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 ( n52), new liver tumors ( n52) 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 posttransplantation 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.

Fabrizii, Veronika1; Kaiser, Alexandra1; Mittermayer, Christoph2; Muellner, Marcus3; Woisetschlaeger, Christian3; Steiniger, Rudolf2; Muehlbacher, Ferdinand2; Hoerl, Walter H.1; Pohanka, Erich1 Author Information