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Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Usefulness of Coded Phase-Inversion Harmonic Sonography

Yasunori Minami1, Masatoshi Kudo1, Toshihiko Kawasaki1, Masayuki Kitano1, Hobyung Chung1, Kiyoshi Maekawa2 and Hitoshi Shiozaki3

1 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511 Japan.
2 Abdominal Ultrasound Unit, Kinki University School of Medicine, Osaka-Sayama, 589-8511, Japan.
3 First Department of Surgery, Kinki University School of Medicine, Osaka-Sayama, 589-8511, Japan.



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  		Fig. 1A. —Hepatocellular carcinoma in 70-year-old woman treated with transcatheter arterial chemoembolization. Phase-inversion sonography displays viable tumor that was not depicted on CT. Transverse CT scan obtained 7 days after chemoembolization shows iodized oil almost totally filling tumor (arrow) in segment VI of liver.

 


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  		Fig. 1B. —Hepatocellular carcinoma in 70-year-old woman treated with transcatheter arterial chemoembolization. Phase-inversion sonography displays viable tumor that was not depicted on CT. Transverse vascular phase sonogram obtained on same day as A reveals tumor with abundant parenchymal blood flow (arrow).

 


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  		Fig. 2A. —58-year-old man with hepatocellular carcinoma after transcatheter arterial chemoembolization. Transverse T1-weighted MR image obtained before bolus injection of gadolinium chelate 7 days after chemoembolization shows spotty high intensity (arrow) in otherwise hypointense tumor.

 


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  		Fig. 2B. —58-year-old man with hepatocellular carcinoma after transcatheter arterial chemoembolization. Transverse T1-weighted dynamic MR image shows nonenhancing area in tumor. High-intensity band (arrow) in nodule indicates fibrous septum of hepatocellular carcinoma.

 


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  		Fig. 2C. —58-year-old man with hepatocellular carcinoma after transcatheter arterial chemoembolization. Unenhanced transverse sonogram obtained 8 days after chemoembolization shows large hyperechoic lesion with unclear margin (circle) in segment VIII of liver. A = measurement software symbol.

 


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  		Fig. 2D. —58-year-old man with hepatocellular carcinoma after transcatheter arterial chemoembolization. Transverse interval-delay sonogram obtained in early arterial phase shows blood flow (arrows) in tumor.

 


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  		Fig. 2E. —58-year-old man with hepatocellular carcinoma after transcatheter arterial chemoembolization. Transverse interval-delay sonogram clearly shows partial enhancement (arrow) in nodule.

 


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  		Fig. 3A. —52-year-old man with 5-cm hepatocellular carcinoma in segment IV of liver that was treated with transcatheter arterial chemoembolization. Transverse interval-delay sonogram obtained shortly after chemoembolization clearly shows vessel-like structure (arrow) in nodule.

 


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  		Fig. 3B. —52-year-old man with 5-cm hepatocellular carcinoma in segment IV of liver that was treated with transcatheter arterial chemoembolization. Transverse arterial phase dynamic CT scan obtained 6 days after chemoembolization shows nonenhancing area in tumor.

 


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  		Fig. 3C. —52-year-old man with 5-cm hepatocellular carcinoma in segment IV of liver that was treated with transcatheter arterial chemoembolization. Conventional CT scan obtained 2 months after chemoembolization clearly shows defect of iodized oil accumulation (arrow) in tumor.

 


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  		Fig. 3D. —52-year-old man with 5-cm hepatocellular carcinoma in segment IV of liver that was treated with transcatheter arterial chemoembolization. Arterial phase dynamic CT scan obtained at same time as C clearly shows partially enhancing area (arrow) corresponding to area lacking iodized oil accumulation.

 

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