage in the phase of early ischemia/reperfusion injury of the rat liver.

Material and Methods: The partial warm ischemia-reperfusion injury model of rat liver was used. Microcirculation and leukocyte-endothelium interaction were measured by intravital microscopy. Hepatic cellular damage was indicated by liver enzyme activity in the sera. The evaluation parameters were measured at baseline and at 30, 60, and 90 min after reperfusion. The contrast media (iomeprol group, n = 6; gadopentetate dimeglumine group, n = 6) or Ringer's solution (control group, n = 8) were applied after 30 min of reperfusion.

Results: No additional injury to the ischemia/reperfusion injury of the liver after intravenous application of radiographic contrast media was found. Some protective effect was even recorded after application of iodinated contrast media.

Conclusion: The use of contrast media during diagnostic procedure of the liver seems to be relatively safe, even in the stage of early reperfusion after liver transplantation.     

Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma by placing a temporary catheter via the subclavian route

Background: A permanent reservoir implantation is considered mandatory for hepatic arterial infusion chemotherapy (HAIC) of hepatocellular carcinoma (HCC). Since treatment sessions of HAIC may be limited for these end-staged patients, a simple alternative technique for this treatment is desirable.

Purpose: To evaluate the feasibility of placing a temporary catheter for HAIC in advanced HCC patients.

Material and Methods: 25 advanced HCC patients underwent HAIC with drugs delivered from a temporary catheter which was placed percutaneously by puncturing the left subclavian artery under ultrasound guidance. A course of chemotherapy consisted of five consecutive daily infusions of 5-fluorouracil, cisplatin, mitomycin C, and leucovorin. The catheter was removed on the 6th day. Therapy was repeated every 4-6 weeks with maximal number of courses of up to six. The total courses of HAIC in each patient, the catheter-placed-related complications, tumor response rate, and median survival of the patients were registered.

Results: A total of 77 courses of HAIC were performed with 100% technical success of catheter placement (1-6 courses in each patient, average 3.1 courses). The overall response rate was 20%, with complete response in two patients and partial response in three patients. Eleven (55%) of the 20 non-responders died within 5 months (mean HAIC, two courses). None of the patients experienced complications such as catheter occlusion, hepatic arterial thrombosis, cerebral infarction, or local infection.

Conclusion: With fewer catheter-related complications, HAIC by temporary catheter placement via subclavian puncture could be a treatment option.     

Bronchial stump fistula: treatment with covered, retrievable, expandable, hinged stents--preliminary clinical experience

Purpose: To evaluate the preliminary clinical efficacy and retrievability of a covered, retrievable, metallic hinged stent in the treatment of bronchial stump fistula (BPF).

Material and Methods: Between April 2003 and March 2005, eight patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types of covered, retrievable, metallic hinged stents. Type A stent was placed in six patients and type B in two under fluoroscopic guidance. The stent was removed with a retrieval set when BPF was healed or complications occurred.

Results: Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BPF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed for 4-16 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BPF was achieved in seven (87.5%) of eight patients.

Conclusion: Use of a covered, retrievable, expandable, metallic hinged stent is a simple, safe, and effective procedure for the closure of bronchial stump fistula. Retrieval of the stent seems feasible.     

Complications following ultrasound-guided thoracocentesis

Purpose: To retrospectively register the number and type of complications following ultrasound-guided thoracocentesis, and to evaluate the need for routine chest X-ray after the procedure.

Material and Methods: Complications were retrospectively registered from the radiological and clinical reports of 371 consecutive patients who had undergone thoracocentesis with a total of 711 procedures.

Results: The mean volume evacuated was 823 ml (range 0-3600 ml). Twenty (2.8%) pneumothoraces were found after 711 thoracocenteses, but in no case was chest tube drainage necessary. Hemoptysis occurred in one patient.

Conclusion: Ultrasound-guided thoracocentesis was found to be a safe procedure. Based on these results, no reason was found to introduce an upper limit of the amount of fluid drained in one session. Routine follow-up chest X-ray is not justified in the absence of clinical symptoms.     

Parameters obtained by hepatobiliary scintigraphy have significant correlation with biochemical factors early after liver transplantation

Background: Early postoperative hepatobiliary scintigraphy after liver transplantation is performed worldwide, but data on its significance for graft function are currently limited.

Purpose: To examine the correlation between the result of early postoperative hepatobiliary scintigraphy and pre- and postoperative biochemical parameters in liver transplantation (LTx) patients.

Material and Methods: Six parameters of hepatobiliary scintigraphy using ^99mTc mebrofenin were statistically analyzed in 108 LTx patients: 1) half-life of the activity of elimination of mebrofenin from the blood; 2) total clearance of mebrofenin from the blood due to all possible routes; 3) half-life of the activity due to liver uptake; 4) clearance of mebrofenin from the blood due to liver uptake; 5) time to maximal uptake in the liver; and 6) the hepatic extraction fraction (HEF) and biochemical data. Analysis between patients with preoperative normal liver function, familial amyloid polyneuropathy (FAP), and end-stage liver disease (non-FAP) was also performed.

Results: Univariate and multivariate analysis revealed that total bilirubin postoperative day 3 correlated with all three scintigraphic parameters, and peak aspartate aminotransferase and alanine aminotransferase correlated with HEF. The analysis between patients with FAP and non-FAP revealed no significant difference of scintigraphic data between the two groups.

Conclusion: A significant correlation between early postoperative scintigraphic results and biochemical parameters was demonstrated.     

A simplified method for continuous hepatic arterial port-catheter system placement not requiring catheter end-hole occlusion

Purpose: To evaluate the efficacy of hepatic port-catheter system placement without distal catheter tip occlusion or gastroduodenal artery embolization distal to the catheter tip.

Material and Methods: A port-catheter system was percutaneously implanted in 29 patients (16 men, 13 women; mean age 65.6 years) with unresectable liver cancer. Persistent blood flow through the end hole of the catheter was verified immediately and 1-10 days after catheter placement.

Results: In all cases, percutaneous port-catheter placement was successfully performed. In seven of 29 (24.1%) patients, flow through the end hole of the catheter was verified immediately after the procedure. However, no flow was seen 1-10 days after the procedure.

Conclusion: It is not necessary to occlude the end hole of the catheter tip and embolize the gastroduodenal artery beyond the catheter tip when placing a port-catheter system for repeated hepatic arterial infusion chemotherapy.     

Intraarterial infusion chemotherapy and conformal radiotherapy for cancer of the mouth: prediction of the histological response to therapy with magnetic resonance imaging

Background: Although intraarterial chemotherapy has been used to treat head and neck cancers, some cases have shown poor response. If we can predict the response to this therapy on MRI, individual treatment plans may be altered to the most appropriate form of treatment.

Purpose: To evaluate whether MRI can predict the histological response to preoperative chemoirradiation in patients with cancer of the mouth.

Material and Methods: This study comprised of 29 consecutive patients with 30 oral cancers. All patients underwent tumor resection after intraarterial infusion chemotherapy and conformal radiotherapy. We compared the margin of the tumor, the presence of bone invasion, tumor area, and volume on pre- and post-treatment MRI with histological responses.

Results: Eighteen lesions showed an excellent response, nine exhibited a good response, and three a poor response. Only the tumor area on pretreatment T1-weighted images and the tumor area and volume on pretreatment enhanced T1-weighted images were significantly correlated with the histological response (P = 0.039, 0.008, and 0.016, respectively); smaller cancers showed better responses. The other factors were not significantly correlated with the histological responses.

Conclusion: MRI parameters, excluding initial tumor area and volume, were not predictive of the histological response of oral tumors to preoperative treatment.     

Detection and characterization of focal liver lesions with contrast-enhanced ultrasonography in patients with hepatitis C-induced liver cirrhosis

Background: Hepatitis C virus (HCV)-associated liver cirrhosis provides a major preneoplastic condition for hepatocellular carcinoma (HCC). Ultrasonography (US) is usually used for screening of HCC, but needs improvement.

Purpose: To assess whether use of a second-generation ultrasound contrast agent can improve characterization of focal liver lesions and detection of HCC in HCV-infected patients with liver cirrhosis.

Material and Methods: In total, 96 US studies in 49 HCV-infected patients with liver cirrhosis were performed. The patients were first examined with a baseline US. After this, a diagnostic decision was made and recorded. The patients were then re-examined with contrast-enhanced ultrasound (CEUS), and the diagnostic triage was repeated. The patients were followed up for at least 1 year.

Results: On baseline US, indeterminate focal lesions were found in 27 examinations. After CEUS, a confident diagnosis of HCC was made in eight of these examinations. In an additional eight US examinations, diagnosis of regenerative/dysplastic noduli was established. In one patient with no detectable focal lesion at baseline examination, an indeterminate malignant lesion was detected with CEUS. This lesion was further investigated with computed tomography and diagnosed as HCC.

Conclusion: Our study indicates that the use of CEUS significantly improves diagnostic confidence. CEUS improves the detection of HCC in patients with HCV-induced liver cirrhosis. Also, CEUS makes it possible to rule out malignancy in many cases where baseline US shows indeterminate focal lesions. In low-endemic countries, the use of CEUS in screening for HCC may be considered.     

Computed-tomography-guided punctures using a new guidance device

Purpose: To evaluate a new adjunctive guidance device, a puncture guide, constructed to simplify computed tomography (CT)-guided punctures and to make the procedure more accurate and safe.

Material and Methods: 17 patients referred for CT-guided punctures were included in the study. There were 10 thoracic and 7 abdominal or pelvic lesions with a mean maximum diameter of 29±18 mm. All punctures were performed using a laser guide combined with the new device. The needle guide created a streak artefact in the image, indicating the needle path.

Results: The puncture was successful at the first attempt in 15 of the 17 patients. The artefact was visible in all patients, and in the majority there was a distinct artefact reaching from the entry point to the lesion. The deviation between the angle of the streak artefact and the final angle of the needle was 1.1°.

Conclusion: The benefits of the puncture guide were the artefact pointing at the target, the needle support, and accuracy when performing CT-guided punctures.