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Small Hepatocellular Carcinoma: Safety and Efficacy of Single High-Dose Percutaneous Acetic Acid Injection for Treatment¹

¹ From the Departments of Radiology (H.L.L., C.F.Y., H.B.P., C.K.H.C., P.H.L.), and Medicine (K.H.L., J.S.C., G.H.L.), Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, Taiwan 813, and the Departments of Radiology (H.L.L., C.F.Y., H.B.P., C.K.H.C., P.H.L.) and Medicine (K.H.L., J.S.C., G.H.L.), National Yang-Ming University, Taipei, Taiwan. Received March 22, 1999; revision requested May 10; revision received June 21; accepted July 20. Address reprint requests to C.F.Y. (e-mail: cfyang@isca.vghks.gov.tw).

PURPOSE: To evaluate the safety and efficacy of single high-dose percutaneous acetic acid injection (PAI) for treatment of small (<3-cm-diameter) hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: Eighteen patients with HCC (22 nodules; diameter range, 1.5–3.0 cm) underwent single PAI. With ultrasonographic or computed tomographic (CT) guidance, 4–11 mL of 50% acetic acid was slowly injected into the center of the nodule through a skinny multiple-side-hole needle. Follow-up was performed with helical contrast material–enhanced CT. Complications of high-dose PAI were recorded.

RESULTS: Seventeen nodules showed no local recurrence (follow-up, 6–29 months) after single PAI. At a mean follow-up of 15.6 months, mean tumor diameter was 2.1 cm and mean injected volume was 6.4 mL. Four nodules showed residual tumor (mean tumor diameter, 2.6 cm; mean injected volume, 5.8 mL). The mean ratio of injected to estimated volume of acetic acid was 1.21 in cases of successful single PAI and 0.72 in cases of local recurrence (P < .001). One patient with preexistent right portal venous thrombosis died of hepatic failure 37 days after PAI. Other complications included severe pain (11%), high fever (4%), and segmental wedge infarction (4%).

CONCLUSION: Single high-dose PAI is safe and effective for treatment of small HCC.

Index terms: Acetic acid, 761.1264, 761.1269 • Alcohol ablation, 761.1264, 761.1269 • Liver, interventional procedures, 761.1264, 761.1269 • Liver neoplasms, 761.323 • Liver neoplasms, CT, 761.12113, 761.12115 • Liver neoplasms, US, 761.12981, 761.12986

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