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Transcatheter Arterial Chemoembolization in Patients with Hepatocellular Carcinoma on the Waiting List for Orthotopic Liver Transplantation

¹ Department of Radiology, Hospital de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
² Department of Surgery, Hospital de Bellvitge, Barcelona, Spain.
³ Department of Pathology, Hospital de Bellvitge, Barcelona, Spain.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —60-year-old man with chronic hepatitis C virus infection. Helical CT scans in arterial phase show hypervascular lesions in segments IV and V (A) and in segment V (B) corresponding to hepatocellular carcinoma.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —60-year-old man with chronic hepatitis C virus infection. Helical CT scans in arterial phase show hypervascular lesions in segments IV and V (A) and in segment V (B) corresponding to hepatocellular carcinoma.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —60-year-old man with chronic hepatitis C virus infection. Selective celiac axis angiography image obtained before transcatheter arterial chemoembolization (TACE) shows two hypervascular lesions. TACE was performed.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —60-year-old man with chronic hepatitis C virus infection. CT scans obtained at follow-up 1 month after TACE confirm complete iodized oil retention inside both nodules. On histopathologic examination, nodule in segments IV and V was not identified.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —60-year-old man with chronic hepatitis C virus infection. CT scans obtained at follow-up 1 month after TACE confirm complete iodized oil retention inside both nodules. On histopathologic examination, nodule in segments IV and V was not identified.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —58-year-old man with chronic alcoholic hepatitis. Arterial phase CT scans show two hypervascular hepatocellular carcinoma nodules in segments VIII and V (A) and in segment V (B).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —58-year-old man with chronic alcoholic hepatitis. Arterial phase CT scans show two hypervascular hepatocellular carcinoma nodules in segments VIII and V (A) and in segment V (B).

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —58-year-old man with chronic alcoholic hepatitis. CT scans obtained at follow-up 1 month after transcatheter arterial chemoembolization confirm complete iodized oil retention inside both lesions. On histopathologic examination, percentage of tumor necrosis was 95% and 100%, respectively.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —58-year-old man with chronic alcoholic hepatitis. CT scans obtained at follow-up 1 month after transcatheter arterial chemoembolization confirm complete iodized oil retention inside both lesions. On histopathologic examination, percentage of tumor necrosis was 95% and 100%, respectively.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —60-year-old man with chronic hepatitis B virus infection. Helical CT scan in arterial phase shows hypervascular lesion in segment VII consistent with HCC. There is also slightly hypodense nodular lesion in segment VIII.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —60-year-old man with chronic hepatitis B virus infection. Corresponding delayed phase CT scan shows that lesion in segment VIII persists and is hypovascular.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —60-year-old man with chronic hepatitis B virus infection. During transcatheter arterial chemoembolization (TACE), there was only one nodule with retention of iodized oil (Lipiodol Ultrafluide, Andre Guerbet).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —60-year-old man with chronic hepatitis B virus infection. CT scan obtained at follow-up 1 month after TACE confirms complete iodized oil retention inside lesion in segment VII. Lesion in segment VIII remained hypodense in all phases (only equilibrium phase shown) and without Lipiodol retention. Histologic examination confirmed two HCC. Percentage of tumor necrosis was 50% in hypervascular lesion and 0% in hypovascular lesion without previous iodized oil retention.

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Graph shows overall actuarial survival rates after liver transplantation.

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