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Impact of Multidetector CT Hepatic Arteriography on the Planning of Chemoembolization Treatment of Hepatocellular Carcinoma

¹ Department of Radiology, Stanford University Medical Center, 3000 Pasteur Dr., H-3646, Stanford, CA 94305-5642.
² Department of Surgery, Stanford University Medical Center, Stanford, CA 94305-5642.

View larger version (114K): [in a new window]   Fig. 1A. —65-year-old woman with hepatitis B. Arterial phase CT scan obtained from referring institution shows large solitary mass (arrow) in segments VI and VII and ill-defined heterogeneity (arrowhead) in segment IV.

View larger version (132K): [in a new window]   Fig. 1B. —65-year-old woman with hepatitis B. Parenchymal phase of digital subtraction hepatic arteriogram in right anterior oblique projection reveals at least three additional hypervascular lesions (arrows).

View larger version (129K): [in a new window]   Fig. 1C. —65-year-old woman with hepatitis B. CT hepatic arteriogram shows large mass in posterior right lobe. Note smaller lesions (arrows) in segments IVb and I.

View larger version (152K): [in a new window]   Fig. 1D. —65-year-old woman with hepatitis B. Axial maximum-intensity-projection image portrays 18 discrete lesions (11 of them 1 cm) suspected of being hepatocellular carcinoma. Patient was treated by two sessions of lobar chemoinfusion, covering entire liver.

View larger version (140K): [in a new window]   Fig. 1E. —65-year-old woman with hepatitis B. Follow-up unenhanced CT scan obtained 4 months after B-D shows sequestered Ethiodol (Savage, Melville, NY) in many small lesions (black arrows) as well as incomplete opacification of largest mass (white arrow). Four months after chemoinfusion, 13 of 18 identified lesions still contained detectable Ethiodol.

View larger version (157K): [in a new window]   Fig. 2A. —51-year-old man with hepatitis C and porphyria. Arterial phase multidetector CT scan obtained after 150 mL IV bolus of contrast material (given at 5 mL/sec) shows hypervascular mass (arrow) in segment VII.

View larger version (153K): [in a new window]   Fig. 2B. —51-year-old man with hepatitis C and porphyria. Arterial phase CT scan obtained at level of portal bifurcation reveals additional small hypervascular mass (arrow) that was not diagnosed prospectively.

View larger version (124K): [in a new window]   Fig. 2C. —51-year-old man with hepatitis C and porphyria. Arterial phase contrast-enhanced T1-weighted gradient-echo MR image obtained at same level as A also shows hypervascular mass (arrow).

View larger version (131K): [in a new window]   Fig. 2D. —51-year-old man with hepatitis C and porphyria. Arterial phase contrast-enhanced MR image at same level as B reveals subtle lesion (arrow) at portal bifurcation that was not diagnosed prospectively.

View larger version (137K): [in a new window]   Fig. 2E. —51-year-old man with hepatitis C and porphyria. Digital subtraction hepatic arteriogram shows only one lesion (arrow).

View larger version (151K): [in a new window]   Fig. 2F. —51-year-old man with hepatitis C and porphyria. CT hepatic arteriogram shows additional 9-mm lesion (arrow) at portal bifurcation. Note marked increase in conspicuity compared with B and D.

View larger version (138K): [in a new window]   Fig. 2G. —51-year-old man with hepatitis C and porphyria. CT hepatic arteriographic maximum-intensity-projection image shows 9-mm lesion (arrow) and its blood supply from middle hepatic artery.

View larger version (144K): [in a new window]   Fig. 2H. —51-year-old man with hepatitis C and porphyria. Subselective digital subtraction hepatic arteriogram reveals additional lesion (arrow).

View larger version (118K): [in a new window]   Fig. 3A. —64-year-old woman with hepatitis C who had previously received multiple chemoembolization treatments for hepatocellular carcinoma. Arterial phase CT scan shows heterogeneous mass (arrow) in segment IVa, possibly invading anterior abdominal wall (arrowhead).

View larger version (158K): [in a new window]   Fig. 3B. —64-year-old woman with hepatitis C who had previously received multiple chemoembolization treatments for hepatocellular carcinoma. Digital subtraction hepatic arteriogram reveals diffuse contour irregularities and occlusions, consistent with chemotherapy-induced vasculitis. No definite hypervascular mass identified. Note subtraction artifact from mass (arrow) previously treated with Ethiodol (Savage, Melville, NY).

View larger version (106K): [in a new window]   Fig. 3C. —64-year-old woman with hepatitis C who had previously received multiple chemoembolization treatments for hepatocellular carcinoma. CT hepatic arteriogram also shows no hypervascular mass but injected contrast material did not opacify region of interest.

View larger version (171K): [in a new window]   Fig. 3D. —64-year-old woman with hepatitis C who had previously received multiple chemoembolization treatments for hepatocellular carcinoma. Right internal thoracic arteriogram shows parasitized arterial supply to mass (arrow).

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