Eii Karasawa

Diagnosis and Clinical Features of Small Hepatocellular Carcinoma With Emphasis on the Utility of Real-Time Ultrasonography: A Study in 51 Patients

The clinical features and usefulness of various methods for diagnosis of small hepatocellular carcinoma, no greater than 5 cm in diameter, were studied in 51 patients. The diagnosis was verified in 28 patients by hepatic resection and in 4 patients at autopsy. The tumor was less than 3 cm in diameter in 23 patients. In 37 patients (72.5%), the tumor was first discovered by real-time linear scan ultrasonography, generally during a routine periodic follow-up examination of patients with chronic liver disease, mostly cirrhosis. Clinically, 62.7% of the patients were asymptomatic, and symptoms in the remainder were not suggestive of carcinoma. Most patients showed only mildly abnormal liver function tests that did not suggest the diagnosis. Serum alpha-fetoprotein level was normal in 25.5%, and it was elevated above 200 ng/ml in only 33.3%. Among the various imaging modalities, ultrasonography had the highest detection rate (92.2%) for these small hepatocellular carcinomas compared with computed tomography (73.2%), scintigraphy (50.0%), and angiography (86.0%). False-positive lesions, however, were also found frequently by ultrasonography, requiring ultrasonography-guided biopsy for differential diagnosis in some of the patients. Routine examination at regular intervals of patients with chronic liver disease using a combination of real-time ultrasonography and alpha-fetoprotein measurement is currently the most effective approach to detecting small hepatocellular carcinoma.

Ultrasonically guided percutaneous drainage of solitary liver abscess: successful treatment in four cases.

We used a specially designed real-time ultrasound probe (puncture transducer) to puncture solitary liver abscesses for diagnosis and drainage therapeutic purposes. The techniques in four patients so treated is described along with the ultrasonograms and roentgenograms of the opacified abscesses.

Contrast‐Enhanced Three Dimensional Ultrasonography supporting HIFU treatment of Small Liver Cancer

HIFU was carried out in the 12 patients with small hepatocellular carcinoma (small HCC) as a extracorporeal ablation therapy, and clinical availability was studied from the results. In carrying out the HIFU therapy, contrast enhanced (CE) three dimensional (3D) ultrasound imaging played an important role to clarify the tumor nature , to monitor the sonication procedure and to assess the tumor ablation and was almost indispensable for the treatment. All the patient had no serious side effects and they are all alive with no local tumor progression for 3 to 14 months after the treatment. Ultrasound supporting HIFU therapy could be usefully available for the treatment of small HCC.

Usefulness of contrast‐enhanced ultrasonography in assessing therapeutic response in hepatocellular carcinoma treated with HIFU

PURPOSE: We evaluated the efficacy and change of contrast‐enhanced ultrasonography after HIFU, and decided on the best timing for contrast‐enhanced ultrasonography to evaluate the response of hepatocellular carcinoma with HIFU.