Transcatheter arterial chemoembolization (TACE) is the mainstay of treatment for unresectable hepatocellular carcinoma (HCC). Although various complications of TACE have been reported, cerebral lipiodol embolism after TACE is rare. We report a 67-year-old man, who had patent foramen ovale and developed cerebral lipiodol embolism after TACE via the inferior phrenic artery. At 20 months after third TACE of 3 cm sized HCC in the left hepatic lobe, computed tomography (CT) revealed about 1.6 cm newly developed HCC in the anterior superior segment of right hepatic lobe. The angiogram revealed the HCC was supplied from the right inferior phrenic artery. Toward the end of TACE, there were accumulations of the iodized oil in the pulmonary vasculature. Immediately after TACE, he complained of weakness in right upper and lower limbs and sensory decrease in right limbs and right hemitrunk. Magnetic resonance imaging revealed a cerebral lipiodol embolism. Transesophageal echocardiography revealed no visible thrombi but contrast-echocardiography using hand agitated saline revealed an intracardiac right to left shunt consistent with patent foramen ovale. Motor weakness and sensory decrease were gradually improved, and all neurological symptoms disappeared over 4 weeks.
Aged ; Carcinoma, Hepatocellular/complications/diagnosis/*therapy ; *Chemoembolization, Therapeutic ; Contrast Media/*adverse effects/diagnostic use ; Humans ; Intracranial Embolism/*diagnosis/*etiology/ultrasonography ; Iodized Oil/*adverse effects/diagnostic use ; Liver Neoplasms/complications/diagnosis/*therapy ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

The interaction between Lipiodol and cells was studied by treating Lipiodol in a human hepatocellular carcinoma cell line(Hep) and mouse fibroblast cell line (L929). Irregular, sustained radioactivity was released from both cell lines shortly after incubation in the radioiodinated Lipiodol mixed media. Lipiodol droplets were found to be firmly attached to the cells following the incubation and these cells were strongly positive for fat stains. The radioiodinated Lipiodol demonstrated the same behavior of accumulation within the cell and on the cell membrane. Although the amount of Lipiodol attached was almost equal in both of the cell lines, the final amount accumulated in the cells was larger in the Hep cells. The accumulation of Lipiodol within the cell and on the cell membrane may play a significant role for its selective targeting and its prolonged retention in the solid tumor.
Carcinoma, Hepatocellular/*pathology/therapy ; Human ; Iodine Radioisotopes/diagnostic use/therapeutic use ; Iodized Oil/pharmacokinetics/*pharmacology/therapeutic use ; Liver Neoplasms/*pathology/therapy ; Support, Non-U.S. Gov't ; Tumor Cells, Cultured/drug effects

OBJECTIVE: To assess the technical feasibility and local efficacy of biplane fluoroscopy plus US-guided percutaneous radiofrequency ablation (RFA) for viable hepatocellular carcinoma (HCC) around retained iodized oil after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Our prospective study was approved by our institutional review board and informed consent was obtained from all participating patients. For patients with viable HCC around retained iodized oil after TACE, biplane fluoroscopy plus US-guided RFA was performed. We evaluated the rate of technical success and major complications on a post-RFA CT examination and local tumor progression with a follow-up CT. RESULTS: Among 40 consecutive patients, 19 were excluded due to one of the following reasons: poorly visible HCC on fluoroscopy (n = 13), high risk location (n = 2), RFA performed under monoplane fluoroscopy and US guidance (n = 2), and poorly identifiable new HCCs on US (n = 2). The remaining 21 patients with 21 viable HCCs were included. The size of total tumors ranged from 1.4 to 5.0 cm (mean: 3.2 cm) in the longest diameter. Technical success was achieved for all 21 HCCs, and major complications were observed in none of the patients. During the follow-up period (mean, 20.3 months; range, 6.5-29.9 months), local tumor progression was found in two patients (2/21, 9.5%). Distant intrahepatic metastasis developed in 76.2% (16/21) of patients. CONCLUSION: When retained iodized oil around the tumor after TACE hampers the targeting of the viable tumor for RFA, biplane fluoroscopy plus US-guided RFA may be performed owing to its technical feasibility and effective treatment for viable HCCs.
Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/radiography/*surgery/therapy ; *Catheter Ablation ; *Chemoembolization, Therapeutic ; Complex Mixtures ; *Contrast Media ; Female ; *Fluoroscopy/methods ; Humans ; Iodized Oil/*administration & dosage ; Iohexol/analogs & derivatives/diagnostic use ; Liver Neoplasms/radiography/*surgery/therapy ; Male ; Middle Aged ; *Ultrasonography, Interventional

OBJECTIVE: The conventional method of dividing hepatic segment 2 (S2) and 3 (S3) is subjective and CT interpretation is unclear. The purpose of our study was to test the validity of our hypothesis that the actual plane dividing S2 and S3 is a vertical plane of equal distance from the S2 and S3 portal veins in clinical situations. MATERIALS AND METHODS: We prospectively performed thin-section iodized-oil CT immediately after segmental chemoembolization of S2 or S3 in 27 consecutive patients and measured the angle of intersegmental plane on sagittal multiplanar reformation (MPR) images to verify its vertical nature. Our hypothetical plane dividing S2 and S3 is vertical and equidistant from the S2 and S3 portal veins (vertical method). To clinically validate this, we retrospectively collected 102 patients with small solitary hepatocellular carcinomas (HCC) on S2 or S3 the segmental location of which was confirmed angiographically. Two reviewers predicted the segmental location of each tumor at CT using the vertical method independently in blind trials. The agreement between CT interpretation and angiographic results was analyzed with Kappa values. We also compared the vertical method with the horizontal one. RESULTS: In MPR images, the average angle of the intersegmental plane was slanted 15 degrees anteriorly from the vertical plane. In predicting the segmental location of small HCC with the vertical method, the Kappa value between CT interpretation and angiographic result was 0.838 for reviewer 1 and 0.756 for reviewer 2. Inter-observer agreement was 0.918. The vertical method was superior to the horizontal method for localization of HCC in the left lobe (p < 0.0001 for reviewers 1 and 2). CONCLUSION: The proposed vertical plane equidistant from S2 and S3 portal vein is simple to use and useful for dividing S2 and S3 of the liver.
Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Antibiotics, Antineoplastic/administration & dosage ; Carcinoma, Hepatocellular/blood supply/radiography/therapy ; Chemoembolization, Therapeutic ; Contrast Media ; Doxorubicin/administration & dosage ; Female ; Humans ; Iodized Oil/diagnostic use ; Liver/*blood supply/*radiography ; Liver Neoplasms/blood supply/radiography/therapy ; Male ; Middle Aged ; Prospective Studies ; Registries ; Retrospective Studies ; *Tomography, Spiral Computed