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Title: Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety

Abstract

Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection (PEI) of hepatomas. This study retrospectively evaluates the safety and efficacy of PEI of unresectable medium-to-large (3.5-9 cm) hepatomas using a multipronged needle and with conscious sedation. Twelve patients, eight men and four women (age 51-77 years; mean: 69) received PEI for hepatomas, mostly subcapsular or exophytic in location with average tumor size of 5.6 cm (range: 3.5-9.0 cm). Patients were consciously sedated and an 18G retractable multipronged needle (Quadrafuse needle; Rex Medical, Philadelphia, PA) was used for injection under real-time ultrasound guidance. By varying the length of the prongs and rotating the needle, the alcohol was widely distributed within the tumor. The progress of ablation was monitored by contrast-enhanced ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) after each weekly injection and within a month after the final (third) injection and 3 months thereafter. An average total of 63 mL (range: 20-154 ml) of alcohol was injected per patient in an average of 2.3 sessions. Contrast-enhanced CT, ultrasound, or MRI was used to determine the degree of necrosis. Complete necrosis was noted in eight patients (67%), near-complete necrosis (90-99%) inmore » two (16.7%), and partial success (50-89%) in two (16.7%). Follow-up in the first 9 months showed local recurrence in two patients and new lesions in another. There was no mortality. One patient developed renal failure, liver failure, and localized perforation of the stomach. He responded to medical treatment and surgery was not required for the perforation. One patient had severe postprocedural abdominal pain and fever, and another had transient hyperbilirubinemia; both recovered with conservative treatment. PEI with a multipronged needle is a new, safe, and efficacious method in treating medium-to-large-sized hepatocellular carcinoma under conscious sedation. Its survival benefits require further investigations.« less

Authors:
;  [1]; ; ; ;  [2]; ; ; ;  [3]
  1. University of Toronto, University Health Network and Mt Sinai Hospital, Department of Medical Imaging (Canada)
  2. University of Toronto, University Health Network and Mt Sinai Hospital, Department of Surgery (Canada)
  3. University of Toronto, University Health Network and Mt Sinai Hospital, Department of Medicine (Canada)
Publication Date:
OSTI Identifier:
21091044
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 30; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-005-0169-y; Copyright (c) 2007 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPUTERIZED TOMOGRAPHY; ETHANOL; FAILURES; FEVER; HEPATOMAS; INJECTION; KIDNEYS; LIVER; NECROSIS; NMR IMAGING; PATIENTS; STOMACH; SURGERY

Citation Formats

Ho, C.S., E-mail: cs.ho@uhn.on.ca, Kachura, J.R., Gallinger, S., Grant, D., Greig, P., McGilvray, I., Knox, J., Sherman, M., Wong, F., and Wong, D.. Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety. United States: N. p., 2007. Web. doi:10.1007/S00270-005-0169-Y.
Ho, C.S., E-mail: cs.ho@uhn.on.ca, Kachura, J.R., Gallinger, S., Grant, D., Greig, P., McGilvray, I., Knox, J., Sherman, M., Wong, F., & Wong, D.. Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety. United States. doi:10.1007/S00270-005-0169-Y.
Ho, C.S., E-mail: cs.ho@uhn.on.ca, Kachura, J.R., Gallinger, S., Grant, D., Greig, P., McGilvray, I., Knox, J., Sherman, M., Wong, F., and Wong, D.. Sun . "Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety". United States. doi:10.1007/S00270-005-0169-Y.
@article{osti_21091044,
title = {Percutaneous Ethanol Injection of Unresectable Medium-to-Large-Sized Hepatomas Using a Multipronged Needle: Efficacy and Safety},
author = {Ho, C.S., E-mail: cs.ho@uhn.on.ca and Kachura, J.R. and Gallinger, S. and Grant, D. and Greig, P. and McGilvray, I. and Knox, J. and Sherman, M. and Wong, F. and Wong, D.},
abstractNote = {Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection (PEI) of hepatomas. This study retrospectively evaluates the safety and efficacy of PEI of unresectable medium-to-large (3.5-9 cm) hepatomas using a multipronged needle and with conscious sedation. Twelve patients, eight men and four women (age 51-77 years; mean: 69) received PEI for hepatomas, mostly subcapsular or exophytic in location with average tumor size of 5.6 cm (range: 3.5-9.0 cm). Patients were consciously sedated and an 18G retractable multipronged needle (Quadrafuse needle; Rex Medical, Philadelphia, PA) was used for injection under real-time ultrasound guidance. By varying the length of the prongs and rotating the needle, the alcohol was widely distributed within the tumor. The progress of ablation was monitored by contrast-enhanced ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) after each weekly injection and within a month after the final (third) injection and 3 months thereafter. An average total of 63 mL (range: 20-154 ml) of alcohol was injected per patient in an average of 2.3 sessions. Contrast-enhanced CT, ultrasound, or MRI was used to determine the degree of necrosis. Complete necrosis was noted in eight patients (67%), near-complete necrosis (90-99%) in two (16.7%), and partial success (50-89%) in two (16.7%). Follow-up in the first 9 months showed local recurrence in two patients and new lesions in another. There was no mortality. One patient developed renal failure, liver failure, and localized perforation of the stomach. He responded to medical treatment and surgery was not required for the perforation. One patient had severe postprocedural abdominal pain and fever, and another had transient hyperbilirubinemia; both recovered with conservative treatment. PEI with a multipronged needle is a new, safe, and efficacious method in treating medium-to-large-sized hepatocellular carcinoma under conscious sedation. Its survival benefits require further investigations.},
doi = {10.1007/S00270-005-0169-Y},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 30,
place = {United States},
year = {Sun Apr 15 00:00:00 EDT 2007},
month = {Sun Apr 15 00:00:00 EDT 2007}
}