Objectives: To evaluate the clinical application value of percutaneousquantified ethanol injection (PQEI) in the treatment for recurrent hep-atocellular carcinoma (HCC) with intercurrent hepatocirrhosis.Methods: The tumors in 298 cases of clinicopathologically provenHCC were injected with quantified ethanol guided by ultrasound every2 to 3 days. The quantity of ethanol was calculated according to theregressive equations which were Y � 2.885X when the mass was �5cm in diameter and Y � 1.805X when the mass was �5 cm in diameter(X is the maximal diameter of the mass with the unit cm, Y is theethanol quantity with the unit ml). The ethanol was injected for 4 to 10times per period for tumors �5 cm in diameter and 10 to 20 times perperiod for tumors �5 cm in diameter. The follow-up period lasted 12to 60 months. The therapeutic efficacy was assessed by clinical symp-tom, the result of US, CT, MRI, color three-dimensional ultrasound(CTDU) and biopsy. The survival rates of 1, 2, 3, 4 and 5 years werecalculated.Results: All the 387 nodules in 298 cases of HCC shrank from 3.4 cmto 2.8 cm in average diameter after 2 to 8 weeks since the last PEI. Thesurvival rates of 1, 2, 3, 4 and 5 years were 89.7%, 78.8%, 66.3%,56.5% and 46.7%, respectively. The median survival time was 44.2months. The 298 cases underwent 2871 PQEI in total. There were nocomplications such as hemorrhage and severe heart and kidney func-tional injuries except Different degrees of pains, Low-fever, jaundice,etc. in short time. Four cases died from accompanying serious hepa-tocirrhosis, which resulted in liver function failure.Conclusions: PQEI is the high clinical application value for the treat-ment of recurrent hepatocellular carcinoma and deserves further re-search.

3320

Application of combination therapy with blood vesselintervention and PMCT for liver tumorsWu N, Jie L, Xu Y, Ding Z, RiZhao Municipal Hospital, China

Objectives: To investigate the efficacy of combination transcatheterarterial transcatheter arterial chemoembolization and percutaneous mi-crowave coagulation therapy (PMCT).Methods: Forty-three patients with liver neoplasm were included inthis study. Twenty patients with 23 tumors were treated by PMCT.Twenty-three patients with 32 tumors were treated by combinationtherapy with transcatheter arterial chemoembolization (TACE) andPMCT. Then followed TACE within 3 days by ultrasound-guidedPMCT. Of them, eight patients with complicated portal vein cancerousembolism under TACE were followed after 2 weeks by percutaneousportal vein chemotherapy (PVC).Results: Forty-one tumors measuring �5 cm in greatest dimensionsshowed very good efficacy by combination therapy. The reduction oftumor size and disappearance of blood flow in tumor and patientsurvival time in the combination therapy group were much better thanthat in the PMCT group.Conclusions: Combination therapy with TACE and PMCT has signif-icant effects for liver tumor. It is an effective combination method formetaphase and terminal period liver tumor.

3321

Sonography guided percutaneous radiofrequency ablation ofhepatocellular carcinomas: Effect of cooperative training onpretreatment assessment of feasibilityKim MJ, Lim HK, Lee EJ, Choi D, Lee WJ, Rhim H-C, Park CK,Samsung Medical Center, Korea

Objectives: The aim of the study was to investigate the effect of acooperative training on the pretreatment assessment of feasibility ofsonography guided percutaneous RF ablation for HCC.

Methods: We prospectively enrolled 146 patients with 200 nodularHCCs for sonography guided percutaneous RF ablation. Three radiol-ogists with differing levels of experience in RF ablation performedpretreatment sonography to evaluate whether RF ablation was feasibleor not. They scanned 74 patients with 100 HCCs independently beforea cooperative training and decided the feasibility. After training, the 72patients with 100 HCCs were examined by the same radiologists. Theydescribed the reasons of unfeasibility. We evaluated the feasibilityrates. The reasons of unfeasibility were analyzed. The interobserveragreement of feasibility before and after a cooperative training wascalculatedResults: The mean feasibility rates were 73%. Two common causesrefraining from performing RF ablation included poor conspicuity oftumors and the absence of a safe route. We found a moderate interob-server agreement before a cooperative training and a good interob-server agreement after training.Conclusions: Although a cooperative training did not affect the feasi-bility rate of each observer, it improved the interobserver agreement inassessing the feasibility of sonography guided percutaneous RF abla-tion for HCC.

3322

Feasibility of radiofrequency thermal ablation of artificialmucinous lesions: In vivo study in rabbit liver modelSuh SI, Park CM, Kim KA, Lee CH, Choi JW, Seol HY, Cha IH, LeeJH, Guro Hospital, Korea University College of Medicine, Korea;Pathology, Guro Hospital, Korea University College of Medicine,Korea

Objectives: To assess the feasibility of ultrasound guided radiofre-quency thermal ablation for the treatment of artificial mucinous hepaticlesions in a rabbit liver model.Methods: Forty-five lesions were created and ablated. After laparot-omy, about 1 ml of ultrasound gel was injected into the hepaticparenchyma for artificial mucinous lesions and LeVeen needle elec-trode was used for ablation. The lesions were assigned to one of threegroups: group A (n � 15): one time; group B (n � 15): two times;group C (n � 15): three times ablation. These were compared in termsof the rate of complete ablation and the change of long diameter beforeand after ablation.Results: RFA was technically successful in all 45 lesions. Microscopicexaminations revealed irregular cavity and coagulative necrosis ofhepatocytes. The rates of complete ablation for each group were fol-lowed: 6.7 % (1/15) for A; 60 % (9/15) for B; 93.3 % (14/15) for C. Thelength ratios of lesions before and after ablation for each group werefollowed: 1.08 (A); 1.23 (B); 1.31 (C). The difference of length ratiofor each group was statistically significant between groups A and B orC (p � 0.05).Conclusions: Radiofrequency ablation is a feasible and effectivemethod for the ablation of the mucinous lesions in a rabbit liver model.

3323

Experimental and clinical study of microwave coagulationtreatment for liver cancer using a new type of internally cooledmicrowave antennaNianan H, Wenping W, Zhenbiao J, Beijian H, Chaolun L, Qian Z,Zhizhang X, Anhui Provincial Hospital, China; Zhongshan Hospitalof Fudan University, China

Objectives: To evaluate the coagulative effect of the new type ofinternally cooled microwave antenna and the antenna without theinternally cooled technique.Methods: A comparison was made in vitro between the two antennasin terms of the coagulation shape, volume, thermal distribution and the

Abstracts P245

performance of anti-adhesion and durability of the antennas. The com-plications and local recurrence were compared in clinical study.Results: The coagulation necrosis of the new type of microwaveelectrode had less carbonization. With its longer short-axis diameter (p� 0.01) and a shorter long-axis diameter (p � 0.01), the coagulationnecrosis took a more round shape. The antenna did not burn the skin.There were less complications and low rate of local recurrence inclinical.Conclusions: The new type of microwave antenna has a better perfor-mance and suits percutaneous microwave coagulation therapy for livercancer.

3324

Study on optimal dosage of slow-released carboplatinmicrospheres for intratumoral injection on rabbit VX2 livertumorZhuo ZX, Zhuo Q, Xinqiao Hospital of the Third Military MedicalUniversity, China

Objectives: To investigate the effect and the side effect of variousdoses treatment groups of slow-released carboplatin microspheres byintratumoral injection on the rabbit VX2 liver tumor.Methods: Rabbits with VX2 liver tumor were divided into five treat-ment groups and control group. Changes of the tumors’ volume andblood routine were observed during the 14 days therapy. Comparisonwas made between the five treatment groups and control group andwithin the five groups.Results: It was shown that slow-released carboplatin microspherespossessed obviously antitumoral effects, manifested as dose-depen-dence. The side effects between groups were insignificant (p � 0.05).Conclusions: Group E was evidenced to have the most effective tumorinhibition and no obvious side effect. It may be considered as theoptimal dosage for the treatment of rabbit liver VX2 tumor.

3325

Intraoperative sonography during liver resection forhepatocellular carcinomaHu J-T, Yang S-S, Lai Y-C, Huang C-S, Hung S-H, Lin G-L, CathayGeneral Hospital, Taiwan; Liver Unit, Cathay General Hospital,Taiwan; Dept of Surgery, Cathay General Hospital, Taiwan; Dept ofPathology, Cathay General Hospital, Taiwan

Objectives: We retrospectively studied the role of intraoperativesonography (IOS) in the resection of hepatocellular carcinoma (HCC).Methods: Ninety-five cirrhotics underwent surgical resection for livertumors were studied. All patients had only one single liver tumor. Eightpatients were excluded for non-HCC. Sixty-four patients having tradi-tional hepatectomy without IOS were classified as Group A. Theremaining 23 patients under IOS were classified as group B. Allpatients had been followed-up for 5 years.Results: The gender (M/F, 45/19 versus 11/12), age (54 � 11 yearsversus 54 � 9 years) and Child-Pugh grading (A/B, 30/34 versus 15/8)were not different between groups A and B. The size of liver tumor(144 � 209 cm3 versus 114 � 274 cm3, p � 0.66) was not differentbetween two groups. Group B had smaller resected liver tissue volume(687 � 685 cm3 versus 369 � 449 cm3, p � 0.02). Group B also hadless hospitalization days (13.8 � 7.5 days versus 9.0 � 3.0 days, p �0.039) and complication rate (44% versus 22%, p � 0.046). The 1-yearsurvival rate (84.4% versus 91.3%, p � 0.409) was not differentbetween two groups.Conclusions: IOS may reduce resected liver tissue volume, complica-tion rate and hospitalization days. Traditional wider resection of livertumor does not improve survival rate.

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US-guided omental core biopsy for differentiation of omentalinfiltration on CTLee JK, Baek SY, Ewha Womans University Mokdong Hospital,Korea

We try to show the clinical utility of core biopsy technique in omentalinfiltration on CT and potential applications beyond the patients havingstrong possibility of malignancy. Although sampling error remains aproblem for core biopsy, US-guided core biopsy of omental mass is asafe and accurate option for achieving a firm diagnosis without re-course to laparoscopy or laparotomy. However, when the pathologypresents as omental infiltration only without mass on CT, it is difficultto decide safety, possibility of adequate sampling, and efficient site ofcore biopsy. We compared contrast-enhanced CT and targeted US ofomental pathology from benign to malignant causes, and demonstratedthe site of core biopsy on contrast-enhanced CT and US. We believethat US-guided core biopsy may be a safe and accurate method toobtain omental tissue, which provides the firm diagnosis of omentalpathology presenting as omental infiltration without omental cakeformation or nodularity on CT.

3327

Value of high-end duplex-sonography for compensation ofneuronavigation pitfallsResch KMD, Schroeder HWS, University of Greifswald, Germany

Objectives: Meanwhile neuronavigation is well established, the weakpoints are now more clear than at introduction. Therefore, intraopera-tive imaging gained an increasing role to overcome these problems.Due to its excellent properties high-end sonography is becoming aninteresting tool in neurosurgery.Methods: In a series of 225 cases of intraoperative high-end sonogra-phy imaging we had 120 cases in which neuronavigation problems hadto be compensated. There were 11 females and 9 males, mean age was33.5 years (0.1 to 57 years). Neuronavigation was done with the Zeissand Brain Lab Navigation System and sonography with the Pro Sound5000 ALOKA machine.Results: In two cases the navigation system could not be used becauseof technical problems of hardware. In 16 cases the operative accuracywas too low to target the lesion, and in four cases navigation wasdisplaced by sonography. There were four small cavernomas, onemelanoma, two cysts, two slit ventricles and 11 tumors. The advantagesof the sonography were the real-time use, the online imaging and theeasy handling. The disadvantage was the unusual appearance of thesono images compared to CT or MRT.Conclusions: In conclusion, high-end sonography can compensateneuronavigation pitfalls easily regarding targeting and orientation.

3328

Endo-neuro-sonography (ENS): First clinical seriesResch KMD, Univ. of Greifswald, Germany

Objectives: The goal to further development had therefore been tomake neuro-endoscopy safer. After laboratory work, in a first series of70 patients with a broad variety of lesions, a sono-catheter for trans-endoscopic imaging was applied for the first time in neurosurgery.Methods: A trans-endoscopic sono-catheter (Aloka DeutschlandGmbH, Dusseldorf/Germany) with a diameter of 1.9 mm (6F) and 2.5mm (8F) was used, and introduced into the working canal of anendoscope. The image produced by the probe is a 360° scan (“brainradar”) displayed on a monitor on which some parameters can be variedto get best view of different anatomical structures.

P246 Ultrasound in Medicine and Biology Volume 32, Number 5S, 2006