CT-guided treatment of ultrasonically invisible hepatocellular carcinoma

New techniques of CT-guided management were introduced to ablate ultrasonic ally invisible hepatocellular carcinomas. In six patients with HCC, a total of six nodules (8-30 mm in diameter) were treated under the guidance of CT . These lesions were not visualized by sonography but were visualized as Li piodol spots on CT after chemoembolization. Tumor localization was successf ul in all patients without difficulty, using a thin needle or hookwire unde r the guidance of CT. Two patients underwent subsequent hepatic resection a nd/or microwave coagulation therapy (MCT) through a small incision after ho okwire placement. Four patients received percutaneous MCT (n = 2) or ethano l injection (PEI) (n = 2) at the time of localization. The postoperative CT with contrast enhancement indicated that tumor ablation was complete in fo ur of the five nodules treated with MCT or PEI. However, in one nodule (30 mm in diameter) treated with PEI, tumor ablation was not complete. There we re no complications. There has been no local tumor recurrence 6-46 months a fter treatment in any of the patients. In conclusion, these CT-guided proce dures were effective in treating ultrasonically invisible hepatocellular ca rcinomas that otherwise would have remained untreated. (C) 2000 by Am. Cell . of Gastroenterology.