Transcatheter arterial embolisation in four dogs with hepatocellular carcinoma

Four dogs with hepatocellular carcinoma were treated by transcatheter arterial embolisation. In all dogs, the tumour-supplying arteries were selectively embolised with gelatine sponge particles. Post-embolisation tumour volumes decreased relative to pre-embolisation volumes in all dogs. No adverse reactions were observed in three dogs after treatment but one dog showed pancreatitis. These results suggest that transcatheter arterial embolisation is a feasible treatment for dogs with hepatocellular carcinoma.

Iodized Oil in the Portal Vein after Arterial Chemoembolization of Liver Metastases — A Caution regarding Hepatic Necrosis

Of 20 patients with hepatic metastases from colorectal cancer treated by arterial chemoembolization, 4 showed iodized oil in peripheral branches of the portal vein. Aseptic necrosis of both the tumor and normal parenchyma in corresponding liver segments developed in 2 of these patients. They were successfully treated with antibiotics and percutaneous drainage. In the 2 remaining patients, the procedure was interrupted before complete arterial occlusion when oil was detected in the portal vein on fluoroscopy, and there was no complication. Appearance of iodized oil in the portal vein during arterial chemoembolization of colorectal liver metastases is an unfavorable event signaling the risk of liver necrosis.

Transcatheter arterial chemoembolization of hepatocellular carcinoma: usefulness of coded phase-inversion harmonic sonography

OBJECTIVE

The purpose of our study was to assess the value of coded phase-inversion harmonic sonography performed approximately 1 week after the patients had undergone transcatheter arterial chemoembolization with iodized oil for hepatocellular carcinoma.

SUBJECTS AND METHODS

We studied 40 patients with 44 nodules measuring 1.5-11.0 cm in diameter (mean +/- SD, 3.9 +/- 2.0 cm) who underwent transcatheter arterial chemoembolization. Coded phase-inversion harmonic sonography, a technique based on a combination of phase-inversion harmonics and coded technology, was performed with a contrast agent approximately 1 week after chemoembolization. The results were compared with those obtained using dynamic CT (n = 44 lesions) and dynamic MR imaging (n = 20 lesions). We also evaluated the recurrence of hepatocellular carcinoma during clinical follow-up in 17 patients who did not undergo additional local therapy.

RESULTS

The detection rates of intratumoral vascularity of coded phase-inversion harmonic sonography, dynamic CT, and dynamic MR imaging were, respectively, 38 (86%) of 44 lesions, 19 (43%) of 44 lesions, and 10 (50%) of 20 lesions. Of 19 nodules of hepatocellular carcinoma treated only by transcatheter arterial chemoembolization, 17 nodules showed enhancement on coded phase-inversion harmonic sonography, suggesting incomplete responses. In all 17 nodules, apparent recurrence was noted on dynamic CT during clinical follow-up, even in nodules that had been observed to be completely filled with iodized oil 1 week after the chemoembolization.

CONCLUSION

We found coded phase-inversion harmonic sonography to be highly sensitive and accurate for evaluating the treatment response in patients with hepatocellular carcinoma even shortly after treatment. Consequently, it allows early recognition of the need for additional local ablation therapy and estimation of the risk of hepatocellular carcinoma recurrence.

Liver VIPoma: report of two cases and literature review

Two cases of neuroendocrine tumor in the liver, positive for VIP, without evidence of a primary tumor outside the liver is presented. One patient had a VIPoma syndrome with diarrhea, hypokalemia, and hypercalcemia, all symptoms were reversible after treatment consisting of somatostatin analogue and arterial liver embolization followed by liver resection. The other patient showed no endocrine symptoms. To the best of our knowledge, VIPomas apparently primary in the liver have not been previously described.