Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

• Published in: Cardiovascular and interventional radiology 2016-06, Vol.39 (6), p.865-874
• Main Authors: Yoshimatsu, Rika, Yamagami, Takuji, Ishikawa, Masaki, Kajiwara, Kenji, Aikata, Hiroshi, Chayama, Kazuaki, Awai, Kazuo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; ARTERIES; Balloon Occlusion - methods; BALLOONS; BIOMEDICAL RADIOGRAPHY; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - drug therapy; Cardiology; Clinical Investigation; COMPARATIVE EVALUATIONS; Computed Tomography Angiography - methods; COMPUTERIZED TOMOGRAPHY; Female; HEPATOMAS; Humans; Imaging; LIVER; Liver - diagnostic imaging; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; OILS; Radiography, Interventional - methods; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasound
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-015-1279-9

Purpose To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE). Methods Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated. Results Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p  = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor. Conclusions Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.