Role of image-guided therapies in hepatocellular carcinoma

According to our previous experience, RFA also obtained greater local efficacy than whole-liver TACE, without its side effects and without impairment of liver function.

PEI is preferred in lesions at risk with RFA, i.e. adjacent to main biliary ducts or to intestinal loops (above all when fibrotic adhesions between the hepatic capsule and intestinal wall were suspected, because of the risk of perforation) (figure 2), in small lesions with a location difficult to reach where the use of the fine needle for PEI assured a less traumatic approach in case of repeated attempts, and in portions of tumor close to large vessels (because of the “heat sink effect”).

Figure 2
Figure 2

Selective TACE is used in lesions not recognizable at ultrasound examination (figure 3), in lesions not completely necrotized and presenting the remnant vital tissue scattered or not recognizable at ultrasound examination for an additional treatment with RFA or PEI, and in the presence of satellite nodules after the achievement of complete necrosis of the main tumor after RFA or PEI (figure 4).

In conformity with our experience, the uptake of such small volumes of neoplastic tissue is given easy by the absence of arterial theft from the rich supply of the main tumor.

Figure 3
Figure 3.1Figure 3.2

Figure 4
Figure 4.1Figure 4.2