Interventional therapies for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma is the third most common cause of cancer-related death. In the past few years, staging systems have been developed that enable patients to be stratified into treatment algorithms in a multidisciplinary setting. Several of these treatments involve minimally invasive image-guided therapy that can be performed by radiologists.

Figure 1

The treatment algorithm.

Figure 2

Arterial phase computed tomography (CT) (a) shows a right subcapsular 2.4-cm arterial enhancing lesion (arrow), which washes out on the delayed phase (b). RFA was performed from an anterior subcostal approach (c). CT 6 weeks after the procedure shows an ablation cavity (arrow), no extracapsular rupture, and no residual arterial enhancement (d).

Figure 3

A right hepatic arteriogram shows a hypervascular lesion (a). Following embolization, the mass shows filling with lipiodol on CT (b).

Figure 4

MRI with gadolinium shows an aterial enhancing lesion (arrow) at the dome of the liver on the right (a) with washout (b). Follow-up MRI in the arterial phase 6 months after TACE (c) shows no residual enhancement at the site of the tumour (arrow).

Figure 5

MRI shows a 4-cm arterial enhancing mass (arrow) in the right lobe with a satellite nodule (a). A common hepatic arteriogram before DEB-TACE confirms the tumour (arrow) (b). MRI 6 months later in the arterial phase (c) shows no residual enhancement in the tumour (arrow).

Figure 6

MRI shows the liver of a patient who has undergone resection for HCC. There is tumour recurrence adjacent to the resection site (arrow) (a). 24 months after treatment with ⁹⁰Y there is no residual tumour (arrow) at the site of recurrence (b).