title: Hepatocellular Carcinoma Post Embolotherapy: Imaging Appearances and Pitfalls on Computed Tomography and Magnetic Resonance Imaging.
abstract: Embolotherapies used in the treatment of hepatocellular carcinoma (HCC) include bland embolization, conventional transarterial chemoembolization (cTACE) using ethiodol as a carrier, TACE with drug-eluting beads and super absorbent polymer microspheres (DEB-TACE), and selective internal radiation therapy (SIRT). Successfully treated HCC lesions undergo coagulation necrosis, and appear as nonenhancing hypoattenuating or hypointense lesions in the embolized region on computed tomography (CT) and magnetic resonance. Residual or recurrent tumours demonstrate arterial enhancement with portal venous phase wash-out of contrast, features characteristic of HCC, in and/or around the embolized area. Certain imaging features that result from the procedure itself may limit assessment of response. In conventional TACE, the high-attenuating retained ethiodized oil may obscure arterially-enhancing tumours and limit detection of residual tumours; thus a noncontrast CT on follow-up imaging is important post-cTACE. Hyperenhancement within or around the treated zone can be seen after cTACE, DEB-TACE, or SIRT due to physiologic inflammatory response and may mimic residual tumour. Recognition of these pitfalls is important in the evaluation embolotherapy response.
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: rywchiu@gmail.com.
authors.forename: Rita Y W
authors.initials: RY
authors.lastname: Chiu
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Wan W
authors.initials: WW
authors.lastname: Yap
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Roshni
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Klass
authors.affiliation: Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alison C
authors.initials: AC
authors.lastname: Harris
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000628:therapy*; D004621:Embolization, Therapeutic; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed
keywords: Drug-eluting beads and super absorbent polymer microspheres; Embolotherapy; Hepatocellular carcinoma; Selective internal radiation therapy; Transarterial chemoembolization