Evaluation of CT and DSA follow-up checkups for primary hepatocellular carcinoma after transcatheter arterial chemoembolization:a comparative study / 介入放射学杂志

ABSTRACT

Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma(PHC)after transcatheter arterial chemoembolization(TACE)with Lipiodol and to compare the effectiveness between CT and DSA.Methods Forty-five patients with HPC underwent CT and DSA within 1-6 months after 1-4 procedure(s)of TACE. The interval between two examinations was 3-5 days.The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed.Results The Lipiodol deposition appearance was classified into three patternscomplete compact pattern(n=9, 20%),defect pattern(n=32,71.1%)and discrete pattern(n=4,8.9%).In patients with complete compact pattern,no signs of recurrence were found on CT and DSA six months after the procedure.Of 32 patients with defect pattern,signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively.During arterial phase,marked enhancement of the lesion was demonstrated in 16 cases, further enhancement in portal venous phase was manifested in 3 cases,which indicated that the portal vein participated in the tumor feeding.On DSA,the above enhancement areas showed pronounced opacification and vascularization.In another 8 cases,the CT signs and DSA findings were not in accord with each other,the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor's vessels and opacification.In patients of discrete pattern,only mild enhancement was seen on dual-phase CT scans,indicating that the tumor was of hypo-vascularization.Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE.Therefore,in evaluating the therapeutic results of TACE,CT study should be considered as the examination of choice.DSA is the most sensitive and specific method for observing and assessing the therapeutic response.A combination of CT and DSA can more effectively guide the clinical treatment.