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Background: Transcatheter arterial chemoembolization (TACE) is a dedicated method for treating intermediate stage hepatocellular carcinoma (HCC). The Lipiodol used in conventional TACE presents the advantage of being easily visualized and quantified on Computed Tomography (CT). Methods: Immediate postprocedural (baseline) and follow-up CT examinations of twenty patients treated by TACE for HCC were evaluated in this study. Lipiodol uptake on baseline images and progressive washout on follow-up examinations were assessed. Results: Statistically significant lower baseline Lipiodol densities are found in patients that develop tumoral recurrence at some point on follow-up examinations (p=0.0280). Using the treated nodule density as a predictive factor for tumoral recurrence, we obtained a diagnostic sensitivity of 92.31% in patients with cut-off values ≤ 545.36 HU, albeit with a low specificity. All patients develop a quantifiable Lipiodol density decrease over time, regardless of tumoral recurrence implication (p=0.0298). There is evidence to suggest that specific Lipiodol accumulation patterns may be associated with a higher risk of tumor recurrence. Conclusions: Baseline post-procedural Lipiodol accumulation levels may serve as a predictor for tumoral recurrence in patients treated for HCC using TACE, with good sensitivity provided a high cut-off value is set for the measured densities.

surgery, gastroenterology and oncology

Lipiodol Uptake and Wash-out Rate Detection on Computed Tomography as Predictors for Tumor Recurrence in Hepatocellular Carcinoma Treated by Transcatheter Arterial Chemoembolization