MR‐guided percutaneous ethanol ablation of hepatocellular carcinomas before liver transplantation

Abstract

It was the objective of this study to evaluate MR‐guided, percutaneous ethanol injection of hepatocellular carcinoma in ten patients scheduled for liver transplantation. Using a 0.2 T open MR scanner (Magnetom Open, Siemens Medical Systems, Erlangen, Germany) and percutaneous instillation of ethanol, 12 liver tumors (median tumor volume, 6.3; range, 0.6–43.2 ccm) were treated. Coagulation necrosis, morbidity, and post‐transplant histology were assessed. No major complications were observed. A mean of 16.4±11.4 ml ethanol was injected for each tumor. The median volume of the ablation necrosis was 12.3 (range, 0.3–48.3) ccm. Three tumors were retreated and complete radiological necrosis before liver transplantation was found in eight of 12 tumors (67%). One patient developed multifocal disease and was excluded from transplantation; thus nine of ten patients underwent liver transplantation within 3.9±3.1 months. In the explants, satellite nodules (n = 2), new liver tumors (n = 2) and a complete necrosis were found in five of 12 treated tumors (42%). During follow‐up (median 41.3; range, 0.4–86.1 months), three patients died, but no tumor‐seeding or post‐transplantation recurrence occurred. MR‐guided ethanol injection is feasible, and may delay tumor progression. However, the local recurrence rate is high, and the spatial resolution of a low‐field MR scanner limits the detection of small tumors.

• Ethanol injection
• hepatocellular carcinoma
• MR‐guided therapy
• tumor ablation
• liver transplantation
• liver cirrhosis/therapy