1,720,996 research outputs found
Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma
No full textOwing to surveillance programs for detection of hepatocellular carcinoma (HCC) in patients with cirrhosis, more tumors are being detected at an early, asymptomatic stage. Percutaneous ablation is considered the best treatment option for patients with Child-Pugh class A or B cirrhosis and a single, nodular-type HCC smaller than 5 cm or as many as three HCC lesions, each smaller than 3 cm, when surgical resection or liver transplantation is not suitable. Radiofrequency ablation (RFA) has emerged as the most powerful method for percutaneous treatment of early-stage HCC. Recent studies have shown that RFA can achieve more effective local tumor control than ethanol injection and with fewer treatment sessions. In a randomized trial, local recurrence-free survival rates were significantly higher in patients who received RFA than in those treated by ethanol injection, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. Due to advances in radiofrequency technology, RFA also has been used to treat patients with more advanced tumors. Preliminary reports have shown that RFA performed after balloon catheter occlusion of the hepatic artery, transarterial embolization, or chemoembolization results in increased volumes of coagulation necrosis, thus enabling successful destruction of large HCC lesions. This report reviews the current status of percutaneous, image-guided RFA in the therapeutic management of HC
Guidelines for the use of contrast-enhanced ultrasound in hepatocellular carcinoma
No full textAbstractSurveillance of patients at risk of developing hepatocellular carcinoma (HCC) relies on ultrasound (US) examinations performed at 6-month intervals. Early detection of HCC on a cirrhotic background is a challenging issue, since the US features of the different entities in the multi-step process of hepatocarcinogenesis – such as low-grade and high-grade dysplastic nodule – do overlap. Contrast-enhanced US allows reliable detection of arterial neo-angiogenesis associated with the malignant change. Several reports have shown that the ability of contrast-enhanced US to diagnose HCC currently approaches that of optimised multidetector computed tomography (CT) or dynamic magnetic resonance (MR) imaging protocols. The use of contrast-enhanced US to characterise nodular lesions in cirrhosis has recently been recommended by the clinical practice guidelines issued by the European Federation of Societies for Ultrasound in Medicine and Biology and the American Association for the Study of Liver Diseases. Contrast-enhanced US has also been successfully used to assess response of HCC to image-guided percutaneous ablation procedures. In this article, we discuss the advantages and limitations of contrast-enhanced US with respect to the other imaging modalities in the setting of HCC
Hepatocellular carcinoma: new options for image-guided ablation
No full textImage-guided percutaneous ablation is currently accepted as the best therapeutic choice for patients with early-stage hepatocellular carcinoma (HCC) when transplantation and resection are precluded. Several methods for chemical or thermal tumor destruction have been developed and tested clinically during the past two decades. The seminal technique used for local treatment of HCC has been percutaneous ethanol injection (PEI). Several studies have provided indirect evidence that PEI improves the natural history of nonsurgical patients with early-stage HCC. Its major limitation is the high rate of local recurrence. Radiofrequency (RF) ablation has been the most widely assessed alternative to PEI. Five randomized controlled trials have shown that RF ablation achieves more effective and reproducible tumor destruction than PEI, leading to a better local control of the disease. As a result, RF ablation has been established as the primary ablative modality. The value of newer thermal and non-thermal methods for local tumor treatment, such as microwave ablation, irreversible electroporation (IRE), and light activated drug therapy, should be investigated in the setting of randomized controlled trial
Clinical management of focal liver lesions: the key role of real-time contrast-enhanced US
No full textUltrasonography (US) is the most commonly used liver imaging modality worldwide. Unfortunately, it has limited sensitivity in the detection of small tumor nodules. Moreover, US findings are often nonspecific, as appearances of benign and malignant liver lesions overlap. The introduction of microbubble contrast agents and the development of contrast-specific techniques have opened new prospects in liver US. The advent of second-generation agents that enable continuous real-time contrast-enhanced imaging has been instrumental in improving the acceptance and reproducibility of the examination. With the publication of guidelines for the use of contrast agents in liver US by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), contrast-enhanced US has entered clinical practice. The guidelines define the indications and recommendations for the use of contrast agents in focal liver lesion detection, characterization, and posttreatment follow-up. Recently, the clinical value of contrast US as a reliable alternative to CT or MR imaging in characterizing hepatocellular carcinoma in cirrhosis has been endorsed by the practice guideline document issued by the American Association for the Study of Liver Diseases and the 2005 Monothematic Conference on Hepatocellular Carcinoma of the European Association for the Study of the Liver. In this article, the current role of contrast US in the diagnostic management of focal liver lesions is discussed with regard to the following clinical scenarios: (1) characterization of incidental findings; (2) diagnosis of hepatocellular carcinoma in patients with cirrhosis; and (3) identification of hepatic metastases in oncology patients; (4) guidance and monitoring of tumor ablation procedure
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