Hepatic arterial collaterals after transcatheter oily chemoembolization of hepatocellular carcinoma.

From July 1989 to June 1999, 100 patients, 76 male and 24 female, were admitted for treatment of hepatocellular carcinoma (HCC) with transcatheter oily chemoembolization (TOCE) using lipiodol 10 ml mixed with an anticancer drug (mitomycin C 20 ml) and gelfoam particles, described by Nakamura H et al. The periodic follow-up angiogram showed hepatic collaterals which developed according to the mode of embolization. For peripheral hepatic arterial embolization such as segmental or lobar arterial embolization, the intrahepatic collaterals were commonly demonstrated. However, for more proximal hepatic arterial embolization of the tumor feeder arteries such as the proper hepatic artery and the common hepatic artery, the extrahepatic collaterals were commonly demonstrated with fine, small tortuous vasculatures, rendering a repeat TOCE more difficult. The hepatic collaterals are presented.

Lipiodol enhanced CT scanning of malignant hepatic tumors.

From August 1984 to March 1991, 41 patients with malignant liver tumors, 30 males and 11 females, aged 30-75 years were treated at Ramathibodi Hospital with injection of mitomycin-C lipiodol emulsion into the tumor via the feeding artery followed by embolization of the feeding artery with gelfoam particles. The patients comprised 30 cases of hepatocellular carcinoma, 4 cases of cholangiocarcinoma and 7 cases of metastatic tumors of which one was from CA stomach, three were from CA breast, and three from CA colon. The vascularity of the tumor was assessed in angiogram obtained prior to treatment and retention pattern of lipiodol in the tumor was evaluated in lipiodol-enhanced CT scan images taken 2-4 weeks following therapy. The results showed that lipiodol CT scan images exhibited four patterns of lipiodol retention in the tumor appearing as opacity as follows (1) homogenous (2) heterogeneous (3) ring-like and (4) none. Lipiodol retention pattern appeared to be somewhat related to vascularity of the tumor. Most of the hypervascular tumors such as hepatocellular carcinoma had homogeneous lipiodol accumulation pattern if the tumor size was less than 5 cm. Metastatic tumors and cholangiocarcinoma showed heterogeneous or ring-like pattern of lipiodol accumulation because they were relatively hypovascular. Hypervascular hepatocellular carcinoma may exhibit heterogeneous or ring-like pattern if they are larger than 5 cms, and have multiple feeding arteries, necrosis or AV shunting. Hepatocellular carcinoma with AV shunting may not show any lipiodol accumulation at all.