Korean J Radiol.  2008 Jun;9(3):268-274. 10.3348/kjr.2008.9.3.268.

Needle Tract Implantation after Percutaneous Interventional Procedures in Hepatocellular Carcinomas: Lessons Learned from a 10-year Experience

• Chang S
• Kim SH
• Lim HK
• Kim SH
• Lee WJ
• Choi D
• Kim YS
• Rhim H

• KMID: 1758461
• DOI: http://doi.org/10.3348/kjr.2008.9.3.268

Abstract

Percutaneous interventional procedures under image guidance, such as biopsy, ethanol injection therapy, and radiofrequency ablation play important roles in the management of hepatocellular carcinomas. Although uncommon, the procedures may result in tumor implantation along the needle tract, which is a major delayed complication. Implanted tumors usually appear as one or a few, round or oval-shaped, enhancing nodules along the needle tract on CT, from the intraperitoneum through the intercostal or abdominal muscles to the subcutaneous or cutaneous tissues. Radiologists should understand the mechanisms and risk factors of needle tract implantation, minimize this complication, and also pay attention to the presence of implanted tumors along the needle tract during follow-up.

Keyword

Hepatocellular carcinoma; Percutaneous biopsy; Percutaneous ethanol injection therapy; Percutaneous radiofrequency ablation; Needle tract implantation; Computed tomography (CT)

MeSH Terms

Aged
Aged, 80 and over
Biopsy, Needle/adverse effects
Carcinoma, Hepatocellular
Catheter Ablation/adverse effects
Ethanol/administration & dosage
Female
Humans
Injections
Liver Neoplasms/*pathology
Male
Middle Aged
*Neoplasm Seeding
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 65-year-old woman with linear or elongated configuration of needle tract implantation after percutaneous biopsy of subcapsular hepatocellular carcinoma. A. Contrast-enhanced CT image showing 7-cm-diameter, subcapsular hepatocellular carcinoma (arrows). This patient underwent percutaneous biopsy using end-cutting needle. B. Contrast-enhanced CT image showing linear soft tissue attenuation lesion (arrow) seen in subcutaneous fat layer of right anterolateral chest wall four months after percutaneous biopsy. Note lipiodol-laden primary tumor after transcatheter arterial chemoembolization (arrowheads).

• 

  Fig. 2 50-year-old man with needle tract implantation with round or oval-shaped configuration and linear arrangement after percutaneous hepatocellular carcinoma biopsy. A. Contrast-enhanced CT image showing small, round nodule (arrow) in peritoneal cavity along previous needle tract three months after percutaneous biopsy using end-cutting needle. Note lipiodol-laden primary tumor (arrowhead) after transcatheter arterial chemoembolization. B. Follow-up CT image showing two round nodules with rapid growth (arrows) in peritoneal cavity and subcutaneous fat layer six months after percutaneous biopsy.

• 

  Fig. 3 66-year-old woman with needle tract implantation with large conglomeration around rib after percutaneous hepatocellular carcinoma biopsy, followed by right hepatic lobectomy. A. Contrast-enhanced CT image showing isoattenuation nodules (arrows) relative to intercostal muscles in intercostal muscles and subcutaneous fat layer five months after percutaneous biopsy using end-cutting needle. B. Follow-up CT image showing conglomerated nodules (arrows) with increased size nine months after percutaneous biopsy.

• 

  Fig. 4 63-year-old man with needle tract implantation after percutaneous biopsy using tru-cut needle. A. Contrast-enhanced CT image obtained on arterial phase showing well-demarcated, hyperattenuating hypervascular nodule (arrow) relative to intercostal muscles in right chest wall. B, C. Contrast-enhanced CT images obtained on portal (B) and equilibrium (C) phases showing nodule (arrows) with persistent enhancement and hyperattenuation relative to intercostal muscles in right chest wall. Note subcapsular lipiodol-laden mass (arrowhead in B).

• 

  Fig. 5 89-year-old man with needle tract implantation after five times of percutaneous ethanol injection therapy for centrally-located hepatocellular carcinoma. A. Contrast-enhanced CT image obtained three months after last percutaneous ethanol injection therapy in right liver shows small tumor (arrow) in subcutaneous fat layer. B, C. Follow-up CT images obtained on arterial (B) and equilibrium (C) phases 51 months after percutaneous ethanol injection therapy showing size increase of implanted tumor (arrows) in subcutaneous fat layer. Imaging findings were similar to needle tract implantation after percutaneous biopsy.

• 

  Fig. 6 72-year-old man with needle tract implantation after percutaneous radiofrequency ablation of hepatocellular carcinoma, with history of transcatheter arterial chemoembolization. A-C. Contrast-enhanced CT images obtained on arterial (A), portal (B), and equilibrium (C) phases 13 months after percutaneous radiofrequency ablation using multitined expandable electrode for viable tumor within partial lipiodol-laden mass. Images show two small enhancing lesions (arrows) involving intercostal muscles along previous needle tract. Imaging findings were similar to needle tract implantation after biopsy and percutaneous ethanol injection therapy. Note subcapsular lipiodol-laden mass (arrowhead) with no residual viable tumor after percutaneous radiofrequency ablation.

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