Author/Editor		Brkljačić, Boris; Sučić, Mate; Božikov, Veljko; Hebrang, Andrija
Title		Treatment of hyperfunctioning thyroid nodules with ultrasound guided percutaneous ethanol injection - 30 months experience
Translated title		Zdravljenje hiperfunkcijskih ščitničnih nodusov z ultrazvočno vodenim perkutanim vbrizgavanjem etanola - 30-mesečne izkušnje
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 33, št. 3
Publication year		1999
Volume		str. 179-87
Language		eng
Abstract		Background. Our technique of performing percutaneous ethanol injection (PEI) and results after 30 months are presented and compared with results from the literature. Material and methods. PEI was performed in 40 patients (37 female, 3 male, age range 28-76 years); in 35 cases, there was a solitary, scintigraphically "hot" nodule, and in 5 cases a toxic nodulargoiter was found. The volume of treated nodules was in the range from 2.5 to 38 ccm (mean volume 20.7+-14.1 ccm). Ethanol was injected with the free-hand technique, usually in multiple sessions, with the color and power Doppler ultrasound guidance. The total injected volume of ethanol was 1.5 times the volume of the treated nodule. Results. The procedure was technically successful in 37 patients (92.5%). Pain during injection was observed in all cases, subcutaneous hematoma in 6 cases, and transitory dysphonia in one patient. There were no long-term complications. In 36 patients, the successfulness of the treatment was evaluated after 3-4 months on the basis of scintigraphy, hormonal status and ultrasonographic findings. A complete and partial cure was achieved in 22 (61.1%) and in 10 patients (278%) of patients, respectively, whereas in 4 patients (11.1 %) the result was unsatisfactory, since only a moderate hormonal remission was observcd after the completion of the procedure. A satisfactory result was observed in 32/36 patients (88.9%). Significant reduction of nodular volume was noted in all cases. A better result was observed in smaller nodules and in cases of autonomous adenomas. No cases of recurrent hyperthyreosis were detected. Conclusions. Percutaneous ethanol injection under ultrasound guidance is an efficient and safe rnethod in the treatment of autonomous thyroid nodules, that enables inactivation of nodules with minimal and/or transitory complications, without permanent or serious complications that can be observed after radioiodine or surgical therapy.
Summary		Izhodišča. V članku predstavljamo svojo tehniko perkutanega vbrizgavanja etanola in rezultate po 30 mesecih zdravljenja ter jih primerjamo z rezultati, objavljenimi v literaturi. Bolniki in metode. Metodo perkutanega vbrizgavanja etanola smo uporabili na 40 bolnikih (37 žensk, 3 moški, starost od 28 do 76 let); od teh je bil pri 35 bolnikih ugotovljen solitaren in scintigrafsko "vroč" nodus, pri 5 pa toksična nodularna golšavost. Volumen zdravljenih nodusov je znašal od 2,5 do 38 ccm (povprečni volumen 20,7 +-14,1 ccm). Etanol smo vbrizgavali s prosto roko, ultrazvočno vodeno z barvnim in energijskim Doplerjem, običajno v več ponovljenih postopkih. Celoten volumen vbrizganega etanola je bil 1,5-krat večji od volumna zdravljenega nodusa. Razultati. Postopek je bil tehnično uspešen pri 37 bolnikih (92,5%). Vsi bolniki so tožili zaradi bolečine med vbrizgavanjem, podkožni hematom je nastal pri 6 bolnikih, prehodna disfonija pa pri 1 bolniku. Daljnoročnih zapletov zdravljenja ni bilo. Pri 36 bolnikih smo 3 do 4 mesece po zdravljenju ocenili uspešnost zdravljenja s scintigrafijo, s hormonskim stanjem ter z ultrazvočno preiskavo. Ozdravljenih je bilo 22 bolnikov (61,1 %), delno ozdravljenih pa 10 bolnikov (27,8 %). Pri 4 bolnikih (11,1 %) so bili rezultati zdravljenja nezadovoljivi, ker je bila ugotovljena le skromna hormonska remisija. Zadovoljivi rezultati zdravljenja so bili doseženi pri 32/36 bolnikih (88,9%). V vseh primerih pa se je volumen nodusa močno zmanjšal. Boljše rezultate zdravljena smo ugotovili pri manjših vozlih in avtonomnih adenomih. Hipertireoza se ni ponovila pri nobenem bolniku. Zaključki. Ultrazvočno vodeno perkutano vbrizgavanje etanola je učinkovita in varna metoda zdravljenja avtonomnih ščitničnih nodusov, ki preprečuje hiperaktivnost nodusov z minimalnimi zapleti zdravljenja. Ti so prehodnega značaja in niso resni, kot jih lahko opazimo po zdravljenju z radioaktivnim jodom ali po operaciji.
Descriptors		THYROID NODULE ALCOHOL, ETHYL THYROID NEOPLASMS ADENOMA TREATMENT OUTCOME