Imaging description

Figure 40.1 depicts an axial MR image obtained in a 17-year-old female with autoimmune hepatitis. On biopsy, the mass in segment 6/7 was consistent with a well-differentiated hepatocellular carcinoma. The patient also had a solitary pulmonary nodule that on resection was consistent with a metastasis from the hepatic primary. Full workup indicated the presence of cirrhosis, portal hypertension, and decreased liver function that precluded operative resection of the tumor. Her metastasis disqualified her from orthotopic liver transplantation. Interventional radiology was consulted to perform transarterial hepatic chemoembolization (TACE) to slow the growth of the primary neoplasm. At angiography, the patient’s segment 6/7 tumor was supplied largely by branches of the right hepatic artery that were embolized to stasis with a cisplatin–doxorubicin–Lipiodol mixture. Following each of three TACE procedures over a 12-month period, the patient continued to have a portion of the tumor that failed to accumulate Lipiodol and thus remained untreated (Fig. 40.2). At a fourth TACE procedure, a right inferior phrenic arteriogram was performed (Fig. 40.3). A 2.7-French microcatheter was advanced into the ectatic, tortuous branch of the right inferior phrenic artery shown to supply the tumor, and TACE was performed. A Dyna-CT scan (Siemens Medical Solutions USA, Malvern, PA) performed immediately after TACE treatment demonstrated dense Lipiodol accumulation within the previously untreated portion of the tumor (Fig. 40.4).