Sharon Wing-Yi Kwan MD, Presenter: Nothing to Disclose

Nicholas Fidelman MD, Abstract Co-Author: Nothing to Disclose

Elizabeth Ma BS, Abstract Co-Author: Nothing to Disclose

Robert K. Kerlan MD, Abstract Co-Author: Nothing to Disclose

Francis Yao MD, Abstract Co-Author: Nothing to Disclose

Transarterial chemoembolization (TACE) is one of the standard therapies for hepatocellular carcinoma (HCC). The purpose of this study was to determine which features on post-treatment cross-sectional imaging studies are associated with tumor necrosis on pathologic specimens.

Records of 76 patients (61 men, 15 women, mean age 58 years) with 102 HCC nodules who underwent liver transplantation 19-571 days (mean 181 days) following TACE with a combination of doxorubicin, mitomycin C, cisplatin, lipiodol, and gelatin sponge slurry were retrospectively reviewed. All patients had follow-up imaging with multiphase contrast-enhanced computed tomography (CT) 1-207 days (mean 57 days) prior to transplantation. Imaging studies were evaluated with respect to change in lesion size from pre-treatment scan, size of the enhancing component, as well as density and distribution of lipiodol within each lesion. CT findings were correlated with presence of greater than 90% tumor necrosis on the explanted specimens. Generalized estimating equation analysis was used to correlate CT and pathologic findings.

Sixty lesions (59%) were found to be completely necrotic at pathology. Greater than 90%, 60-90%, 30-59%, and <30% necrosis was achieved in 71%, 5%, 8%, and 16% of nodules respectively. Presence of greater than 90% lesion necrosis at pathology was associated with the following imaging findings on the post-TACE CT scans: lack of residual contrast enhancement (p<0.0001), a decrease in lesion size from pre-treatment to pre-transplant scans (p=0.009), high lesion density on the pre-contrast scans due to lipiodol accumulation (p=0.005), and diffuse distribution of lipiodol throughout the lesion (p<0.0001).

Triple-drug TACE is an effective means at achieving complete tumor necrosis prior to liver transplantation. Lack of residual contrast enhancement, decrease in lesion size, as well as dense and diffuse lipiodol accumulation within a lesion are associated with complete or near complete tumor necrosis.

Lack of arterial enhancement, decrease in lesion size, as well as dense and diffuse lipiodol accumulation within a lesion are associated with complete or near complete tumor necrosis following TACE.

Kwan, S, Fidelman, N, Ma, E, Kerlan, R, Yao, F, Imaging Predictors of Tumor Response Following Transarterial Chemoembolization for Hepatocellular Carcinoma: Radiologic-Pathologic Correlation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007462.html