Transarterial Bleomycin-Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma. Cardiovasc Intervent Radiol. 2018;41:1674-1682. [PMID: 29922860 DOI: 10.1007/s00270-018-2010-4]

Transcatheter Arterial Embolization with Bleomycin-Lipiodol of Hepatic Hemangiomas: Safety, Efficacy and Predictors of Response

PURPOSE

To evaluate the safety, efficacy and predictors of response of transcatheter arterial embolization (TAE) to treat hepatic hemangiomas (HHs).

MATERIALS AND METHODS

A retrospective analysis was conducted of consecutive HH patients who received TAE with bleomycin-Lipiodol emulsion and gelatin sponge particles at three institutions from January 2014 to January 2021. TAE effectiveness was defined as more than 50% reduction of tumor volume. The effectiveness, safety, and CT changes of hemangiomas after TAE were assessed. Factors affecting TAE efficacy on tumor size were analyzed with logistic regression analysis.

RESULTS

A total of 102 patients with 109 HHs were included. After treatment, both the tumor diameter and volume were significantly reduced from 8.5 ± 3.9 to 5.9 ± 3.8 cm (P < 0.001) and 412.6 ± 742.3 cm3 to 102.0 ± 232.7 cm3 (P < 0.001), respectively. TAE effectiveness was achieved in 80.7% (88/109) of hemangiomas, which was characterized by progressive reduction in tumor volume over time with Lipiodol retention. Atypical enhancement pattern (tiny enhancing dots in the hepatic arterial and portal venous phase) (p = 0.001) and central arterioportal shunt (APS) (p = 0.002) associated with the tumor were independent predictors of TAE ineffectiveness. Postembolization syndrome and transient increase in liver enzymes were common without severe complications and death.

CONCLUSION

TAE was safe and effective in reducing HH size. Lesion enhancement pattern and APS type were associated with TAE efficacy on tumor shrinkage.

LEVEL OF EVIDENCE

Level 3, non-controlled retrospective cohort study.

Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness

This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin-lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin-lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies.

Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas

Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin-lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7-20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin-lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition.

Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients

BACKGROUND

To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH).

METHODS

This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7 cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated.

RESULTS

Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5 cm to 1.9 cm (P < 0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients.

CONCLUSIONS

TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.

Computed Tomography Fluoroscopy-Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma

PURPOSE

To determine the safety and efficacy of computed tomography (CT) fluoroscopy-guided percutaneous transhepatic sclerotherapy with a bleomycin/ethiodized oil emulsion for symptomatic giant hepatic hemangiomas.

MATERIALS AND METHODS

The procedure was performed on 22 patients with symptomatic giant hepatic hemangiomas in an outpatient setting between 2018 and 2020. All patients were followed clinically and underwent contrast-enhanced magnetic resonance imaging after 1 month and again at a mean time of 15 months ± 2. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0), in which a severe adverse event was defined as an adverse event with a grade of ≥3. The desired radiologic response (volume and index size) and improvement of pain intensity (visual analog scale [VAS]) and other symptoms were recorded as outcomes.

RESULTS

Overall, patients showed a 36.4% ± 8.6 reduction in volume and a 14% ± 1.6 reduction in index size after 1 month, with P values of .002 and .001, respectively. The final follow-up volume and index size were 194.7 cm³ ± 25.8 and 77 mm ± 36, respectively. Moreover, a 53.0% ± 7 reduction in volume and 22% ± 3.7 reduction in index size during the final imaging were reported, with the P values of .001 and .001, respectively. Significant reductions in the mean pain intensity (90% of patients with lower VAS scores after intervention) and symptoms were reported. Four patients were classified as clinically unsuccessful, and were recommended further procedures for residual pain.

CONCLUSIONS

CT fluoroscopy-guided transhepatic sclerotherapy is an effective, safe, and minimally invasive method to manage giant hepatic hemangiomas in an outpatient setting.

Medium and Long-Term Outcome of Superselective Transcatheter Arterial Embolization with Lipiodol-Bleomycin Emulsion for Giant Hepatic Hemangiomas: Results in 241 Patients

Purpose: To evaluate the medium and long-term efficacy of superselective transcatheter arterial embolization (TAE) with lipiodol−bleomycin emulsions (LBE) for giant hepatic hemangiomas. Methods: A total of 241 patients who had underwent TAE with LBE for hepatic hemangiomas from January 2010 to December 2016 were retrospectively reviewed. Blood tests were performed 3 and 7 days after TAE and procedural-related complications were recorded. The patients were followed up by enhanced CT or MRI imaging at 6, 12, 36, and 60 months post-TAE, respectively. Technical success of TAE was defined as successful embolization of all identifiable arteries supplying to the hemangiomas. Clinical success was defined as improvement of the abdominal symptoms and indications on the imaging examinations that the hemangiomas had decreased by more than 50% in maximum diameter. Results: TAE was performed successfully in all patients without serious complications. Improvement of the abdominal symptoms was recorded in 102/102 cases (100%). The reduction rate of the tumor maximum diameter with >50% at 6, 12, 36, and 60 months was 88.1% (190/210), 86.7% (170/196), 85.2% (124/142), and 86.5% (45/52), respectively. There was a significant change from pre-TAE to follow-up values in maximum diameter (p < 0.05). Conclusion: TAE with LBE was feasible and effective for giant hepatic hemangiomas. The reductions of the tumor maximum diameter with >50% at medium (≥3 years) and long-term (≥5 years) follow-up were satisfactory, with 85.2% and 86.5%, respectively.

Long-term outcomes of transarterial embolization with lipiodol-bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score-matched analysis

OBJECTIVES

To compare the efficacy of transarterial embolization (TAE) with polyvinyl alcohol (PVA) particles alone and lipiodol-bleomycin emulsion (LBE) plus PVA particles for patients with unresectable large symptomatic focal nodular hyperplasia (FNH).

METHODS

We performed a retrospective analysis of patients who underwent TAE either with PVA particles alone (group A, n = 46) or LBE plus PVA particles (group B, n = 35) for large (≥ 7 cm) symptomatic FNH between January 2002 and February 2019. Propensity score matching (PSM) (1:1) was performed to adjust for potential baseline confounders. Technical success, adverse events (AEs), symptom relief, and changes in the lesion size after TAE were evaluated. Statistical analysis included Wilcoxon rank sum test and χ² test.

RESULTS

After PSM, no significant differences in baseline characteristics were found between the groups (31 in group A and 31 in group B, with a mean age of 31 years). Technical success was achieved in all patients (100%), without major AEs in both groups. Complete resolution of the abdominal symptoms was reported in 77.4% in group A and 100% in group B (p = 0.037) during a mean follow-up period of 72 months; complete resolution (CR) of the FNH rate was significantly higher in group B than in group A (93.6% vs. 67.7%; p = 0.019).

CONCLUSION

Compared with the use PVA particles alone, TAE with LBE plus PVA particles in the treatment of patients with large symptomatic FNH had a significantly higher rates of CR of the FNH and complete relief of the symptoms.

KEY POINTS

• Transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus PVA particles for the large symptomatic FNH yielded better results than with PVA particles alone, in terms of complete resolution of FNH lesions (93.6% vs 67.7%) and complete relief of the abdominal symptoms (100% vs 77.4%) during a mean follow-up period of 72 months (38-170 months). • No major complications were recorded in both groups, and no significant difference in the incidence of postembolization syndrome were observed between the two groups.

Ultrasound-guided percutaneous sclerotherapy versus surgical resection in the treatment of large hepatic hemangiomas: a retrospective study

BACKGROUND

It is no consensus on the best management for patients with large hepatic hemangiomas. This study was designed to evaluate the efficacy and safety of percutaneous sclerotherapy compared to surgical resection for large hepatic hemangiomas.

METHODS

A total of 89 patients with large hepatic hemangiomas from single center underwent either percutaneous sclerotherapy (n = 14) or surgical resection (n = 75) as first-line treatment was retrospectively studied, followed up for 9-24 months using ultrasound. Terms of intraoperative and postoperative information, postoperative complications, and treatment effectiveness were compared between the two groups.

RESULTS

Percutaneous sclerotherapy had shorter operative time (p < 0.001), less blood loss, lower rate of prophylactic abdominal drainage (97.3% vs. 0%, p < 0.001), fewer minor complications (48.0% vs. 7.1%, p < 0.01), shorter hospital stay (p < 0.001), lower hospital cost (p < 0.001), higher Alb level (p < 0.001) and lower postoperative clinical index including ALT, AST and WBC (p < 0.001 for both) than did surgical resection. The major complications were demonstrated no significant difference between the two groups. In addition, the mean maximum cross-sectional areas of hemangioma dropped from 5044.1 ± 2058.0 mm² to 1924.6 ± 1989.5 mm² (65.2% reduction) during 9-24 months follow-up (p < 0.001) in the percutaneous sclerotherapy group, while all patients in the surgical resection group achieved complete response.

CONCLUSION

Percutaneous sclerotherapy is the preferred method for the treatment of large hepatic hemangioma over surgical resection when compared with the items of postoperative recovery, blood loss, complications, hospital stays, and lower hospital costs. The reduction of the maximum cross-sectional area of hepatic hemangioma in the percutaneous sclerotherapy group is satisfactory.

A Nomogram Model for Predicting the Response to Transcatheter Arterial Embolization in Patients With Symptomatic Hepatic Hemangioma

Background: Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma.

Methods: We retrospectively studied 276 patients treated with TAE for hepatic hemangioma at our center from January 2011 to December 2019. The full cohort was randomly divided into training and validation cohorts. After assessing the potential predictive factors for the efficacy of TAE in the training cohort, a nomogram model was established and evaluated by discrimination and calibration.

Results: During follow-up, the symptom relief rate was 100%. The tumor blood supply (p < 0.001), tumor number (p = 0.004), and tumor size (p = 0.006) were identified as significant predictors of the failure of tumor shrinkage in response to TAE. The nomogram model showed favorable discrimination and calibration, with a C-index of 0.775 (95% CI, 0.705–0.845) in the training cohort, which was further confirmed in the validation cohort (C-index 0.768; 95% CI, 0.680–0.856). The side effects of TAE were relatively minor and included mainly abdominal pain, nausea, vomiting, fever, and the presence of elevated hepatic transaminases.

Conclusion: TAE is a safe and effective treatment for symptomatic hepatic hemangioma. The established nomogram performed well for the estimation of the effect of TAE in patients with hepatic hemangioma and can facilitate the selection of patients who would benefit most from the treatment.

Giant Hepatic Hemangioma Regressed Significantly Without Surgical Management: A Case Report and Literature Review

Hepatic hemangioma (HH) is a congenital vascular anomaly comprising networks of abnormal blood and/or lymphatic vessels with endothelial cell proliferation. Their pathophysiology is not fully understood, and no specific drug is available to treat them. Conservative management, which limits observation, is preferred for most patients. A HH larger than 4 cm is considered a giant HH that may be treated using surgery ranging from embolization to hepatic resection or liver transplantation. Here, we describe a case with multiple and giant HHs that regressed significantly after treatment with azithromycin (AZM). A systematic literature review of HH and the effects of AZM on angiogenesis was then conducted.

Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma

Background Percutaneous sclerotherapy with bleomycin has been proven to have a potential benefit in the management of low-flow venous malformations. Liver hemangiomas are considered low-flow venous malformations. Thus, percutaneous sclerotherapy could potentially have a promising result in their management. Purpose To investigate the feasibility, efficacy, and safety of percutaneous sclerotherapy with bleomycin in the management of symptomatic giant liver hemangioma (GLH). Materials and Methods This single-institute prospective study was conducted between September 2018 and July 2020. Percutaneous sclerotherapy was performed using a mixture of bleomycin and ethiodized oil under guidance of US and fluoroscopy in participants with GLH who were experiencing related abdominal pain or fullness. Technical success was recorded. Change in symptom severity, according to visual analog scale (VAS), was considered the primary outcome of the study. Volume change, based on the lesion volume at CT, and complications, based on the classification of the Society of Interventional Radiology, were regarded as secondary outcomes. The primary and secondary outcomes were recorded 6 and 12 months after the procedure. Comparison was performed by using the Wilcoxon signed-rank test or paired t test. Results Twenty-eight participants (mean age, 45 years ± 9; 25 women) were evaluated. Technical success was 100%. The mean VAS score was 8.3 before the procedure, which decreased to 1.4 (84.7% reduction) and 1.5 (83.5% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). All participants reported relief of symptoms (17 of 28 participants [61%] with complete relief; 11 [39%] with partial relief) at 12-month follow-up. Mean GLH volumes dropped from 856.3 cm³ to 309.8 cm³ (65.7% reduction) and 206.0 cm³ (76% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). No major complications were detected. Conclusion Percutaneous sclerotherapy is a safe and feasible method with promising results in the treatment of patients with symptomatic giant liver hemangioma. Clinical trial registration no. NCT03649113 © RSNA, 2021 See also the editorial by McGahan and Goldman in this issue.

Laparoscopy-guided percutaneous microwave ablation for symptomatic 12.8 cm hepatic hemangioma with low blood loss and short hospital stay post-operation: A case report and literature review

We described a patient with symptomatic giant hepatic hemangioma (GHH) treated with laparoscopic guided percutaneous microwave ablation (MWA). A 58 years' old woman was referred to our hospital who presented with upper abdominal distension and appetite loss for more than 1 year. The medical history included untreated multiple hepatic hemangiomas (HH) that had been detected 13 years ago and hypertension for more than 12 years. Initial laboratory tests revealed D-dimer mild increase and negative tumor markers. Magnetic resonance (MR) imaging demonstrated multiple nodules of different sizes in the liver and the largest lesion was located on the left lobe (longest diameter 12.8 cm), which replaced the whole enlarged left lobe and compressed the gastric body and inferior vena cava. Contrast-enhanced ultrasound (CEUS) and contrast-enhanced MR imaging both showed the typical enhancement pattern of hemangioma and abnormal perfusion was seen in the surrounding liver parenchyma. With the laparoscopy guidance, we performed microwave ablation till the whole tumor was seen atrophy. The total operation duration was 2 hours, with intra-operative blood loss less than 20 ml. The post-operative course was uneventful. The patient was discharged 3 days after the operation. Abdominal distension decreased, appetite improved, blood pressure controlled at normal level after the operation. MR revealed significant volume reduction of the tumor after the operation.

Bland Embolization of Benign Liver Tumors: Review of the Literature and a Single Center Experience

Transarterial embolization has shown promise as a safe, effective, and less invasive treatment modality for benign liver lesions (hemangioma, focal nodular hyperplasia (FNH), and hepatic adenoma (HA)) with fewer complications compared to surgical intervention. There is no consensus regarding the most appropriate embolization material(s) for the treatment of benign liver tumors. The purpose of this study was to review the current literature regarding the transarterial embolization of benign liver tumors and to share our single center experience. This was a non-blinded, retrospective, single-institution review of the bland embolization of benign liver tumors. Clinical data and imaging before and after embolization were used to evaluate lesion response to transarterial embolization. Twelve patients were included in the study. Five patients with six hemangiomas were treated. Pain was a presenting complaint in all five of these patients. The median change in tumor volume was −12.4% and ranged from −30.1% to +42.3%. One patient with two FNH lesions was treated, and both lesion volumes decreased by more than 50%. Six patients with 10 adenomas were treated. Pain was a presenting complaint in three patients, and five patients had a lesion >5 cm. The median change in tumor volume was −67.0% and ranged from −92.9% to +65.8%. Bland transarterial embolization of liver hemangiomas, FNH, and HA can be an effective and minimally invasive treatment modality to control the size and/or symptoms of these lesions. There is a variable response depending on tumor type and the embolization materials used.

Transarterial Embolization in Neonatal Kasabach-Merritt Syndrome

Background: Kasabach-Merritt syndrome (KMS) is characterized by large hemangiomas and persistent thrombocytopenia, which may result in visceral hemorrhage and disseminated intravascular coagulation. This study aimed to evaluate the value of transarterial embolization (TAE) in neonatal KMS patients. Patients and Methods: The clinical course of 11 neonates with KMS who underwent TAE in the Department of Neonatology, Anhui Provincal Children's Hospital, Anhui Medical University, China, were reviewed retrospectively. Results: Eleven neonates with KMS (nine male and two female) were admitted to our hospital between the age of 1 h and 6 days. All were born with progressively enlarged hemangiomas and persistent thrombocytopenia. The largest lesion had its maximum size reached at 15 × 8 × 8 cm. Eight patients had cutaneous hemangiomas (1 right face, one oropharynx, one left upper arm, two back, one left lumbar, one right lower leg, and one right thigh), and three patients had liver hemangiomas. All 11 patients underwent TAE. Nine patients underwent two TAEs, and two patients underwent only one embolization procedure. They all obtained >80% devascularization of their lesions without a major complication. The platelet count increased at 2-5 days after treatment and reached normal count and coagulation profile at 18-28 days after the TAE. Conclusions: TAE is a safe and effective alternative therapy for neonatal KMS patients.

Effectiveness of Transarterial Embolization in Treatment of Symptomatic Hepatic Hemangiomas: Systematic Review and Meta-analysis

PURPOSE

To evaluate the current evidence for the effectiveness of transarterial embolization (TAE) in treatment of symptomatic hepatic hemangiomas.

MATERIALS AND METHODS

A systematic literature review was conducted in PubMed, CINAHL and Scopus databases to identify studies of hepatic hemangiomas treated with transarterial embolization. Main outcome was defined as the mean difference between pre- and post-TAE hemangioma diameters. Treatment agents were categorized as Lipiodol based [bleomycin (L + BE), pingyangmycin (L + PYG) or ethanol (L + ethanol)] and non-Lipiodol based (polyvinyl-alcohol-only). Conventional random-effect meta-analysis technique was applied to analyze data.

RESULTS

Of 3080 initially inspected publications, 21 studies were included in the meta-analysis comprising of 1450 patients with total of 1871 hemangiomas (36.2% male, mean age: 46.3 ± 3.6 years). One hundred and twenty-six, 1666, 41 and 38 lesions were treated with L + BE, L + PYG, L + ethanol and PVA, respectively. Median follow-up time after embolization was 12 months. Lipiodol-based treatments showed significant effect in reducing hemangioma size after TAE compared to PVA (P < 0.001). Pooled diameter reduction (cm) (95% confidence interval) was - 4.37( - 5.32, - 3.42), - 4.70( - 5.70, - 3.71), - 0.93( - 2.02, 0.16) for overall TAE treatment, Lipiodol-based and non-Lipiodol-based treatments, respectively. Main complications included post-embolization syndrome and transient liver enzyme elevation (pooled incidence for Lipiodol-based and non-Lipiodol-based techniques: 36% and 33%; and 37% and 0, respectively). No fatal complications were reported. Symptomatic improvement was reported in 63.3%-100% of the cases with majority of studies (15/21) reporting improvement in all cases (pooled response rate: 98%).

CONCLUSIONS

Transarterial embolization with bleomycin, pingyangmycin or ethanol in combination with Lipiodol is safe and associated with reduced size of hemangiomas resulting in symptoms alleviation.

Hepatic hemangioma: What internists need to know

Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. This tumor arises from a vascular malformation; however, the pathophysiology has not been clearly elucidated. Symptoms usually correlate with the size and location of the tumor. Less commonly the presence of a large HH may cause life-threatening conditions. The diagnosis can be established by the identification of HH hallmarks in several imaging studies. In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause. In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques. Progression of the tumor is seen in less than 40%. Hormone stimulation may play a role in HH growth; however, there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence. When clinicians encounter this condition, they should discern between observation and surgical or non-surgical management based on the clinical presentation.

Hepatic hemangioma with arterioportal shunt: Prevalence and lesion characteristics based on DSA, CT and MR imaging

PURPOSE

To evaluate the prevalence and lesion characteristics of hepatic hemangioma (HH) with arterioportal shunt (APS) based on digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR) imaging.

METHOD

Ninety-eight consecutive patients with 189 HHs who underwent DSA, CT and/or MR imaging of the liver between January 2014 and December 2017 were included. The diagnosis of APS was established by DSA. APS was categorized as peripheral and central shunt based on imaging findings. The incidence and appearance of APS on DSA were compared with those on CT/MR images. Eleven possible lesion characteristics associated with APS were compared between HHs with and those without APS. Multiple logistic regression modeling was used to identify the independent lesion characteristics associated with APS.

RESULTS

APS was diagnosed in 103 (103/189, 54.5%) HHs on DSA, of which 96 lesions appeared as peripheral APS and 7 appeared as central. In contrast, APS was detected only in 57 HHs (57/103, 55.34%) on CT/MR imaging, of which 50 (50/96, 52.08%) appeared as peripheral APS while 7 (7/7, 100%) appeared as central. Lesion size (P <  .001), enhancement rapidity (P =  .031), and vascularization degree (P <  .001) were found to be significant independent imaging characteristics associated with APS.

CONCLUSIONS

APS can occur in HH with high frequency. DSA was superior to CT/MR imaging in detection of APS, particularly for the peripheral APS. Lesion size, enhancement rapidity and vascularization degree were associated with the presence of APS.

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate -Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience

AIMS

To evaluate the therapeutic effect and safety of transarterial embolisation using a bleomycin-Lipiodol mixture and N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture (BNL) for the treatment of polycystic liver disease (PLD).

MATERIALS AND METHODS

From June 2012 to July 2018, a total of consecutive 14 symptomatic patients (13 women and 1 man; mean age, 49.3±9.9 years) with PLD were referred and underwent transcatheter arterial embolisation (TAE) with BNL.

RESULTS

Technical success was achieved in all cases. PLD-related severe symptoms were improved remarkably in 13 of the treated patients. The mean maximum abdominal circumference decreased significantly from 100.6±9.4 to 94.9±9.1 cm (p<0.01). The total liver volume decreased significantly compared with pre-TAE in 13 patients at 6-12 months after TAE. It decreased from 9,776±2,219 to 8,303±2,009 cm³ (p<0.01). There were no major complications associated with the procedure.

CONCLUSION

TAE with the bleomycin-Lipiodol mixture and NBCA-Lipiodol mixture may be an effective method for treating symptomatic PLD patients, with improvement of symptoms and shrinkage of cyst volume.

Invasive management of symptomatic hepatic hemangioma

Hepatic hemangioma is common among benign liver tumors and usually grows slowly. About 50-70% of hepatic hemangiomas are asymptomatic, and management is not necessary; however, management should be considered in symptomatic patients. The optimal management of symptomatic hepatic hemangioma depends on multiple factors. Invasive management of symptomatic hepatic hemangioma mainly consists of surgery and interventional radiology, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy. Although both surgery and interventional radiology are promising in the management of symptomatic hepatic hemangioma, multiple and/or giant hemangiomas represent a clinical dilemma because the complication rate and recurrence rate are relatively high, and symptom relief is not always achieved. However, a review of recent advances in treatment is lacking. We therefore summarized the current invasive management techniques for symptomatic hepatic hemangioma to potentially facilitate clinical decision-making.

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Background

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