Comparison of CT Findings with Resected Specimens After Chemoembolization with Iodized Oil for Hepatocellular Carcinoma
Kenichi Takayasu1,
Shigeki Arii2,
Naoki Matsuo3,
Masaharu Yoshikawa4,
Munemasa Ryu5,
Ken Takasaki6,
Morio Sato7,
Naoki Yamanaka8,
Yoshiyuki Shimamura9 and
Masao Ohto4
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.
View larger version (141K):
[in a new window]
|
Fig. 1A. —47-year-old man with solitary hepatocellular carcinoma who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride in proper hepatic artery. Unenhanced CT scan reveals retention
of iodized oil in lesion (arrows).
|
|
View larger version (127K):
[in a new window]
|
Fig. 1B. —47-year-old man with solitary hepatocellular carcinoma who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride in proper hepatic artery. Early enhanced CT scan shows slight
enhancement of peripheral (arrows) and central portions of lesion
suggestive of viable cancer tissue.
|
|
View larger version (121K):
[in a new window]
|
Fig. 1C. —47-year-old man with solitary hepatocellular carcinoma who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride in proper hepatic artery. Cut surface of resected specimen
obtained 36 days after A shows histopathologically verified fully
viable tumor.
|
|
View larger version (74K):
[in a new window]
|
Fig. 2A. —66-year-old woman with small hepatocellular carcinoma who underwent
injection of emulsion of 7 mL of iodized oil and 25 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in right
hepatic artery. Dynamic CT scan reveals enhancing tumor measuring 2.5 x
2.5 cm in diameter in segment VIII
[26].
|
|
View larger version (121K):
[in a new window]
|
Fig. 2B. —66-year-old woman with small hepatocellular carcinoma who underwent
injection of emulsion of 7 mL of iodized oil and 25 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in right
hepatic artery. Dynamic CT scan obtained 117 days after A shows dense
deposition of iodized oil in tumor that measures 2.0 x 2.0 cm.
Enhancement of tumor was not seen, suggesting complete necrosis. Reduction
rate was 36%.
|
|
View larger version (111K):
[in a new window]
|
Fig. 2C. —66-year-old woman with small hepatocellular carcinoma who underwent
injection of emulsion of 7 mL of iodized oil and 25 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in right
hepatic artery. Cut surface of specimen resected 23 days after B shows
completely necrotic tissue with thick fibrous capsule.
|
|
View larger version (127K):
[in a new window]
|
Fig. 3A. —45-year-old man with incidentally found tumor who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in proper
hepatic artery. Dynamic CT scan obtained during portal dominant arterial phase
reveals large encapsulated hepatocellular carcinoma measuring 10.7 x 8.1
cm homogeneously enhanced except for central unenhanced area (necrosis). Oily
chemoembolization was performed 6 days later.
|
|
View larger version (127K):
[in a new window]
|
Fig. 3B. —45-year-old man with incidentally found tumor who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in proper
hepatic artery. Dynamic CT scan obtained during early phase (58 days after
A) reveals scattered depositions of iodized oil and small enhancing
area (arrow) measuring 8.7 x 7.4 cm. Necrosis rate in tumor was
75%. Enhanced dorsal portion changed to low attenuation in late phase (not
shown). Reduction rate was 25.7%.
|
|
View larger version (144K):
[in a new window]
|
Fig. 3C. —45-year-old man with incidentally found tumor who underwent
injection of emulsion of 5 mL of iodized oil and 20 mg of doxorubicin
hydrochloride followed by Gelfoam particles (Upjohn, Kalamazoo, Ml) in proper
hepatic artery. Cut surface of specimen resected 15 days after B shows
coagulative necrosis of entire tumor except for viable cancer tissue with
hemorrhage in dorsal portion (arrows) that corresponds to
contrast-enhanced area in B.
|
|
View larger version (17K):
[in a new window]
|
Fig. 4. —Graph shows relationship between necrosis rate for tumor at maximum
tumor size revealed on CT and pathologically proven necrosis rate, based on
assumption that portion of tumor that retained iodized oil was necrotic.
(r = 0.83)
|
|
View larger version (16K):
[in a new window]
|
Fig. 5. —Graph shows relationship between necrosis rate for tumor at maximum
tumor size revealed on CT and pathologically proven necrosis rate, based on
assumption that portion of tumor that retained iodized oil was viable cancer
tissue. (r=-0.04)
|
|
View larger version (15K):
[in a new window]
|
Fig. 6. —Graph shows relationship between reduction rate for tumor revealed
on CT and pathologically proven necrosis rate for tumor. (r=0.38)
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2000 by the American Roentgen Ray Society.
