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Imaging Features of Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization and Radiofrequency Ablation

Hyo Soon Lim1, Yong Yeon Jeong1, Heoung Keun Kang1, Jae Kyu Kim2 and Jin Gyoon Park2

1 Department of Diagnostic Radiology, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, South Korea.
2 Department of Diagnostic Radiology, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea.


Figure 1
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  		Fig. 1A —Four types (with type I broken down into two parts) of accumulation patterns of iodized oil on CT after transcatheter arterial chemoembolization. Greater amount of accumulation of iodized oil within tumor indicates greater area of necrosis. Type Ia, seen in 60-year-old man, has homogeneous accumulation, with accumulation also seen around tumor.

 

Figure 2
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  		Fig. 1B —Four types (with type I broken down into two parts) of accumulation patterns of iodized oil on CT after transcatheter arterial chemoembolization. Greater amount of accumulation of iodized oil within tumor indicates greater area of necrosis. Type Ib, seen in 59-year-old man, has homogeneous accumulation with accumulation not seen around tumor.

 

Figure 3
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  		Fig. 1C —Four types (with type I broken down into two parts) of accumulation patterns of iodized oil on CT after transcatheter arterial chemoembolization. Greater amount of accumulation of iodized oil within tumor indicates greater area of necrosis. Type II, seen in 73-year-old man, has partial defect in accumulation.

 

Figure 4
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  		Fig. 1D —Four types (with type I broken down into two parts) of accumulation patterns of iodized oil on CT after transcatheter arterial chemoembolization. Greater amount of accumulation of iodized oil within tumor indicates greater area of necrosis. Type III, seen in 65-year-old woman, has faint accumulation.

 

Figure 5
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  		Fig. 1E —Four types (with type I broken down into two parts) of accumulation patterns of iodized oil on CT after transcatheter arterial chemoembolization. Greater amount of accumulation of iodized oil within tumor indicates greater area of necrosis. Type IV, seen in 70-year-old man, has no or slight accumulation.

 

Figure 6
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  		Fig. 2A —56-year-old man with residual viable tumor that shows faint accumulation of iodized oil after transcatheter arterial chemoembolization (TACE). On follow-up unenhanced CT scan 3 weeks after TACE, faint accumulation of iodized oil (arrow) within tumor is seen.

 

Figure 7
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  		Fig. 2B —56-year-old man with residual viable tumor that shows faint accumulation of iodized oil after transcatheter arterial chemoembolization (TACE). Arterial phase CT scan shows contrast enhancement (arrow) around faint accumulation of iodized oil, suggesting remaining viable tumor.

 

Figure 8
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  		Fig. 2C —56-year-old man with residual viable tumor that shows faint accumulation of iodized oil after transcatheter arterial chemoembolization (TACE). Subsequent angiogram shows hypervascular mass (arrows) in hepatic dome. Because of this finding, TACE was repeated.

 

Figure 9
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  		Fig. 3A —54-year-old man with residual viable tumor with defective accumulation of iodized oil after transcatheter arterial chemoembolization (TACE). On unenhanced CT scan 3 weeks after TACE, defective accumulation of iodized oil (arrows) within tumor is seen.

 

Figure 10
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  		Fig. 3B —54-year-old man with residual viable tumor with defective accumulation of iodized oil after transcatheter arterial chemoembolization (TACE). Arterial phase CT scan shows contrast enhancement (arrows) within defective uptake of iodized oil, suggesting remaining viable tumor.

 

Figure 11
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  		Fig. 4A —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. On unenhanced CT scan, dense intratumoral retention of iodized oil (arrow) is shown with beam-hardening artifact.

 

Figure 12
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  		Fig. 4B —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. On arterial phase CT scan, contrast enhancement of tumor (arrow) is unclear.

 

Figure 13
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  		Fig. 4C —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. Axial T1-weighted gradient-echo (TR/TE, 120/4.2) MR image shows hyperintense lesion (arrow).

 

Figure 14
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  		Fig. 4D —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. Axial T2-weighted single-shot fast spin-echo (infinite/92) MR image shows heterogeneous hyperintense lesion. Necrotic lesions (arrowheads) have higher signal intensity than do viable lesions (arrow).

 

Figure 15
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  		Fig. 4E —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. On gradient-echo (180/1.8) T1-weighted MR images after administration of gadolinium chelates, residual viable tumor (arrow) shows intense enhancement in arterial phase (E) and washout in delayed phase (F). Necrotic lesion (arrowheads) shows no enhancement in either phase.

 

Figure 16
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  		Fig. 4F —66-year-old woman with residual viable tumor after transcatheter arterial chemoembolization. On gradient-echo (180/1.8) T1-weighted MR images after administration of gadolinium chelates, residual viable tumor (arrow) shows intense enhancement in arterial phase (E) and washout in delayed phase (F). Necrotic lesion (arrowheads) shows no enhancement in either phase.

 

Figure 17
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  		Fig. 5A —64-year-old man with complete necrosis of hepatocellular carcinoma after transcatheter arterial chemoembolization. Axial T1-weighted gradient-echo (TR/TE, 120/4.2) MR image shows hyperintense lesion (arrow).

 

Figure 18
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  		Fig. 5B —64-year-old man with complete necrosis of hepatocellular carcinoma after transcatheter arterial chemoembolization. Axial T2-weighted single-shot fast spin-echo (infinite/92) MR image shows hypointense lesion (arrow), which represents coagulation necrosis. Compact uptake of iodized oil is seen within tumor on CT (not shown).

 

Figure 19
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  		Fig. 6A —74-year-old man with incomplete necrosis of hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE). On follow-up unenhanced CT scan 3 weeks after TACE, defective accumulation of iodized oil (arrow) within tumor is seen.

 

Figure 20
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  		Fig. 6B —74-year-old man with incomplete necrosis of hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE). Arterial phase CT scan shows contrast enhancement (arrow) within lesion.

 

Figure 21
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  		Fig. 6C —74-year-old man with incomplete necrosis of hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE). Contrast-enhanced sonography clearly shows enhancement of lesion (arrows) irrespective of accumulation of iodized oil on CT.

 

Figure 22
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  		Fig. 7A —70-year-old man with successful radiofrequency ablation. Arterial phase CT scan 1 day after radiofrequency ablation shows unenhanced oval ablated lesion (arrow).

 

Figure 23
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  		Fig. 7B —70-year-old man with successful radiofrequency ablation. Axial T1-weighted gradient-echo (TR/TE, 180/1.8) MR image 2 months after radiofrequency ablation shows oval ablated lesion (arrow) with high signal intensity relative to surrounding liver parenchyma.

 

Figure 24
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  		Fig. 7C —70-year-old man with successful radiofrequency ablation. Axial T2-weighted fast spin-echo (7,500/90) MR image shows oval ablated lesion (arrow) with low signal intensity relative to surrounding liver parenchyma, representing coagulative necrosis. Note high-signal-intensity rim (arrowheads) representing reactive change.

 

Figure 25
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  		Fig. 7D —70-year-old man with successful radiofrequency ablation. On T1-weighted MR image after administration of gadolinium chelates, ablated lesion (arrow) shows lack of enhancement, although high signal intensity on unenhanced MR image interferes with proper evaluation of arterial phase enhancement.

 

Figure 26
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  		Fig. 8A —62-year-old man with residual tumor after radiofrequency ablation. On follow-up CT scan 2 months after radiofrequency ablation, arterial phase CT scan shows nodular enhancement (arrowheads) at anterior aspect of ablated lesion (arrow).

 

Figure 27
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  		Fig. 8B —62-year-old man with residual tumor after radiofrequency ablation. Delayed phase CT scan shows washout of nodular enhancement (arrowhead) around ablated lesion (arrow). Nodule was thought to represent residual viable tumor and was treated with repeat radiofrequency ablation.

 

Figure 28
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  		Fig. 9A —55-year-old man with successful radiofrequency ablation. Arterial phase CT scan 1 day after radiofrequency ablation shows oval-shaped ablated lesion (arrow) with surrounding hyperemia (arrowheads).

 

Figure 29
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  		Fig. 9B —55-year-old man with successful radiofrequency ablation. On follow-up CT scan 8 months later, ablated lesion (arrow) shows no contrast enhancement and interval decrease in size.

 

Figure 30
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  		Fig. 10A —80-year-old man with residual viable tumor after radiofrequency ablation. Axial T1-weighted gradient-echo (TR/TE, 180/4.2) MR image 2 months after radiofrequency ablation shows hypointense lesion (arrow).

 

Figure 31
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  		Fig. 10B —80-year-old man with residual viable tumor after radiofrequency ablation. Axial T2-weighted fast spin-echo (500/91) MR image shows hyperintense lesion (arrow) that represents viable tumor. Bright signal intensity is seen in peripheral portion (arrowhead) of ablated lesion, representing necrosis.

 

Figure 32
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  		Fig. 10C —80-year-old man with residual viable tumor after radiofrequency ablation. On axial T1-weighted MR image after administration of gadolinium chelates, ablated lesion (arrow) shows peripheral area of enhancement (arrowheads), suggesting residual viable tumor.

 

Figure 33
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  		Fig. 11A —73-year-old man with marginal recurrent tumor after radiofrequency ablation. Follow-up CT scan 8 months after radiofrequency ablation shows small enhancing nodule (arrowheads) at posterior aspect of ablated lesion (arrow), representing marginal recurrent tumor.

 

Figure 34
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  		Fig. 11B —73-year-old man with marginal recurrent tumor after radiofrequency ablation. Contrast-enhanced sonography also shows focal flow signals (arrowheads) that represent recurrent tumor vessels within ablated area (arrow). Recurred tumor was treated with repeat radiofrequency ablation.

 

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