Günkan Ahmet, Elek Alperen, Ohannesian Victor Arthur, Mendes Lucas Lima, Pehlivan Umur Anil, Fouad Mohamed E M, Shafeea Murtaja Satea, Loffroy Romaric, Hannallah Jack, Woodhead Gregory, Young Shamar
Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona.
Department of Interventional Radiology, Ege University Faculty of Medicine, Izmir, Turkey.
J Vasc Interv Radiol. 2025 Jul 7. doi: 10.1016/j.jvir.2025.06.025.
To evaluate the safety and effectiveness of image-guided therapies-including transarterial chemoembolization (TACE), radiofrequency (RF) ablation, microwave ablation, and percutaneous sclerotherapy-for the treatment of giant hepatic hemangiomas (GHHs).
A comprehensive search was performed across PubMed, Scopus, and Web of Science, including studies with ≥5 patients that reported image-guided treatment of GHHs. Primary outcomes included technical success, adverse events (AEs; classified according to the Society of Interventional Radiology [SIR] system), clinical success (symptom relief without additional intervention), and radiologic success (≥50% size reduction and/or lack of enhancement on follow-up imaging). A subgroup analysis was performed for GHHs of ≥10 cm. Outcomes were analyzed using a random-effect meta-analysis.
Twenty-eight studies (2,617 patients; 32.5% men; mean age, 46.1 years [SD ± 3.2]) with 2,996 GHHs, ranging from 4 to 30 cm, were included. Of these, 22 were noncomparative, and 6 compared either 2 image-guided therapies or surgery, reporting outcomes for TACE (n = 13), RF ablation (n = 7), microwave ablation (n = 6), and percutaneous sclerotherapy (n = 4). The pooled technical success rate was 99.9%. Grade 2-4 AEs occurred in 1.64%, with TACE having the lowest rate (0.2%) and RF ablation the highest (2.1%). Clinical success at final follow-up was 99.9%, while radiological success was 85.7%. Grade 2-4 AEs were significantly higher in the subanalysis of GHHs of ≥10 cm (10.6%; P < .001), despite similar technical success and radiological and clinical outcomes.
Image-guided therapies are safe and effective for GHHs, achieving high technical, clinical, and radiological success with minimal Grade 2-4 AEs. However, for GHHs ≥10 cm, AE rates were higher.
评估包括经动脉化疗栓塞术（TACE）、射频（RF）消融、微波消融和经皮硬化治疗在内的影像引导治疗对巨大肝血管瘤（GHH）的安全性和有效性。
对PubMed、Scopus和Web of Science进行全面检索，纳入报告了对GHH进行影像引导治疗且患者数量≥5例的研究。主要结局包括技术成功率、不良事件（AE；根据介入放射学会[SIR]系统分类）、临床成功率（无需额外干预的症状缓解）和影像学成功率（随访成像时尺寸缩小≥50%和/或无强化）。对直径≥10 cm的GHH进行亚组分析。采用随机效应荟萃分析对结局进行分析。
纳入了28项研究（2617例患者；男性占32.5%；平均年龄46.1岁[标准差±3.2]），共2996个GHH，直径范围为4至30 cm。其中，22项为非对比研究，6项对比了两种影像引导治疗或手术，报告了TACE（n = 13）、RF消融（n = 7）、微波消融（n = 6）和经皮硬化治疗（n = 4）的结局。汇总技术成功率为99.9%。2-4级AE发生率为1.64%，其中TACE发生率最低（0.2%），RF消融发生率最高（2.1%）。末次随访时临床成功率为99.9%，影像学成功率为85.7%。在直径≥10 cm的GHH亚组分析中，尽管技术成功率、影像学和临床结局相似，但2-4级AE发生率显著更高（10.6%；P <.001）。
影像引导治疗对GHH是安全有效的，能实现较高的技术、临床和影像学成功率，且2-4级AE极少。然而，对于直径≥10 cm的GHH，AE发生率更高。
