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© 2002 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 21:1015-1022 • 0278-4297

Technical Advance

Hepatocellular Carcinoma

Therapeutic Experience With Percutaneous Ethanol Injection Under Real-time Contrast-Enhanced Color Doppler Sonography With the Contrast Agent Levovist

Kazuhito Shirato, MD, Manabu Morimoto, MD, Naohiko Tomita, MD, Atsushi Kokawa, MD, Kazuya Sugimori, MD, Toshifumi Saito, MD, Kazushi Numata, MD, Hisahiko Sekihara, MD and Katsuaki Tanaka, MD

Gastroenterological Center, Yokohama City University Medical Center (K.Sh., M.M., N.T., A.K., K.Su., T.S., K.T.), and Third Department of Internal Medicine, Yokohama City University School of Medicine (K.N., H.S.), Yokohama, Japan.

Address correspondence and reprint requests to Kazuhito Shirato, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.

Objective. To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. Methods. Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean ± SD, 2.7 ± 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. Results. After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. Conclusions. Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.

Abbreviations: CDS, color Doppler sonography • CT, computed tomography • HCC, hepatocellular carcinoma • PEI, percutaneous ethanol injection • TAE, transcatheter arterial embolization • TAI, transcatheter arterial infusion

Key Words: contrast-enhanced color Doppler sonography • hepatocellular carcinoma • percutaneous ethanol injection • sonographic contrast agent




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