Abstract No. 386: Contrast retention in HCC on non contrast CT scans immediatly post TACE with DEB (2011)

PurposeDrug-eluting beads (DEB) for TACE are being used for the management of HCC. The beads are mixed with chemo and contrast. There has not been a definitive way of evaluating the success of the procedure until f/u imaging or explant results have been obtained. We perform non-contrast CT scans immediately post TACE to look for contrast retention in the tumor. We report the different patterns noted in 82 consecutive patients and suggest the possible significance of these findings.Materials and MethodsIRB approval was obtained for this retrospective review. 82 patients with 183 focal lesions consistent with HCC by imaging criteria were included. Infiltrative lesions and cases where CT was not obtained within 6 hours of TACE were excluded. Contrast retention was assessed to be present in the lesion both by subjective radiologist observation and by using statistically significant increase in the maximum HUs within the lesion as compared to surrounding liver tissue.ResultsRadiologists interpreted uptake in 139/183 (76%). Other than some contrast noted in vessels, very little if any contrast was noted in surrounding non-tumor liver. Four patterns were noted: 1) “Whole lesion” (dense uptake throughout lesion)-19 lesions, 2) “pacman” (dense uptake except for a portion of the lesion)-108 lesions, 3) “ringlike” (peripheral uptake-non centrally)-12 lesions, 4) no uptake-44 lesions. Of significance, 13 additional lesions (focal areas that retained contrast) were noted that were not suspected on the pre TACE imaging and in retrospect were likely HCCs. When no uptake was seen or when portions did not retain contrast we hypothesized that either the lesion or portion of the lesion was not targeted, was atypical with a poor vascular supply or did not opacify due to other technical factors. These tumors are being followed and long term results based on the post TACE CT will be reported separately.ConclusionNon contrast CT post TACE with DEB demonstrates contrast accumulation in over 75% of cases without accumulation in the adjacent liver parenchyma. This information may prove to be useful in determining if the lesion was adequately treated or if early repeat TACE is indicated to search for additional vascular supply. PurposeDrug-eluting beads (DEB) for TACE are being used for the management of HCC. The beads are mixed with chemo and contrast. There has not been a definitive way of evaluating the success of the procedure until f/u imaging or explant results have been obtained. We perform non-contrast CT scans immediately post TACE to look for contrast retention in the tumor. We report the different patterns noted in 82 consecutive patients and suggest the possible significance of these findings. Drug-eluting beads (DEB) for TACE are being used for the management of HCC. The beads are mixed with chemo and contrast. There has not been a definitive way of evaluating the success of the procedure until f/u imaging or explant results have been obtained. We perform non-contrast CT scans immediately post TACE to look for contrast retention in the tumor. We report the different patterns noted in 82 consecutive patients and suggest the possible significance of these findings. Materials and MethodsIRB approval was obtained for this retrospective review. 82 patients with 183 focal lesions consistent with HCC by imaging criteria were included. Infiltrative lesions and cases where CT was not obtained within 6 hours of TACE were excluded. Contrast retention was assessed to be present in the lesion both by subjective radiologist observation and by using statistically significant increase in the maximum HUs within the lesion as compared to surrounding liver tissue. IRB approval was obtained for this retrospective review. 82 patients with 183 focal lesions consistent with HCC by imaging criteria were included. Infiltrative lesions and cases where CT was not obtained within 6 hours of TACE were excluded. Contrast retention was assessed to be present in the lesion both by subjective radiologist observation and by using statistically significant increase in the maximum HUs within the lesion as compared to surrounding liver tissue. ResultsRadiologists interpreted uptake in 139/183 (76%). Other than some contrast noted in vessels, very little if any contrast was noted in surrounding non-tumor liver. Four patterns were noted: 1) “Whole lesion” (dense uptake throughout lesion)-19 lesions, 2) “pacman” (dense uptake except for a portion of the lesion)-108 lesions, 3) “ringlike” (peripheral uptake-non centrally)-12 lesions, 4) no uptake-44 lesions. Of significance, 13 additional lesions (focal areas that retained contrast) were noted that were not suspected on the pre TACE imaging and in retrospect were likely HCCs. When no uptake was seen or when portions did not retain contrast we hypothesized that either the lesion or portion of the lesion was not targeted, was atypical with a poor vascular supply or did not opacify due to other technical factors. These tumors are being followed and long term results based on the post TACE CT will be reported separately. Radiologists interpreted uptake in 139/183 (76%). Other than some contrast noted in vessels, very little if any contrast was noted in surrounding non-tumor liver. Four patterns were noted: 1) “Whole lesion” (dense uptake throughout lesion)-19 lesions, 2) “pacman” (dense uptake except for a portion of the lesion)-108 lesions, 3) “ringlike” (peripheral uptake-non centrally)-12 lesions, 4) no uptake-44 lesions. Of significance, 13 additional lesions (focal areas that retained contrast) were noted that were not suspected on the pre TACE imaging and in retrospect were likely HCCs. When no uptake was seen or when portions did not retain contrast we hypothesized that either the lesion or portion of the lesion was not targeted, was atypical with a poor vascular supply or did not opacify due to other technical factors. These tumors are being followed and long term results based on the post TACE CT will be reported separately. ConclusionNon contrast CT post TACE with DEB demonstrates contrast accumulation in over 75% of cases without accumulation in the adjacent liver parenchyma. This information may prove to be useful in determining if the lesion was adequately treated or if early repeat TACE is indicated to search for additional vascular supply. Non contrast CT post TACE with DEB demonstrates contrast accumulation in over 75% of cases without accumulation in the adjacent liver parenchyma. This information may prove to be useful in determining if the lesion was adequately treated or if early repeat TACE is indicated to search for additional vascular supply.