Background: The predictive value of
Lipiodol was evaluated for response evaluation of
hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE) by analysis of the enhancement pattern during angiography and in postinterventional computed tomography (CT). Materials and Methods: This retrospective study included 30 patients (mean age 63 years, range: 36 to 82 years, 22 males) with HCC. Patients received three
Lipiodol-based cTACE sessions, each followed by an unenhanced CT within 24-h. Contrast-enhanced magnetic resonance imaging (MRI) was acquired before and after the treatment to determine
tumor response.
Lipiodol enhancement pattern,
tumor vascularization, and density were evaluated by angiography and CT. Initial
tumor size and response to cTACE were analyzed by MRI according to modified response evaluation criteria in solid tumors (mRECIST) in a 4-week follow-up. Results: Analysis of HCC lesions (68 lesions in 30 patients) during cTACE revealed clear visibility and hypervascularization in angiography as a potential independent parameter able to predict
tumor response. A significant correlation was found for response measurements by volume (p = 0.012), diameter (p = 0.006), and according to mRECIST (p = 0.039). The amount of
Lipiodol and enhancement pattern in postinterventional CT did not correlate with
therapy response. Measurements of Hounsfield unit values after cTACE do not allow sufficient prediction of the
tumor response. Conclusion: Hypervascularized HCC lesions with clear visibility after
Lipiodol administration in the angiography respond significantly better to cTACE compared to hypo- or nonvascularized lesions.