Fan-shaped hepatic parenchymal damage after ethanol injection therapy for hepatocellular carcinoma: MRI appearances |
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Authors: | T Fujita K Honjo K Ito T Arita S Koike K Takano S Tamura T Matsumoto N Matsunaga |
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Institution: | (1) Department of Radiology, Yamaguchi University School of Medicine, 1144 Kogushi, Ube, Yamaguchi 755, Japan, JP |
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Abstract: | Background: T1- and T2-weighted magnetic resonance (MR) images frequently show fan-shaped areas of hypo- or hyperintensity in the hepatic
parenchyma adjacent to a treated hepatocellular carcinoma after percutaneous ethanol injection (PEI) therapy. These areas
correspond to abnormal contrast enhancement on serial dynamic MR images. The purpose of the present study was to describe
the location, appearance, and frequency of these abnormalities because it is important to understand these entities for the
correct assessment of therapeutic efficacy.
Methods: MR imaging including a multisection dynamic study was performed in 20 consecutive patients with hepatocellular carcinoma
treated with PEI therapy. We retrospectively evaluated the presence of fan-shaped hypointensities adjacent to treated tumors
in the liver parenchyma on T1-weighted images and hyperintensities on T2-weighted images and corresponding fan-shaped contrast
enhancement on both arterial-dominant and delayed-phase dynamic MR images. We review the location, appearance, and frequency
of these findings, and we discuss the possible causes on the basis of pathologic examinations.
Results: Seven (35%) of the 20 patients showed fan-shaped hyperintense areas adjacent to the treated tumors on T2-weighted images.
These areas showed isointensity in five patients and hypointensity in two patients on T1-weighted images. Of these seven patients,
one (14%) underwent the MR imaging within 1 month after the completion of PEI therapy, and six (86%) had it 2–9 months after
the completion of PEI therapy (mean = 6 months). In all seven patients, fan-shaped hyperperfusion abnormalities corresponding
to these areas of hyperintensity on T2-weighted images were seen on both arterial-dominant and delayed-phase dynamic MR images.
Pathologically, the coagulative necrosis of the hepatocytes with sinusoidal dilatation and the restoration by the development
of fibrous tissue were seen in these fan-shaped areas.
Conclusion: The fan-shaped areas of abnormal intensity on T1- and T2-weighted images and contrast enhancement on dynamic MR images seem
to be attributable to pathologic changes in the normal liver parenchyma induced by the toxic reaction of ethanol. Awareness
of the occurrence of such abnormalities in the peripheral liver parenchyma adjacent to the treated tumor is important for
the correct assessment of therapeutic efficacy.
RID="ID="<e5>Correspondence to:</e5> T. Fujita
Received: 24 June 1997/Accepted after revision: 22 October 1997 |
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Keywords: | : Magnetic resonance imaging (MRI)— Liver— Hepatocellular carcinoma— Percutaneous ethanol injection therapy— Parenchymal damage |
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