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Comparison of CT Findings with Resected Specimens After Chemoembolization with Iodized Oil for Hepatocellular Carcinoma

¹ Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 114-0045, Japan.
² First Department of Surgery, Kyoto University, 54, Kawara-cho, Seigoin, Sakyo-ku, Kyoto 606-8507, Japan.
³ Department of Radiology, Nara Prefectural Medical College, 840, Shijo-cho, Kashihara, Nara 634-8522, Japan.
⁴ First Department of Medicine, Chiba School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba 260-8766, Japan.
⁵ Department of Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-0882, Japan.
⁶ Department of Surgery, Tokyo Women's Medical College, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
⁷ Department of Radiology, Wakayama Prefectural Medical College, 811-1, Kimidera, Wakayama 641-8509, Japan.
⁸ First Department of Surgery, Hyogo School of Medicine, 1-1, Bukogawa-cho, Nishimiya, Hyogo 663-8501, Japan.
⁹ Department of Surgery, Chiba-nishi Hospital, 107-1, Kanegasaku, Matsudo, Chiba 270-2251, Japan.

OBJECTIVE. We assessed the role of dynamic CT in the evaluation of the efficacy of transarterial chemoembolization with iodized oil for hepatocellular carcinoma.

MATERIALS AND METHODS. We examined 41 hepatocellular carcinoma lesions (mean diameter, 5.0 cm) in 40 patients (mean age, 60.6 years) who underwent transarterial injection of iodized oil alone (n = 3) or emulsion of iodized oil and doxorubicin hydrochloride (n = 10) followed by gelatin sponge particles (n = 27) and subsequent hepatectomy. On dynamic CT performed within 3 weeks before oily transarterial chemoembolization and within 4 weeks before surgery, we calculated the rate of necrosis on the basis of the assumption that the portion that retained iodized oil represented necrosis. We also calculated the reduction rate of the tumor. CT findings were compared with pathologic findings of resected specimens.

RESULTS. Pathologic specimens and the necrosis rate measured on CT showed a good correlation (r = 0.83) when the portion of tumor that retained iodized oil was considered necrosis. No correlation existed if the portion that retained iodized oil was considered viable. We noted no significant correlation (r = 0.38) between the reduction rate of the tumor and necrosis rate. Also, we noted no correlation (r = 0.52) between the interval between transarterial oily chemoembolization and surgery and the reduction rate of the tumor.

CONCLUSION. CT is suitable for the evaluation of the efficacy of oily chemoembolization for hepatocellular carcinoma on the basis of the assumption that the portion of tumor that retains iodized oil is necrotic. The rate of tumor size reduction measured on CT did not correlate with the therapeutic effect of chemoembolization.

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