Usefulness of pulsed doppler ultrasound in detection of angiographically evident recurrence of hepatocellular carcinoma after arterial embolization treatment
Satoshi MochidaShigeki HayashiItsuro OgataNaohiko MasakiSumiko NagoshiTomoaki TomiyaAkihiko OhnoKatsuyoshi TakatsukiYasuhiko OhtaShinwa YamadaYuzuru SatoKuni OhtomoKenji Fujiwara
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Abstract:
Because hepatocellular carcinoma treated by transcatheter arterial embolization often regains its size, routine follow-up is necessary. The usefulness of pulsed Doppler ultrasound for detection of this type of recurrence was compared with ultrasonography and computed tomography in 21 such hepatocellular carcinomas. Of 15 hepatocellular carcinomas diagnosed by angiography as showing recurrence, four were detected with ultrasonography and five were detected with computed tomography. Doppler signals were obtained in the peripheral portions corresponding to tumor vessels or stains on angiograms in 14 of these 15 hepatocellular carcinomas, but they were undetectable in six hepatocellular carcinomas with no recurrence. All signals disappeared after transcatheter arterial embolization. One false-negative hepatocellular carcinoma with pulsed Doppler ultrasound showed faint tumor stains on angiograms; these were also negative on ultrasonography and computed tomography. Pulsed Doppler ultrasound may be superior to ultrasonography and computed tomography as a routine procedure to detect the recurrence of hepatocellular carcinoma treated by transcatheter arterial embolization. (Hepatology 1991;13:434-437.)Keywords:
Arterial Embolization
Doppler ultrasound
Doppler ultrasound
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Objectives To assess the value of high frequency colour Doppler ultrasound in the detection of vascular injuries.Methods 11 patients with vascular injuries were examined by high frequency colour Doppler Ultrasound,and were compared with angiogram and post-operative results .Results in 11 patients,8 cases were patients with pseudoaneurysm,2 cases were patients with the vein breaks ,1 cases were patients with the vein breaks and the arterial breaks .Conclusion High frequency colour Doppler ultrasound has high value in diagnosing patients with pseudoaneurysm .Though vascular break is not able to shown directly,can make a definite diagnosis by indirect sign with selectivity angiogram,.
Pseudoaneurysm
High frequency ultrasound
Doppler ultrasound
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Objective To investigate the value of uterial arterial embolization treatment of postpartum hemorrhage.Methods 14 patients with postpartum hemorrhage failed to the drugs treatment were performed supersellective uterial arterial embolization by Seldinger technique.Results 12 case were successfully embolized through uterial artery,2 cases were embolized by arteria iliaca interna;Bleeding were cessation after the arterial embolization in 12 patients,Subtotal hysterectomy were performed in 2 cases because of incomplete haemostasis;The followup study showed that 12 patients had normal menstrual periods in 3-10 months and no serious complications were found.Conclusion Uterial arterial embolisis is an effective method for postpartum hemorrhage,with the characteristic of fast hemostasis and less complications.
Arterial Embolization
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Objective:To evaluate the clinical application of splenic arterial embolization in interventional treatment for hepatocellular carcinoma.Methods:11 patients with hepatocellular carcinoma were treated by superselective splenic arterial embolization (8 cases) or selective splenic arterial embolization (3 cases).Before and after the operation, the blood routine and hepatic function were observed.Results:Compared with the condition before operation, the GPT decreased and WBC and Plt rose obviously. No severe complication occurred in all patients.Conclusion:Splenic arterial embolization is safe and effective treatment for hepatocellular carcinoma. It can improve hepatic function and reduce or eliminate hypersplenism.
Arterial Embolization
Liver function
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Arterial Embolization
Transcatheter arterial chemoembolization
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Objective:To compare the clinical value of ultrasound and CT in the diagnosis of small hepatocellular carcinoma.Methods:The CT and ultrasound results of 48 cases,who were diagnosed as small hepatocellular carcinoma by ultrasound,were compared.Results:Among the 48 cases diagnosed as hepatocellular carcinoma by ultrasound,6 cases were misdiagnosed,so the diagnostic rate of ultrasound was 87.5%,while,5 cases were missed by CT,so the diagnostic rate of CT was 89.6%.Conclusion:Small hepatocellular carcinoma has typical imaging characteristics both in ultrasound and CT examinations,but in the early stage, misdiagnosis may take place in CT examination.This is mainly because of the small lesion and the absence of typical tissue necrosis,which may result from the equal density of the lesion and deficiency of hepatic artery blood supply.The combination of ultrasound with digital subtraction angiography(DSA) can enhance the detection rate of small hepatocellular carcinoma.
Digital subtraction angiography
Blood supply
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Arterial Embolization
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Transcatheter arterial embolization induces marked antitumor response in patients with hepatocellular carcinoma, but the survival benefit of transcatheter arterial embolization remains to be determined. This study investigated prognostic factors in patients with advanced hepatocellular carcinoma treated by transcatheter arterial embolization.A total of 128 consecutive patients with non-resectable hepatocellular carcinoma, who had undergone transcatheter arterial embolization between May 1990 and August 1998, were analyzed to investigate prognostic factors.Median survival time and survival proportions at 1, 3 and 5 years were 3.3 years, 92.0, 54.6 and 23.4%, respectively. By multivariate analysis using the accelerated failure time model, age <60 years, hepatitis C virus antibody positivity, serum albumin >3.5 g/dl, absence of portal vein invasion and serum alpha-fetoprotein level <400 ng/ml were significantly associated with favorable survival. For clinical application, we also propose a prognostic equation with combination of specific prognostic factors, by which survival curves of each patient could be predicted directly.The findings of the current study may be helpful in predicting the life expectancy of hepatocellular carcinoma patients treated by transcatheter arterial embolization and in designing future clinical trials of transcatheter arterial embolization for hepatocellular carcinoma.
Arterial Embolization
Transcatheter arterial chemoembolization
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Objective To investigate the value of contrast enhanced ultrasound(CEUS)in evaluati-ng the effect of high intensity focused ultrasound(HIFU) combined with transcatheter arterial embol-ization(TAE)on liver cancer.Methods Fifteen patients with primary liver cancer and 9 patients with metastatic hepatocellular carcinoma(31 lesions) underwent HIFU within 1 week after TAE.Contrast enhanced ultrasound was performed before and 7-14 days after treatment and ultrasound findings were compared with color Doppler ultrasound and contrast enhanced MRI.Results Among the 31 lesions,contrast enhanced ultrasound showed no enhancement(complete tumor growth inhibition)in 19(61.3%),and edge or central local arterial phase hyperenhancement and portal phase and delayed phase hypoenhancement tumor persistence in 12(38.7%).According to the final diagnosis as the gold standard, the diagnostic accuracy of CEUS,contrast enhanced MRI and color Doppler ultrasound was 90.3%,93.5% and 48.4%,respectively.There were no significant differences in the sensitivity,speci-ficity and accuracy for evaluating tumor inactivation between CEUS and contrast enhanced MRI.However,the accuracy of contrast-enhanced ultrasound was higher than that of color Doppler ultrasound for evalu-ating tumor inactivation(P0.05).Conclusion CEUS can accurately determine the degree of tumor inactivation after HIFU combined with TAE in patients with liver cancer.Therefore,CEUS provides a basis for evaluating short-term efficacy and has a high clinical value in liver cancer.
Contrast-enhanced ultrasound
High-intensity focused ultrasound
Liver Cancer
Intensity
Doppler ultrasound
Color doppler
Arterial Embolization
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Thirty-one patients with hepatocellular carcinoma underwent duplex scanning of their lesions with comparative angiography and serum alpha-fetoprotein determinations before and after transcatheter arterial embolization. Duplex ultrasound correctly identified 26 patients with patent tumor vessels after embolization. The Doppler signals became undetectable after embolization in the other five patients. Comparative angiography demonstrated good devascularization of their lesions. However, tiny tumor blush or small satellite nodules around the periphery of the devascularized masses were found. Therefore, the presence of signals after therapy indubitably needs further embolization. The timing of the second embolization for the patient with undetectable Doppler signals after the first embolization needs to be justified by further evaluations.
Arterial Embolization
Duplex (building)
Doppler ultrasound
Duplex ultrasonography
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