Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations

Eur Radiol (2008) 18: 15961603DOI 10.1007/s00330-008-0916-y HEPATOBILIARY-PANCREAS

Sung Ho Hwang Jeong-Sik Yu Jin Chung Jae-Joon Chung Joo Hee KimKi Whang Kim

Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations

Abstract The purpose of this study was to investigate the natural history of transcatheter arterial chemoembolization (TACE)-induced, transient hepatic attenuation difference (THAD). Among the patients who underwent TACE for treatment of hepatocellular carcinomas during a 32-month period, 32 patients with 40 newly developed THADs defined as localized, transient, peripheral hepatic parenchymal enhancement during the hepatic arterial phase of dynamic CT (axial dimension, 1.98.8 cm; mean,4.9 cm) in the vicinity of iodized-oil accumulation were subjected to a retrospective analysis of serial follow-up CT examinations. Among the 40 TACE-induced THADs, 18 (45%) and 9 (23%) were accompanied with arterial-portal venous fistula (APF) and portal venous stenosis (PVS), respectively, while 2 (5%) THADs showed both APF and PVS simultaneously. Thirty-eight (95%) THADs disappeared spontaneously during the fol-

low-up period (range, 426 months; mean, 9 months), and 11 (29%) of them showed progressive atrophy of the corresponding hepatic parenchyma. Regardless of the presence of APF, 10 (91%) of 11 THADs of following parenchymal atrophy had shown PVSs (P<0.001). During the long-term follow-up period after TACE, almost all of the TACE-induced THADs spontaneously disappeared and either had or did not have corresponding parenchymal atrophy, which is strongly related to the presence of PVS. Understanding the nature of these CT features would be helpful for radiologists in determining the prognosis of the TACE-induced hepatic injuries as well as in distinguishing them from the recurrent tumour.

Keywords Hepatocellular carcinoma . CT . Chemotherapeutic embolization

Received: 26 September 2007Revised: 20 December 2007Accepted: 6 January 2008Published online: 20 March 2008# European Society of Radiology 2008

S. H. Hwang . J.-S. Yu (*) . J. Chung .J.-J. Chung . J. H. Kim . K. W. Kim Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital,146-92 Dogok-Dong,Gangnam-Gu, Seoul, 135-720, Republic of Koreae-mail: [email protected].: [phone]Fax: [phone]

Introduction

The liver has a dual blood supply with compensatory relationships between the two inflows, the hepatic artery and portal vein. The transient hepatic attenuation difference (THAD) is defined as an area of parenchymal...