Radiofrequency ablation of hepatocellular carcinoma in patients with decompensated cirrhosis: evaluation of therapeutic efficacy and safety

OBJECTIVE: Our objective was to determine the therapeutic efficacy and safety of radiofrequency ablation in the treatment of hepatocellular carcinoma (HCC) in patients with decompensated cirrhosis. SUBJECTS AND METHODS: Nineteen patients with 26 HCC nodules (range, 0.8-5 cm; mean, 1.96 cm) and decompensated liver cirrhosis (mean Child score, 10.7) were treated with radiofrequency ablation using cooled-tip electrodes and a 200-W generator. Radiofrequency ablation was performed under the guidance of sonography or CT. Procedure-related complications, therapeutic efficacy, each patient's survival, changes in blood test results--that is, serum aminotransferase and bilirubin--and changes in the Child score before and after ablation therapy were analyzed. To assess the therapeutic response of the tumor to radiofrequency ablation, we performed contrast-enhanced CT after the procedure and during follow-up. RESULTS: Complete necrosis without marginal recurrence at the 6-month follow-up was attained in 23 lesions (88.5%). During follow-up (mean, 13.3 months), one patient experienced a remote tumor recurrence in the liver. The median survival time was 12.0 +/- 1.7 months. Two patients died of liver failure--one at 2 months and one at 4 months after treatment. The other patients were followed for at least 6 months (range, 6-28 months; mean, 12 months). The first and second weeks after therapy, the serum aminotransferase and bilirubin levels were significantly higher than were pretreatment levels (p < 0.05). However, 3 weeks after therapy, those figures were nearly restored to the pretreatment levels. The mean Child scores 3 weeks after radiofrequency ablation (10.8) were similar to those before treatment (10.7). CONCLUSION: Radiofrequency ablation can be used selectively for treatment of HCC in patients with decompensated cirrhosis but has the potential to aggravate the preexisting hepatic dysfunction

Comparison of gadobenate dimeglumine-enhanced dynamic MRI and 16-MDCT for the detection of hepatocellular carcinoma

OBJECTIVE: The objective of our study was to compare the diagnostic performance of gadobenate dimeglumine-enhanced MRI with that of 16-MDCT for the detection of hepatocellular carcinoma using receiver operating characteristic (ROC) curve analysis. MATERIALS AND METHODS: Thirty-one patients with 53 hepatocellular carcinomas underwent gadobenate dimeglumine-enhanced dynamic MRI and multiphasic CT using 16-MDCT within a mean interval of 5 days (range, 3-9 days). The dynamic MRI examination was performed using 3D fat-saturated volumetric interpolated imaging and sensitivity encoding on a 1.5-T unit. Both dynamic MRI and multiphasic MDCT included dual arterial phase images. Three observers independently interpreted the CT and MR images in random order, separately, and without patient identifiers. The diagnostic accuracy of each technique was evaluated using the alternative-free response ROC method. The sensitivity and positive predictive values were also calculated. RESULTS: The sensitivities of gadobenate dimeglumine-enhanced MRI for all observers were significantly higher than those of MDCT for all the lesions and for lesions 1.0 cm or smaller (p < 0.05); however, for lesions larger than 1.0 cm, the sensitivities of the two imaging techniques were similar. The mean area under the ROC curve (A(z)) of gadobenate dimeglumine-enhanced MRI (0.87 +/- 0.03 [SD]) was higher than that of MDCT (0.83 +/- 0.04), but no significant difference was found between them (p = 0.31). The number of false-positive findings on dynamic MRI was slightly higher than on MDCT, but no significant difference in the positive predictive value between the two imaging techniques was detected (observer 1, p = 0.06; observer 2, p = 0.13; observer 3, p = 1.00). CONCLUSION: Gadobenate dimeglumine-enhanced MRI has a higher sensitivity for small hepatocellular carcinomas (</= 1 cm) but a higher false-positive rate due to nonspecific enhancement of benign lesions, such as arterioportal shunt, leading to no significant difference of overall accuracy when compared with MDCT