Role of image-guided therapies in hepatocellular carcinoma

Pre and post-treatment work-up

For all patients, pre and post-treatment work-up includes ultrasound examination, more recently using second-generation echo-enhancers (Sonovue, Bracco, Milan, Italy), as well as unenhanced and dual phase, contrast-enhanced helical computed tomography. The work-up is performed before treatment, 1 month and subsequently every 4-6 months after treatment. In some patients, usually at the beginning of RFA experience or in cases at risk, CT examination was performed the day after treatment. Additionally, AFP and DCP levels are obtained using the same timing in all patients.


PAT are performed under real-time ultrasound guidance. For RFA, 20-cm-long, 18-gauge internally cooled electrodes (Radionics Inc., Burlington, MA, USA) are used (figure 5).

Figure 5
Figure 5.1Figure 5.2

For PEI we use a 21-gauge needle with a closed conical tip and three terminal side holes (PEIT needle; Hakko, Tokyo, Japan). For sTACE, a 3.0 F microcatheter (FasTracker-325; Boston Scientific, Cork, Ireland) is inserted into the feeding segmental or sub-segmental artery through a 5-F catheter indwelling in the proximal hepatic artery.
An emulsion of 1-5 ml iodized poppyseed oil (Lipiodol Ultra-Fluid; Guerbet, Paris, France) and 10-20 mg epirubicin hydrochloride (Farmorubicina; Pharmacia & Upjohn, Milan, Italy) is introduced, followed by gelatin sponge particles (Gelfoam;Upjohn, Kalamazoo, USA). More detailed technical information about the procedures have been already published.