Small hepatocellular carcinoma treated with percutaneous ethanol injection: MR imaging findings

Article Abstract:

An increasing number of patients with liver disease are being diagnosed as having small liver tumors because of increased screening and selected needle biopsies. The prognosis for these patients is good if the tumors are immediately removed surgically, but surgery is not an option in some cases. Percutaneous ethanol injection (PEI) is an alternative to surgery. It involves directly injecting alcohol around and into the tumor or tumors to destroy the tumorous tissue. A number of treatments are required, depending on the size of the tumor and its response to treatment. Diagnostic imaging is important when using PEI in determining if treatment is effective in eliminating the tumor. Computed tomography (CT), a specialized X-ray technique using a computer to generate images of tissues, is currently used to evaluate the effectiveness of PEI treatment. This study examined whether magnetic resonance imaging (MRI), another technique that uses magnetic properties of tissues to produce images, is useful in evaluating the effectiveness of PEI treatment of liver tumors. MRI was performed prior to PEI treatment and within one month after treatment ended on 19 patients with liver tumors. CT results were also available for 11 patients and MRI results taken six months after the end of treatment were available for 17 patients. Imaging results were compared with results of biopsy obtained after treatment. A total of 23 tumors in 19 patients were treated, of which 18 decreased in size in response to PEI. On MRI, the tumors all had high signal intensities before treatment, indicating large amounts of tumorous tissue. After treatment, the signal intensities were low for 21 of the 23 tumors. Biopsies of these 21 tumors all found necrotic or dead tissue, meaning that the tumors were being destroyed. In the two tumors that still showed high intensity signals, biopsy samples contained active tumor tissue. MRI results taken six months after treatment was ended were similar to those taken right after the end of treatment. In nine cases, a biopsy was again taken and no active tumor tissue was found. These results indicate that MRI may be useful in determining the effectiveness of PEI in treating liver tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Magnetic resonance imaging, Injections, Hypodermic, Subcutaneous injections

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Liver metastases: results of percutaneous ethanol injection in 14 patients

Article Abstract:

Percutaneous ethanol injection (PEI) is a new treatment for certain types of liver cancers; recent studies have reported it is more effective than surgery. The treatment involves injecting ethanol (an alcohol) with a needle into the tumor. The needle is guided by ultrasound (US), an imaging technique that uses high-frequency sound waves. The technique has the advantage of not destroying healthy tissue, because the alcohol does not diffuse out of the tumor. This study examined the effectiveness of PEI for treating a variety of types of cancer in the liver. It was performed on 14 patients with a total of 21 liver tumors; these tumors were the result of metastasis, or spreading of cancer from primary cancers located in other parts of the body. The primary cancer was a colorectal adenocarcinoma in seven patients, a stomach adenocarcinoma in four patients, an abdominal leiomyosarcoma in one patient, and a bronchial carcinoid in one patient. A total of 204 injections were performed on the 21 tumors. Results showed that treatment caused a complete response in 11 tumors and a partial response in two tumors. Five tumors showed no change and three grew. Nine of the 11 tumors that responded completely were less than 2 centimeters in diameter. Four of the lesions that responded completely were in two patients, one with gastrinoma and the other with carcinoid, both being endocrine cancers. These results indicate that PEI is effective only for treating single, small tumors that are either endocrine metastases or metastases of adenocarcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ultrasound imaging, Metastasis, Cancer metastasis

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Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results

Article Abstract:

Plummer disease is a form of hyperthyroidism, the secretion of excess thyroid hormone. In Plummer disease, thyroid nodules independent of the thyroid gland are responsible for the hyperthyroidism. These nodules are routinely treated with surgery and radioiodine therapy. Successful treatment of parathyroid tumors with percutaneous ethanol injections (PEI) lead to the investigation of this treatment for thyroid nodules. Eight Plummer disease patients with thyroid nodules that were identified with ultrasound (US) imaging agreed to receive this treatment. This procedure involves injecting alcohol directly into the nodule once or twice a week, providing a total of three to six injections per lesion. These nodules are well demarcated and the alcohol did not perfuse into the surrounding tissue. No anesthesia was needed for this procedure, and all of the patients tolerated it well with minimum discomfort. All of the patients had positive results, with the symptoms and signs of hyperthyroidism subsiding in each case. The normal thyroid tissue was not harmed in any way, and this procedure has fewer side effects than surgery and radioiodine therapy. Further study may conclude that PEI is the most viable treatment for thyroid nodules. (Consumer Summary produced by Reliance Medical Information, Inc.)

Thyroid diseases, Hyperthyroidism

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