Radiofrequency ablation for hepatocellular carcinoma - analysis of the clinical outcome

Introduction/Objective. Radiofrequency ablation (RFA) is a minimally invasive treatment modality for primary and metastatic liver tumors. It can be performed percutaneously or as a laparoscopic or open surgical procedure under ultrasound or computerized tomography guidance. The objective of the study was to evaluate the clinical outcome of the initial 16 patients with hepatocellular carcinoma (HCC) managed by percutaneous RFA at a tertiary institution and to assess the efficacy of this procedure in the management of selected patients with HCC. Method. From June 2011 until December 2013, 16 patients with early-stage HCC were managed by percutaneous radiofrequency ablation at the Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade. All the patients were treated by the same team composed of an interventional radiologist and a liver surgeon. We analyzed the clinical outcome and the biologic effect of this treatment by comparing the pre- and post-treatment levels of alpha-fetoprotein (AFP). Results. Post-treatment values of liver transaminase levels returned to the pre-treatment values from Day 3. Post-treatment hospital stay was two days. Post-procedural complications included mild pain in all patients, skin necrosis at the site of the electrode puncture in five patients, and transient hepatic decompensation in one patient. In all the patients the AFP level correlated with the findings of liver imaging (ultrasound and/or magnetic resonance imaging with liver-specific contrast agent) indicating viability of the treated tumor. Conclusion. RFA is a feasible and effective procedure providing favorable clinical outcome in patients with early-stage HCC.

Synthesis and Evaluation of a Biocompatible Macromolecular Gadolinium Compound as a Liver-Specific Contrast Agent for MRI

A new macromolecular biocompatible gadolinium chelate complex (PAI-N2-DOTA-Gd) as a liver-specific magnetic resonance imaging (MRI) contrast agent was synthesised and evaluated. An aspartic acid–isoleucine copolymer was chemically linked with Gd-DOTA via ethylenediamine to give PAI-N2-DOTA-Gd. In vitro, the T1-relaxivity of PAI-N2-DOTA-Gd (14.38 mmol–1⋅L⋅s–1, 0.5 T) was much higher than that of the clinically used Gd-DOTA (4.96 mmol–1⋅L⋅s–1, 0.5 T), with obvious imaging signal enhancement. In the imaging experiments in vivo, PAI-N2-DOTA-Gd exhibited good liver selectivity, and had a greater intensity enhancement (68.8 ± 5.6 %) and a longer imaging window time (30–70 min), compared to Gd-DOTA (21.1 ± 5.3 %, 10–30 min). Furthermore, the in vivo histological studies of PAI-N2-DOTA-Gd showed a low acute toxicity and desirable biocompatibility. The results of this study indicate that PAI-N2-DOTA-Gd is a feasible liver-specific contrast agent for MRI.