Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency (RF)ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors. Methods Three hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients(0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed. Results Two patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date. Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

北京肿瘤医院自1999年开展超声引导射频消融（RFA）以来，共治疗符合RFA治疗适应证的肝细胞癌（HCC）256例（409人次）。入选标准为：（1）肿瘤最大径≤8.0cm；（2）数目≤4个；（3）未明显侵犯周围其他重要脏器；（4）无门静脉或下腔静脉的广泛瘤栓；（5）凝血酶原活动度>60%，血小板≥50×109/L。

目的：观察新型超声造影剂SonoVue及实时灰阶造影成像技术（CnTI）对肝脏肿瘤的灌注过程及回声变化规律，探讨其对肝脏恶性肿瘤诊断及射频消融治疗的应用价值。方法：35例超声不能完全明确诊断或漏诊的肝脏占位患者，26例经手术或穿刺病理确诊，9例为增强CT、核磁共振等临床资料证实；原发性肝癌23例，肝转移癌5例，良性病变7例。原发性肝癌中14例为射频治疗前检查。结果：原发性肝癌23例均发生动脉早期强化，21例（91.3%）实质期呈快速消退，即“快进快出”型；另2例<2cm的高分化小肝癌则消退缓慢。肝转移性肿瘤5例表现多样，呈动脉期或门脉期环状强化或不同程度强化，消退快慢不一。肝血管瘤3例动脉期瘤内无强化，门静脉期呈向心性填充增强，持续数分钟后消退；余4例良性病灶变化不典型。射频组14例26个HCC瘤灶中9个肿瘤（34.6%）可显示荷瘤血管；12个灶（46.1%）造影后显示原病灶范围增大，其中边界不清晰及无晕征的肿瘤增大明显，此结果有助于确定射频消融范围。结论：新型超声造影技术对肝脏占位病变的定性诊断灵敏而有效，显示肿瘤实际大小、数目和发现微小病灶等可极大地提高超声对肝脏占位病变的诊断价值，并为射频适应征的选择和治疗方案的制定提供了依据。

Background The advent of second generation agent-SonoVue arid low mechanical index real-time contrast enhanced uhrasonography (CEUS) imaging have been shown to improve the diagnostic performance of ultrasonography in hepatocellular carcinoma (HCC). But no report has described the effect of high mechanical index (MI) post-CEUS This study aimed to investigate the value of post-CEUS in displaying tissue structures of HCC. Methods Seventy-six HCCs in 65 patients were included in the study Each patient undm~ent three scans, high-MI (MI: 0.15-1.6) pre-contrast ultrasound, low-MI (Mi: 0.04-0.08) CEUS with contrast agent SonoVue, and high-MI post-contrast ultrasound, which was performed within 3 minutes after CEUS The size, boundary, echogenicity, internal echotexture arid posterior acoustic enhancement of the HCCs in the conventional scans before and after CEUS were evaluated According to pathological evidence, diagnosis rates of pre-contrast, CEUS arid post-contrast scans were determined arid compared The potential mechanism of post-contrast ultrasound imaging was also discussed. Results Compared with pre-contrast, post-contrast ultrasound showed improvement in image quality in most HCCs: twenty-six (34.2%) more lesions showed well defined margins and fourteen (18.4%) more nodules showed halo sign; twenty-three (30.3%) lesions demonstrated enlarged in sizes; changes in echogenicity were seen in 30 lesions(39.5%): eighteen(23.7%) more lesions showed heterogeneeity and 20 (26.3%) more lesions showed "mosaic" or "nodule-in-nodule" sign: twelve (15.8%) more lesions showed posterior acoustic enhancement Post-contrast ultrasound showed increased diagnostic accuracy of 93.4% (71/76), compare with 88.2% (67/76) of CEUS alone. Conclusions High-MI post-contrast ultrasound utilizes harmonic signals during the rupture of microbubbles, and significantly improves the display of echo-characteristics of HCCs in ultrasound images, which adds diagnostic values for CEUS Post-contrast ultrasound could play an important role in tissue characterization, and may be included in CEUS protocols.