title: Nitroglycerine use in transcatheter arterial (chemo)embolization in patients with hepatocellular carcinoma and dual-energy CT assessment of Lipiodol retention.
abstract: OBJECTIVE
  To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT.
  
  
  METHODS
  HCC patients (BCLC stage A or B) were randomized to (n = 51) or not to (n = 50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3 months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours.
  
  
  RESULTS
  Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11 % vs. 12.5 %, respectively), and was statistically significant in the group receiving nitroglycerine (P = 0.023). There was no difference between the two groups in disease response (P = 0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05 mg/mL vs. 4.40 mg/mL, respectively, P < 0.001; median percentage 82.01 % vs. 36.75 %, respectively, P < 0.001).
  
  
  CONCLUSIONS
  Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours.
  
  
  CONCLUSIONS
  • Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention.                         • In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction.                         • Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE.
authors.affiliation: Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan, Taiwan, 704, Republic of China.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Liu
authors.forename: Ming-Tsung
authors.initials: MT
authors.lastname: Chuang
authors.forename: Yi-Shan
authors.initials: YS
authors.lastname: Tsai
authors.forename: Hong-Ming
authors.initials: HM
authors.lastname: Tsai
authors.forename: Xi-Zhang
authors.initials: XZ
authors.lastname: Lin
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D002406:Catheterization, Peripheral; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000970:Antineoplastic Agents; D014665:Vasodilator Agents; D004998:Ethiodized Oil; D005996:Nitroglycerin