The effect of lipiodol deposition in HCC after TACE on the necrosis range of PMCT

Abstract

Objective: To study the impact of lipiodol deposition in the lesion of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE) on the necrosis area of percutaneous microwave coagulation therapy (PMCT).

Materials and methods: A total of 44 patients with HCC with 56 nodules, with a size ranging from 1.5 to 3.5 cm, was selected in our study. About 23 patients (26 nodules) underwent PMCT treatment only as Group A and 21 patients (30 nodules) were treated by PMCT-combined TACE as Group B. All patients underwent PMCT with single-electrode and one-point ablation. Paired t-test was used to analyze pre- and postoperatively the volume of tumor and the necrosis volume after PMCT. Independent t-test was used to compare the difference in the necrosis area between two groups (α=0.05).

Results: All patients underwent PMCT or PMCT combined with TACE successfully. The tumor and necrosis size of Group A was 16.29±19.23 cm³ and 17.98±18.49 cm³ (P=0.650), and 11.95±12.78 cm³ and 16.60±11.70 cm³ of Group B (P=0.017). There was no significant difference on necrosis volume between the two groups (P=0.581). The necrosis area of Group B was larger than the size of the tumor (P=0.017), but the ablation area of the two groups was smaller than the theoretic area (P=0.001). (The theoretic area means that the necrosis area of ablation should be 1.0 cm larger than the tumor in diameter.).

Conclusion: PMCT combined with TACE could enlarge the ablation area, but will not lead to an ideal necrosis area than the PMCT alone. The lipiodol deposition in the tumor lesion may hinder the expansion of the heating field. Therefore, further research was needed.

Keywords: hepatocellular carcinoma; lipiodol; percutaneous microwave coagulation therapy; transarterial chemoembolization.

Figure 1

One male patient with HCC, the necrosis range of PMCT after TACE did not enlarged. Notes: (A) Male patient with low-density lesion at segment VIII on plain CT scan (CT PS). (B) Lipiodol deposit well into the lesion after TACE, the same patient with (A). (C) One month after PMCT, lipiodol deposit well into the lesion, but no low-density belt surrounded the lesion. Abbreviations: PMCT, percutaneous microwave coagulation therapy; TACE, transarterial chemoembolization.

Figure 2

One month after PMCT only, the necrosis area surrounded the tumor area completely (CT CE). Abbreviation: PMCT, percutaneous microwave coagulation therapy.

Figure 3

(A) One and a half months later, CT image showed that the heating area spread to the opposite direction of the surface liver because of the obstruction in the lipiodol deposition (CT CE axial). (B) One a and a half months later, the same case of (A), CT image showed that the heating area spread to the opposite direction of the liver surface (CT CE, coronal).