Selective accumulation , persistent deposition and gradual disappear-ance of lipiodol in hepatocellular carcinoma following hepatic arterial chemoembo1ization
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Objective :This study was conducted to clarify the characteristics of selective accumulation,per-sistent deposition and gradual disappearance of lipiodol in hepatocellular carcinoma ( HCC ) and the histopathologic morphology of tumors following transcatheter hepatic arterial chemoembolization(TAE )。 Methods :The findings of hepatic arteriography and those of CT obtained 4 to l5 d following lipiodol-TAE were compared and analyzed in 58 cases. The deposition and disappearance of lipiodol in 28 cases were ob-served by CT dynamically, in l2 of whom, CT or soft x-ray radiograms and the findings of histological exam-ination were compared.Results :Lipiodol accumulated selectively in hypervascular tumor and the amount of lipiodol accumulation correlated with the vascularity of the tumors. There was little or no lipiodol accumula-tion in hypovascular tumors。 In the necrotic tumors areas induced by chemoembolization ,lipiodol accumulat-ed selectively and deposited persistently for 2 to 6 months and sometimes even longer , with remarkable shrinkage of tumors,whereas in the tumor survival areas,selectively accumulated as lipiodol did,it disap-peared gradually in 1 to 2 months,without remarkable shrinkage of the tumors.Lipiodol in tumor-free areas disappeared much earlier,generally 2 weeks after embolization,Conclusions : Lipiodol accumulated selective-ly in hypervascular tumor tissues and deposited persistently in necrotic tumor areas induced by embolization。Therefore, CT follow-up to observe the deposition and disappearance of lipiodol in tumors is of clinical im-portance in assessing the anti-tumor effect and in deciding the time for further treatment.Keywords:
Lipiodol
Vascularity
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ABSTRACT— Intrahepatic distribution of Lipiodol and I‐131 Lipiodol infused via the hepatic arteries was evaluated in six patients with HCC who had undergone hepatic lobectomy or segmentectomy. CT scan and gamma camera radiograph confirmed that the oily contrast material or I‐131 radioactivity accumulated selectively in the tumor over a long period. One to two thirds of the tumor mass appeared necrotic, although the extent tended to be larger in the case of radioactive Lipiodol infusion. The tumor cells contained numerous lipid globules within the cytoplasm. Also, oil red 0 stain demonstrated that the individual tumor cells had non‐globular lipid on their surface. In conclusion, Lipiodol leaks out of the vascular spaces to attach to the cancer cell membrane as a non‐globular lipid as well as to enter the cancer cells as a globular lipid. This phenomenon specific to cancer cells suggests a biochemical membrane change which may have occurred during carcinogenesis, causing alteration of membrane transport and cell death.
Lipiodol
Stain
Liver Cancer
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Objective To investigate the relationship between enhancement in arterial- phase, indicating arterial blood supply of the lesions of hepatocellular carcinoma and lipiodol accumulation after the trans- arterial chemoembotherapy. Methods CT images of primary hepatocellular carcinoma in 32 cases during the hepatic arterial- phase were retrospectively compared with the CT images of lipiodol distribution within the tumor after the trans- arterial chemoembotherapy. Results The lipiodol distribution was classified into five types: homogeneous and compact( n=11) , inhomogeneous though compact( n=7) , scanty( n=5) , poorly filled( n=3) and miscellaneous( n=3) . The lipiodol has a homogeneous or inhomogeneous but compact distribution when remarkable enhancement of the tumor or dominant neoplastic vascularity was demonstrated during hepatic arterial- phase. The lipiodol distribution was scanty, poorly filled, or miscellaneous distributed in the nidus of the hepatocellular carcinoma with no or poor enhancement, or with hypo- vascularity during hepatic arterial- phase. Where there was abundant vascularity of the tumor, there would be a satisfying accumulation of the lipiodol. Conclusion The CT assessmant of the arterial- phase vascularity of the hepatocellular provides valuable information of lipiodol accumulation after the trans- arterial chemoembotherapy.
Lipiodol
Vascularity
Arterial Embolization
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Objective To investigate the intrahepatic distribution of Lipiodol in chemoembolization therapy for primary hepatic cellular carcinoma (HCC).Materials and Methods Thirtysix patients with HCC, proved by imaging and/or biopsy, were randomly divided into three groups and were treated with common Lipiodol (n=11), Ultra Fluide Lipiodol (n=13), or a mixture of the above two preparations with a ratio of 1∶1 (n=12), respectively. The distribution of Lipiodol in the liver demonstrated on plain films and CT scans was observed in 15～20 days after chemoembolization. The distribution was graded as follows. (1) Excellent: all Lipiodol was deposited in the lesions; (2) Good: most Lipiodol was deposited in the lesions, while small amount of Lipiodol stayed in normal hepatic parenchyma; (3) Poor: Lipiodol was deposited in both lesions and normal hepatic parenchyma about equally.Results The occurrences of Lipiodol deposit seen only inside the lesions in the common group, Ultra Fluide group and mixture group were 91% (10/11), 7.7% (1/13) and 33% (4/12), respectively. Followup CT scans showed that Ultra Fluide Lipiodol easily escaped from the lesions.Conclusion In chemoembolization therapy with Lipiodol for HCC, the common Lipiodol can almost always deposit in the lesions rather than in the normal parenchyma as seen in the case of using Ultra Fluide Lipiodol.
Lipiodol
Parenchyma
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Objective:To evaluate the clinic value of transcatheter arterial chemoembolization(TACE)with ContourSe microsphere and lipiodol in patients with large hepatocellular carcinoma(HCC).Methods:Nineteen patients with large hepatocellular carcinoma including 13 patients with poor lipiodol deposition after routine TACE were treated with two different chemoembolization protocols.Group1(n=10),chemotherapy and emulsion of lipiodol and EADM followed by gelfoam pledgets,and group2(n=9),chemotherapy and slurry of lipiodol,ContourSe(300～500μm)and EADM followed by gelfoam pledgets.Tumor necrosis,maximum tumor diameter and lipiodol deposition were followed up by CT.Postembolization syndrome,complication,AFP and liver function examination were assessed.Results:Maximum tumor diameter reductions were detected in 3 cases for group 1 and 6 cases for group 2.Complete necrosis was found in 3 cases for group 2,and partial necrosis in 2 cases for group 2.Complete compact lipiodol deposition was found in the tumors with lipiodol filling defect after routine TACE in 1 case for group2.No significant difference in the change of liver function examination was detected between pre-and post-embolization and between the two groups.AFP level decreased in 4 cases for group1 and 5 cases for group 2.Liver abcess was found in one case for group 2.Conclusion:ContourSe microspheres as adjuvant embolic agents had good early response in TACE of large HCC.TACE with use of ContourSe for large HCC is feasible.The optimal indication for use of ContourSe is the first interventional therapy for large HCC.
Lipiodol
Transcatheter arterial chemoembolization
Liver function
Liver Cancer
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Lipiodol
Arterial Embolization
Coagulative necrosis
Nodule (geology)
Portography
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We performed intrahepatic arterial infusion of 'I-labelled Lipiodol (1311-Lipiodol) as an internal radiation therapy in twenty patients with (HCC ). Turmr sizes were reduced in all attempted patients, and serum AFP levels were also decreased in the patients with high levels of serum AFP. Furthermore, the resected specimens of the tumors revealed complete or nearly complete necrosis in 2 patients who were underwent the surgical resection after the treatment. No significant side effects were observed in all attempted patients. These results suggest that intrahepatic arterial infusion of '31I-Lipiodol is a safe and effective therapeutic method for HCC.
Lipiodol
Arterial Embolization
Transcatheter arterial chemoembolization
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Objective :To evaluate the relationship between place of catheter and amount of lipiodol and its in- fluence upon clinical effects and negative effects. Methods :86 cases of transcatheter proper hepatic arterial em- bolization and 250 cases of super selective segmental transarterial embolization(STAE) were analyzed respective- ly and curative effects and negative effects of the two and the relationship with amount of lipiodol were com- pared. Results: Liver neoplastic size of all cases were 3 - 15cm. For 86 cases of proper hepatoarterial emboliza- tion, the amount of lipiodol was 5 - 10ml. Obvious tumor shrinking occurred in 20 cases(23% ) , the 2-year sur- vival in 5 cases (6%).For 250 cases of STAE,the amount of lipiodol was 15 - 40ml. Obvious tumor shrinking occurred in 163cases (65%) ,the 2 - year survival occurred in 78 cases(31%). Conclusion :For STAE,amount of lipiodol is in direct proportion to curative effects and negative effects increase slightly as the amount of lipiodol increases. For transcatheter proper hepatic arterial embolization,curative effects were poor,negative effects were obvious.
Lipiodol
Liver Cancer
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An iodized oil such as Ethiodol or Lipiodol was selectively retained in the tumor vessels of the large hepatomas as well as in the small daughter hepatomas for long periods following the intra-arterial hepatic injection of such contrast material. The specific aim of the study is to deliver a high internal radiation dose to hepatocellular carcinoma (HCC) in an attempt to control the disease. We were able to replace a small fraction of the stable iodine (I-127) of the 37% iodine in Lipiodol by the with 100% exchange efficiency. labeled Lipiodol was injected through the super-selected tumor feeding artery under superselection or into the proper hepatic arterial level of patients who have malignant hepatomas confirmed by aspiration cytology serum AFP and various imaging modalities. Clinical traial was performed on 43 cases during recent 6 months and follow-up observation was carried out. No severe complications or other adverse reactions were encountered until nowdays. was stable in vivo and no significant activity was noted in the thyroid, stomach, blood and urine after the injection. Only small fraction of radioisotope activity was noticed in the both side of lungs. Tumor to normal liver radio was very high. Therefore, (or P-32-Lipiodol) will be effective delivering high internal radiation dose to the tumor while delivering small radiation doses to normal tissues. Labeling, tumor dose calculation and preliminary findings will be presented.
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Objecteve To assess CT manifestations and the relative factors of development of hepatic cancer(PHC) after hepatic arterial chemoembolization with lipiodol and anticancerous agents(Lp-HAE).Methods Tumor development in 78 cases with liver cancer after Lp-HAE Was discovered by follow-up CT examination.Results The CT manifestations included:①the growth of tumors located of the border of the original lesion were 26 cases(33.3 %);②development of the border of and the growth of tumors in other part of the liver 27 cases (34.6 %);③increase in the size of whole tumor were 14 cases (17.9 %);④the growth of tumors in other part of the liver were 5 cases(6.4 %);⑤increase in size of whole tumor and the growth of tumor in other part of the liver were 6 cases (7.7 %).Conclusion The authors were of the opinion that we can assess the therapeutic effect and growth of tumor after Lp-HAE according to the lipiodol depostion pattern on the border of the tumor after Lp-HAE for (PLC).
Lipiodol
Liver Cancer
Liver tumor
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Purpose: To report on the safety and efficacy of superselective transcatheter arterial chemoemboli-zation( TACE) of tumor feeding branches originating from the cystic artery for the treatment of hepatocellular Materials and Methods: From, May 1995 to, September 1999, eleven HCC patients aged between 38 and 82 (mean, 57.4) years with tumor-feeding branches originating from the cystic artery underwent TACE. In eight,for whom superselection of these branches was possible, TACE was done with the use of Gelfoam and a mix-ture of Lipiodol and cisplatin, while for three, for whom superselection was impossible, a mixture of Lipiodol and cisplatin only was used. Immediately after TACE, remnant tumor staining was angiographically evaluat-ed,and tumor response was determined by follow-up CT at one month. After procedure, the development of cholecystitis was assessed clinically.Results: Post-TACE angiography showed remnant tumor staining in one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, and in one for whom the mixture of Lipiodol & cis-platin only was used. Among the eight for whom Gelfoam and the mixture of Lipiodol and cisplatin was used,one-month follow-up CT showed compact Lipiodol uptake in five, partial Lipiodol uptake in three, no change in tumor size in six, increased tumor size in one, and decreased tumor size in one. Among the three for whom the mixture of Lipiodol and cisplatin only was used, one-month follow-up CT showed neither Lipiodol uptake nor change in tumor size in one patient, partial Lipiodol uptake and increased tumor size in one, and compact Lipiodol uptake and decreased tumor size in one. Cholecystitis developed in only one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, but was cured by conservative treat-ment.Conclusion: Superselective TACE of tumor feeding branches originating from the cystic artery seems to be a safe and effective method for the treatment of hepatocellular carcinoma.
Lipiodol
Arterial Embolization
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