Mauro Mattace Raso MD, Abstract Co-Author: Nothing to Disclose

Orlando Catalano MD, Abstract Co-Author: Nothing to Disclose

Antonio Nunziata MD, Presenter: Nothing to Disclose

A Alvino, Abstract Co-Author: Nothing to Disclose

Alfredo Siani MD, Abstract Co-Author: Nothing to Disclose

We have previously proposed a classification of recurring HCC patterns after initially successful PAT. We now report our experience in the treatment of HCC recurrence, mainly based on these imaging patterns.

In the last 2 years we have evaluated 72 cirrhotic patients with HCC recurrence after successful PAT. Retreatment was mainly on helical CT and contrast-enhanced sonography (US) patterns of recurrence. Pattern A: enhancing tissue within edge of ablated nodule (“in-growth”) - patient undergoes new PAT session/s. Pattern B: enhancing tissue around the treated nodule but continuous to its border (“out-growth”) - patient undergoes chemoembolization (TACE). Pattern C: enhancing tissue within same segment of treated nodule (“spread”) - patient undergoes PAT or TACE basing on the number and size of nodules. Pattern D: enhancing tissue within different segments from treated nodule (“disease progression”) - patient undergoes PAT or TACE basing on number and size of nodules.

No additional treatment was performed in 3 Child C patients. Six patients with pattern A of recurrence were submitted to new PAT (1-4 sessions), achieving complete necrosis in 5 cases. Twenty subjects with pattern B were treatment with TACE (1-3 sessions), achieving complete necrosis in 13. Twenty-nine patients showing pattern C were treatment with PAT (18 cases, 1-4 sessions) or with TACE (11 cases, 1-4 sessions), achieving complete necrosis in 20. Fourteen patients showing pattern D were treatment with PAT (8 cases, 1-3 sessions) and TACE (6 cases, 1-3 sessions), achieving complete necrosis in 10.

Four patterns of HCC recurrence after successful PAT have been categorized and can be applied to helical CT, dynamic MRI, and contrast-enhanced US. Further patient management can be based on thse patterns.

Mattace Raso, M, Catalano, O, Nunziata, A, Alvino, A, Siani, A, Recurring Hepatocellular Carcinoma (HCC) in Patients Successfully Treated with Percutaneous Ablation Therapies (PATs): Imaging-based Management.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4404266.html