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Contrast-enhanced ultrasonography of superficial organs has long been considered unlikely because the main resonance frequency of these agents, which depends mainly on the size of microbubbles, is in the range of abdominal ultrasound applications. It has been suggested that microbubble contrast agents would not produce useful non-linear signals at the frequencies needed to provide the spatial resolution required for evaluation of superficial structures (Cosgrove 2004). [ABSTRACT FROM AUTHOR]

A variety of cystic lumps can be recognized in the penis, either congenital or acquired. Diagnosis of most of them is straightforward based on clinical appearance, but imaging can be required, especially in large lesions, to confirm diagnosis and to assess relationships with adjacent penile structures. [ABSTRACT FROM AUTHOR]

The urethra is a tubular structure through which urine is expelled after accumulating in the physiological reservoir called the bladder. In men, this canal is also used by the seminal ducts and carries the sperm from the veru montanum all the way to the external urethral orifice. [ABSTRACT FROM AUTHOR]

The corpora cavernosa consist of smooth muscle cells, loose areolar tissue, blood vessels, nerves and collagen fibers. All these components play a role in the complex physiologic event of erection, together with endocrinal, vascular, neural and psychogenic factors (Jevtich et al. 1990). [ABSTRACT FROM AUTHOR]

Penile inflammations caused by infections of the glans and foreskin are common pathological entities that occur in about 11% of male genitourinary clinics attendees. This group of pathologies, however, has a poor radiological relevance except in cases of severe inflammation with involvement of the corpora cavernosa or abscess formation (Pearle and Wendel 1993). [ABSTRACT FROM AUTHOR]

A variety of surgical procedures has been developed to manage different penile pathologies and malformations. Penile surgery produces anatomical and vascular changes that can be successfully investigated with grey scale and color Doppler ultrasonography. In particular, early and late surgical complications can be identified, and postoperative changes of the normal ultrasound appearance of the penile envelopes, of the penile bodies and of flow characteristics in the penile vessels can be investigated. [ABSTRACT FROM AUTHOR]

A variety of surgical procedures have been described to treat various penile diseases. Nowadays the purpose of all surgical techniques in penile surgery is not only the correct treatment of the primary condition, but also to preserve sexual function and to maintain cosmesis of the penis. [ABSTRACT FROM AUTHOR]

Penile tumor is uncommon in developed countries. As illustrated in Chapter 13, however, in some developing countries it accounts for as many as 10% to 20% of all malignancies in men (Algaba et al. 2002; Pow-Sang et al. 2002). [ABSTRACT FROM AUTHOR]

Penile cancer is an uncommon malignancy in developed countries. In the United States, 1,530 cases occur per year. Higher incidence rates (Narayana et al. 1982) are seen in Africa and Asia (10% to 20%), and in areas of Brazil penile cancer accounts for 17% of all malignancies in men (Ornellas et al. 1994). Penile cancer most commonly affects men between 50 and 70 years of age (Hoppmann and Fraley 1978). Younger individuals are also affected; approximately 22% of patients are less than 40 years of age. [ABSTRACT FROM AUTHOR]

Since the penis is mobile and largely protected by its position, it is much less frequently injured than other parts of the body. As mentioned in Chapter 11, however, it can be wounded as a result of various accidents, and in the erect state it is more prone to trauma in the form of penile fracture. Distinction between penetrating and non-penetrating penile trauma is important because the management of the patient is different, and as regards non-penetrating traumas, the erectile state of the penis during the traumatic event must be recognized as well. [ABSTRACT FROM AUTHOR]

From the clinical point of view, the first important distinction in patients presenting with penile traumas is between penetrating and non-penetrating lesions. [ABSTRACT FROM AUTHOR]

As described in Chapter 9, priapism is an uncommon medical condition defined as persistent tumescence or erection not associated with sexual desire or stimulation (Pautler and Brock 2001). Different pathophysiologies have been described. Low-flow or ischemic priapism is characterized by complete painful erection secondary to inadequate venous outflow leading to hypoxia, acidosis and pain (Lue et al. 1986; Pautler and Brock 2001). High-flow priapism is usually associated with penile or perineal blunt trauma and cavernosal artery tear (Pautler and Brock 2001). Patients with high-flow priapism usually develop a painless partial erection and are able to increase rigidity with sexual stimulation. Venous outflow can be relatively compromised (Bertolotto et al. 2003), but usually is maintained, preventing complete erection, stasis and tissue hypoxia. [ABSTRACT FROM AUTHOR]

Priapism is defined as a persistent erection of the penis not accompanied by sexual desire or stimulation, usually lasting more than 6 h and typically involving only the corpora cavernosa and resulting in dorsal penile erection with the ventral penis and glans being flaccid (Keoghane et al. 2002). Rare exceptions with involvement of the corpus spongiosum and sparing of the cavernosal spaces have been reported (Tarry et al. 1987). This condition has many different causes and in some cases can be a urological emergency. The recently published American Urological Association Guideline on the management of priapism sheds further light on the management of this potentially emergent condition, but the guideline does not establish a fixed set of rules or define the legal standard of care for the treatment of priapism (Montague et al. 2003). [ABSTRACT FROM AUTHOR]

Peyronie's disease is characterized by formation of fibrous tissue plaques within the tunica albuginea causing penile pain, deformity, and shortening. As illustrated in Chapter 7, the diagnosis is based on medical history, autophotography, and a clinical examination with plaque palpation. Ultrasound and other imaging modalities are confirming and allow accurate evaluation of disease extent and assessment of associated erectile dysfunction. [ABSTRACT FROM AUTHOR]

In 1743, François Gigot de la Peyronie described the fibrous penile plaques that we now associate with his name. These plaques have been characterized histologically (Brock et al. 1997), ultrastructurally (Hirano et al. 1997), and, to some degree, molecularly (El-Sakka et al. 1997b; Hirano et al. 1997; Magee et al. 2002). Although there is no universal consensus on the definition, most authors describe Peyronie's disease as some combination of penile pain, deformity, and/or palpable plaque (Mulhall et al. 2004; Zargooshi 2004). In general, the penile deformity adopts a dorsal curvature although the manifestation may be protean. One series described 46% dorsal curvature, 29% lateral, and 9% ventral, with the remained being mixed or a combination of curvatures (Kadioglu et al. 2002). Although curvature is the most common deformity, other malformations can occur, including penile shortening, hinging, and indentations or bottle-neck configurations. Additionally, erectile dysfunction is a common (20-40%) associated finding; this may be generalized or localized (i.e., flaccidity limited to distal to the lesion). [ABSTRACT FROM AUTHOR]

Grey-scale and color-Doppler ultrasonographies are the most widely used, non-invasive and readily available imaging modalities for diagnostic purposes in studying erectile dysfunction (Lehmann et al. 1996). In fact, after clinical examination, it is the first tool in imaging algorithms used for the evaluation of the anatomic and functional status of the penis and of the penile vessels in patients who complain of erectile problems (NIH 1993). [ABSTRACT FROM AUTHOR]

Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. In fact, improved spatial resolution and increased color Doppler sensitivity provided by the latest generation of ultrasound equipment allow an excellent evaluation of normal and pathological penile structures. Ultrasound evaluation of the penis, however, requires a good knowledge of penile anatomy to identify subtle changes that can be appreciated in pathological conditions. [ABSTRACT FROM AUTHOR]

Penile erection is primarily a neurovascular event modulated by psychological and hormonal status. Sexual stimulation causes a release of neurotransmitters from the cavernous nerve terminals and relaxing factors from the endothelial cells in the penis, resulting in relaxation of smooth muscle in the arteries and arterioles supplying the erectile tissue. [ABSTRACT FROM AUTHOR]

The penis is essentially a tripartite structure, with bilateral corpora cavernosa and the midline ventral corpus spongiosum/glans, all three of which are surrounded by loose subcutaneous tissue and skin that can be moved freely over the erect organ (Fig. 2.1). [ABSTRACT FROM AUTHOR]

The latest generation of beam-forming technologies and use of new broadband high-frequency probes have improved significantly the quality of ultrasound imaging, particularly in the examination of superficial structures. Penile sonography, in particular, has gained many benefits from the introduction of these new technologies. Improved spatial resolution allows evaluating normal and pathological structures generally of less than 1 mm with excellent detail, and increased color Doppler sensitivity for low flows allows full evaluation of the penile vasculature. Using higher frequency transducers with increased bandwidth and tissue penetration, in particular, has significantly increased the possibility of evaluating the tunica albuginea and its pathological changes in detail. [ABSTRACT FROM AUTHOR]

In recent decades, image-guided interventions have become daily routine in radiology departments worldwide. Radiologists and clinicians alike clearly see the advantages of image-guided interventions, as it is minimally invasive, well tolerated by patients and has shown to have a low level of complications. [ABSTRACT FROM AUTHOR]

Appendicitis most commonly occurs over the age of 5 years, is rare in those under 2 years, but may occur at any age and is the most common condition requiring emergency abdominal surgery in children (Janik and Firor 1979). Incidence in the paediatric age group shows wide geographical variation but overall incidence appears to be declining. Previous quoted incidence rates were approximately 1 in every 250 children but a recent study now suggests rates may be as low as 1 in 850 in children and young adults (Williams et al. 1998). The aetiology is that of appendiceal luminal obstruction, most commonly by lymphoid hyperplasia (60%) but also by hard concretions (faecoliths 33%), faecal impaction or appendiceal calculi (appendicolith). Rarer causes in children include tumour, stricture, parasites and Crohn's disease. Appendiceal obstruction is followed by luminal distention, ischaemia and bacterial invasion. Necrosis of the appendiceal wall then develops resulting in perforation and abscess formation. [ABSTRACT FROM AUTHOR]

The radiological approach to the pediatric upper and lower gastrointestinal (GI) tract varies according to the clinical condition of the child, the patient's age and the differential diagnostic considerations. [ABSTRACT FROM AUTHOR]

At birth a normal liver can extend below the costal margin, and occupy two fifths of the abdominal cavity. However, when the child starts growing, these proportions will change to adult proportions. Of the modalities useful in imaging of the liver in children, ultrasound (US) in particular has proved to be an excellent screening and diagnostic tool in children (Siegel 2001a). Conventional radiology can only indirectly "image" the liver, CT "costs" ionizing radiation, while MR is cumbersome and only useful in targeted instances [magnetic resonance cholangiopancreaticography (MRCP), etc.]. [ABSTRACT FROM AUTHOR]

In the normal embryo, the abdominal portion of the foregut is visibly divided into the esophagus, stomach and proximal duodenum by the fifth week (Larsen 2001). During the fifth week, the stomach starts out as a straight tube but since there is differential growth of its dorsal and ventral wall, the greater curvature will become more elongated than the lesser curvature. Continued differential expansion of the superior part of the greater curvature gives rise to the fundus and cardiac incisure by the end of the seventh week. [ABSTRACT FROM AUTHOR]

The esophagus and trachea form from a single common tubular structure that separates into an anterior laryngotracheal groove and a posterior esophagus (Collins 1995). Development of the esophagus begins in the fourth week of fetal life when the respiratory diverticula, or lung buds, appear on the ventral wall of the foregut at the border with the pharyngeal gut. Lateral invagination of the mesodermal esophagotracheal septum gradually partitions this diverticulum from the foregut, thus dividing into the ventral respiratory primordium and the dorsal esophagus. Epithelial growth obliterates the lumen, which recanalizes at the tenth week (Sadler 2000). The esophagus is initially short, but lengthens rapidly with descent of the heart and lungs, and attains normal length by 7 weeks. Occasionally, the esophagus fails to lengthen sufficiently, and the stomach is pulled up into the esophageal hiatus through the diaphragm, resulting in a congenital hiatal hernia (Sadler 2000). [ABSTRACT FROM AUTHOR]

Intestinal obstruction is the most common abdominal emergency in the neonatal period. It is almost always the result of a congenital anomaly of the gastrointestinal tract, which must be rectifi ed surgically if the infant is to survive. Mortality in surgically untreated patients is close to 100%, and the rate of survival is closely related to the time of surgical intervention (Hajivassiliou 2003). The most common clinical findings are abdominal distension, vomiting, and sometimes failure to pass meconium, depending on the level of the obstruction. These findings usually prompt the clinician to consult the radiologist, who must answer three major questions: Is the obstruction present? What is the location of the obstruction? What is the aetiology? The most valuable means of determining whether or not obstruction is present is the plain abdominal radiograph. Plain radiographs are often diagnostic. When not diagnostic, they may provide important clues suggesting the subsequent most valuable diagnostic procedure (Singleton et al. 1977). [ABSTRACT FROM AUTHOR]

Among the palliative therapy regimens of hepatocellular carcinoma (HCC), the intra-arterial application of iodine-131-lipiodol (131I-lipiodol) has been established, particularly in Asia and in French-speaking Europe (Lambert and Van de Wiele 2005). Lipiodol (Laboratoire Guerbet, France) is a poppy seed oil containing 38% iodine by weight. It was first used as an X-ray contrast medium for hepatic angiography and has been shown to be cleared less rapidly from HCC cells than normal liver tissue, when injected into the hepatic artery (Nakakuma et al. 1985; Okayasu et al. 1988). [ABSTRACT FROM AUTHOR]

The majority of primary and secondary malignant hepatic tumors are not suitable for surgical resection, which makes systemic chemotherapy treatments and/or local ablative therapies important components of intention-to-treat concepts or palliation. Tumor load and type of response determine the efficacy of these therapies. [ABSTRACT FROM AUTHOR]

Primary lung cancer is a severe worldwide health problem causing a greater death toll than breast, prostate, and colorectal cancer combined (Brescia 2001). Non-small cell lung cancer (NSCLC) accounts for 80% of primary lung cancer. Unresectability represents the poorest prognostic factor for survival outcome (Strauss 1997). Less than one in five patients can be resected with a curative intent at the time of presentation. Even those patients able to have a complete resection often relapse, making lung cancer one of the most biologically aggressive cancers known with a 5-year mortality rate of nearly 90% (Salgia and Skarin 1998). [ABSTRACT FROM AUTHOR]

The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1:2000. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is considered to be one of the most common malignancies worldwide, and the most common one in Africa and Asia. Over the last decade, a rising incidence of up to 10-15/100,000 per population has been seen in the Western world, with an estimate of 250,000 deaths and more than a million worldwide per year. By the year 2010, the World Health Organization expects that HCC will be the leading cause of cancer mortality surpassing lung cancer. This increasing incidence is most likely related to an increasing prevalence of chronic hepatitis C (HC) and B (HB) virus infections and other diseases inducing chronic inflammation (Befeler and Di Bisceglie 2002; Llovet et al. 2003). [ABSTRACT FROM AUTHOR]

Breast cancer is a major health problem and is the most common cancer in women in industrialized countries. Each year in Germany 55,100 new breast cancer cases are diagnosed. These cases represent 26.8% of all cancers which occur in women (Robert-Koch Institut 2004). Of these breast cancer patients, 40% are younger than 60 years. In North America one in eight women will develop breast cancer during her lifetime (Gordon et al. 2004). [ABSTRACT FROM AUTHOR]

The head and neck area contains a multitude of small, complexly arranged anatomical structures; intimate knowledge of normal spatial relationships and variations is necessary to plan and implement appropriate therapy. Lesions often lie near vital structures, complicating diagnostic and therapeutic procedures. Improved visualization during such procedures can therefore provide the physician with critical information, permitting innovative procedures and improved outcomes. [ABSTRACT FROM AUTHOR]

The radiologist has emerged as a consultant with increased interaction with patients. In fact, the interventional radiologist has assumed the role of the surgeon for many conditions; for example, minimally invasive therapy of bone metastases using radiofrequency techniques. Recent advances in imaging and interventional techniques have had an impact on medical diagnosis. Interventional imaging-based procedures include percutaneous biopsy, which has decreased the need for open surgical procedures. Due to the advent of system hardware and improvements in different technical systems and instruments, interventional radiology is now an upcoming special field in radiology. [ABSTRACT FROM AUTHOR]

Pulmonary metastases are very common, being more frequently associated with tumors that have a rich systemic venous drainage, such as bone sarcomas, choriocarcinomas, melanomas, testicular teratomas, and renal and thyroid carcinomas. The detection of pulmonary metastases is crucial in the treatment of patients with cancer. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, due to its high rate of incidence in Africa (south of the Sahara), and a high association with hepatitis viruses (HBV and HCV), consumption of alcohol, aflatoxin B1, and hepatic cirrhosis (Bruix et al. 1991). The incidence of HCC has increased both because of a real increase in the occurrence of the disease, and because modern imaging techniques allow diagnosis at an earlier stage of disease. Surgical resection and liver transplantation remain the most effective treatment strategies for small and oligonodular (five or fewer intrahepatic lesions) HCCs. Some studies yield excellent survival rates using percutaneous ethanol injection (PEI) (Bruix et al. 1991; Sironi et al. 1991, 1993; Amin et al. 1993; Livraghi et al. 1995; Kawai et al. 1997). [ABSTRACT FROM AUTHOR]

Renal cancer is a large socioeconomic problem, accounting for 3% of the estimated new cancer cases in men. During 2004 the American Cancer Society reported 35,710 new cases and estimated 12,480 deaths from renal cancer (Jemal et al. 2004). Historically renal cell carcinoma (RCC) has been detected by flank pain and hematuria. The widespread availability of cross-sectional imaging techniques such as ultrasound (US) and computed tomography (CT) led to an increased detection rate of small renal tumors (Pantuck et al. 2001). Further advances in medical imaging with the introduction of multidetector row spiral CT (MDCT) and magnetic resonance (MR) imaging in clinical routine have resulted in even earlier tumor detection. About two-thirds of all RCCs are now discovered incidentally (Homma et al. 1995). However, the differentiation of small renal tumors remains a diagnostic dilemma (Zagoria and Dyer 1998). [ABSTRACT FROM AUTHOR]

Although percutaneous tumor ablation has been used in the treatment of various organs, the liver has proven to be an ideal target for this interventional treatment technique. Simultaneously, three different techniques were developed worldwide, namely cryotherapy, laser-induced thermotherapy (LITT), and radiofrequency ablation (RF). The liver plays a central role in human metabolism and so represents one of the organ systems most often affected, especially by tumorous diseases. In principle the liver can be affected by both primary malignant tumors such as hepatocellular carcinoma and, more frequently, by secondary manifestations such as liver metastases. A large number of primary tumors often cause liver metastases as well as bone, lung, and brain metastases. The group of colorectal carcinomas attack this organ metastatically almost exclusively, which, according to studies by Weiss et al., can be attributed to the venous drainage of the intestines through the portal vein (Weiss 1994; Weiss et al. 1986). [ABSTRACT FROM AUTHOR]

In most patients suffering from cancer, the primary tumor can be resected in a curative intention. However, during patient's history, liver metastases occur — depending on the tumor — in up to 70%. There are data from large autopsy studies showing that liver metastases are detectable in more than 40% of all malignancies (Tranberg 2004). Liver metastases therefore have the highest impact on patient's long-term survival and are responsible for the largest part of cancer-related deaths worldwide (Tranberg 2004). In the western world metastases of colorectal cancer are the most common indication for resection, followed by metastases of breast cancer. It has been shown that the 3-, 5-, and 10-year survival rates after a successful resection of liver metastases are as high as 45%, 30%, and 20% respectively (Ohlsson et al. 1998; Scheele et al. 1995). For this reason, in recent years surgical resection was considered to be the only curative option in liver metastases, while chemotherapy and radiation therapy were viewed as only palliative treatment options. [ABSTRACT FROM AUTHOR]

A diagnosis of hepatocellular carcinoma (HCC) implies a poor prognosis. HCC is the cause of 250,000 deaths worldwide each year. Early HCC is typically clinically silent, and the disease is often well advanced at the first manifestation. Since the introduction of surveillance in patients at high risk of developing HCC, the diagnosis of small HCC has increased, especially in endemic areas such as in parts of Asia. Without treatment, there is a 5-year survival rate of less than 5% (Llovet et al. 1999b; Ulner 2000). According to the World Health Organization, by the year 2010, HCC will have surpassed lung cancer as the foremost cause of cancer mortality. The increasing incidence may be related to the wide spread transmission of viral hepatitis, specifically of types B and C, during the 1970s and early 1980s, when illicit use of intravenous narcotics, needle sharing, unsafe sexual activity, and transfusion of unsafe blood and blood products were common practices (Bruix et al. 2001). Patients with liver cirrhosis are at greatest risk for developing HCC and should be monitored every 6 months to detect the tumor at an asymptomatic stage (Bruix and Llovet 2002). [ABSTRACT FROM AUTHOR]

As yet there is no general consensus on a common rational therapeutic approach to hepatocellular carcinoma (HCC). Therefore, treatment strategies for HCC vary throughout the world due to geographical differences in the incidence and presentation of the disease and the treatment options available. Several treatment guidelines have been published by the European Association for the Study of the Liver (EASL) (Bruix et al. 2001), with the Barcelona Clinic Liver Cancer (BCLC) staging recommendation being the most accepted (Fig. 3.2.1) (Mor et al. 1998; Sala et al. 2004). It links tumoral stage with treatment strategy, and is aimed at incorporating an estimation of the prognosis and potential treatment advancements in a single unified proposal (Sala et al. 2004). According to these guidelines percutaneous alcohol instillation (PAI) has a place in the treatment strategy of HCC, generally as a second choice when surgical techniques are precluded, such as in patients with early-stage tumors; nevertheless, in some centers in Italy and Japan PAI is used as a first-line treatment option (Llovet et al. 2003). [ABSTRACT FROM AUTHOR]

Surgical procedures are a standard treatment of primary and secondary malignant hepatic tumors. However, surgery is only a therapeutic option in 15% of hepatocellular carcinoma (HCC) cases and only overall 5-year survival rates of 25%-40% are reported (Nagasue et al. 1993). On this account new forms of treatments with the aim of an improved survival are needed, such as several promising minimally invasive treatment techniques which may replace or augment surgical resection. These include amongst others new minimally invasive ablative treatment techniques such as laser-induced thermotherapy (LITT), radiofrequency ablation (RF), microwave ablation or cryoablation. The survival rates of these procedures seem to be favorably comparable with those of hepatic surgery (Allgaier et al. 1998; Curley et al. 2000; Dwerryhouse et al. 1998; Finlay et al. 2000; Goldberg et al. 2000; Lencioni et al. 2003; Livraghi 2001; Shibata et al. 2002a; Shiina et al. 2002; Solbiati et al. 2001; Vogl et al. 2002a). [ABSTRACT FROM AUTHOR]

The first percutaneous vertebroplasty was performed in 1984 by the interventional neuroradiologists Galibert and Deramond and reported first in the literature in 1987 for the treatment of an aggressive hemangioma of a vertebral body (Galibert et al. 1987). Since then, vertebral augmentation with an injection of a mixture of polymethylmethacrylate (PMMA) and a contrast agent has been widely accepted as an option to treat vertebral body compression fractures due to different underlying pathologies, such as hemangioma, multiple myeloma, osteolytic metastases, and primary or secondary osteoporosis (Kobayashi et al. 2005; Larsson 2002). The other option for treating an osteoporotic compression fracture of a vertebral body is to use an inflatable balloon to restore the height of the vertebral body — so-called kyphoplasty. One of the postulated effects is that kyphoplasty is able to reduce the resulting kyphotic deformity and stabilizes its effect by a cement injection; it was first described by Reiley in the early 1990s (Mathis et al. 2004). [ABSTRACT FROM AUTHOR]

Percutaneous alcohol instillation (PAI) continues to be performed in many centers despite gradual displacement by newer technologies such as thermoablation. It can be readily and easily performed under imaging guidance with the use of existing equipment and considerably low costs. In addition it may offer distinct advantages over other regional therapies in some situations (Livraghi et al. 1995; Lin et al. 2005). [ABSTRACT FROM AUTHOR]

The impact of surgical resection on prognosis and patient outcome in certain malignancies in the absence of extrahepatic disease is unchallenged. Percutaneous, image-guided tumor ablation has developed and stands today as a genuine, dedicated and widely used procedure for patients with otherwise non-resectable primary or secondary liver malignancies. Procedures based on thermal tissue effects (e.g., thermal ablation and cryoablation) were initially developed with the intention of treating hepatic malignancies. Visual guidance by computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound is necessary for all percutaneous approaches to the liver. [ABSTRACT FROM AUTHOR]

Primary and secondary malignant hepatic tumors are a major health problem worldwide. While metastases are common in western countries, primary liver cancers are frequently diagnosed in Asia and Africa. However, recent data suggest that the incidence and mortality of hepatocellular carcinoma (HCC) in Western nations are on the rise (Taylor- Robinson et al. 1997; Llovet et al. 2003). Likewise, the liver is the most common site for metastases. In 25%-50% of patients with malignancies liver metastases were observed at autopsy (Bernardino et al. 1982). The most frequent primary sites are colon, breast, pancreas, and lung. In the case of colorectal metastatic disease, the liver is the only metastatic site in 20%-30% of patients (Sasson and Sigurdson 2002). [ABSTRACT FROM AUTHOR]

Regional chemotherapy is a form of anticancer therapy which has recently made striking advances. The rationale for regional application of cytotoxic agents is to increase local efficacy on one hand and to reduce systemic side-effects on the other hand. Regional administration of anticancer drugs may be recommended, if is known and if it is relatively localized and not disseminated. Many attempts have been made to increase the response by administering high concentrations of anticancer drugs selectively to the tumor tissue. It is advantageous for anticancer treatment if the toxic effects of the cytostatics on normal tissue are minimized by administering the drugs only to the cancer tissue in such a way that the drugs do not reach the normal tissue. [ABSTRACT FROM AUTHOR]

Interstitial laser-induced thermotherapy (LITT) is a minimally invasive technique suitable for local tumor destruction within solid organs, using optical fibers to deliver high-energy laser radiation to the target lesion. Due to light absorption, temperatures of up to 120°C are reached within the tumor, leading to substantial thermocoagulation. MR imaging is used both for placement of the laser applicator in the tumor and for monitoring progress of thermocoagulation. The thermosensitivity of certain MR sequences is the key to real-time monitoring, allowing accurate estimation of the actual extent of thermal damage. [ABSTRACT FROM AUTHOR]

Microwave (MW) interstitial thermoablation offers several advantages over the more commonly applied thermal ablative technique of radiofrequency (RF) ablation for targeted tumor destruction, such as higher ablation temperature, faster treatment time, reduced heat-sink effect, effective ablation of cystic lesions, a technologically easier multi-applicator approach, no necessity for grounding pads, and no risk of skin burns. The technique may be used in different treatment approaches, including imagingguided percutaneous, laparoscopic, and open surgical access. MW ablation constitutes one of the most recent developments in interstitial tumor ablation techniques; however, as yet no FDA-approved commercial device is available. In MW ablation, electromagnetic MW irradiation applied to the tumor tissue causes water molecules to vibrate and rotate, resulting in tissue heating and subsequently cell death via thermal-induced protein denaturation. In first pilot studies, MW ablation has shown immense potential for the treatment of primary and secondary liver tumors, primary and secondary lung cancer, renal cell carcinoma, and bone metastases. [ABSTRACT FROM AUTHOR]