Korean J Radiol.  2010 Feb;11(1):69-74. 10.3348/kjr.2010.11.1.69.

CT Findings of Completely Regressed Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis after Transcatheter Arterial Chemoembolization

• Yoon JH
• Kim HC
• Chung JW
• Yoon JH
• Jae HJ
• Park JH

• KMID: 1787016
• DOI: http://doi.org/10.3348/kjr.2010.11.1.69

Abstract

OBJECTIVE
The objective of this study was to determine the sequential CT findings of controlled hepatocellular carcinoma (HCC) with main portal vein (MPV) thrombosis with the use of transcatheter arterial chemoembolization and additional intra-arterial cisplatin infusion.
MATERIALS AND METHODS
From January 2004 to September 2006, 138 patients with HCC invading MPV were referred to the angiography unit of our institution for chemoembolization and additional intra-arterial cisplatin infusion. Until August 2008, seven (5%) of 138 patients were followed-up and found not to have tumor recurrence. CT scans were retrospectively reviewed by two radiologists, focusing on the following parameters: the extent of portal vein thrombosis, the diameter of the affected portal vein, and enhancement of portal vein thrombosis.
RESULTS
The extent of portal vein thrombosis at the initial presentation was variable: left portal vein (LPV) and MPV (n = 1), right portal vein (RPV) and MPV (n = 3), as well as RPV, LPV and MPV (n = 3). The extent and diameter of the affected portal vein decreased during follow-up examinations. In addition, the degree of enhancement for tumor thrombi and serum alpha-feto-protein levels decreased after the transcatheter arterial chemoembolization. Portal vein thrombosis was found to be completely resolved in one patient, whereas residual thrombus without viability was persistent in six patients.
CONCLUSION
If chemoembolization is effective in patients with HCC that invades the portal vein, the extent and enhancement of portal vein thrombosis is reduced, but residual thrombosis frequently persists for months or years, without evidence of a viable tumor.

Keyword

Portal vein thrombosis; Hepatocellular carcinoma; Chemoembolization

MeSH Terms

Adult
Aged
Antineoplastic Agents/administration & dosage
Carcinoma, Hepatocellular/pathology/*radiography/therapy
*Chemoembolization, Therapeutic/adverse effects
Cisplatin/administration & dosage
Female
Humans
Liver Neoplasms/pathology/*radiography/therapy
Male
Middle Aged
*Neoplastic Cells, Circulating
Portal Vein/*radiography
*Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Imaging findings are presented for 64-year-old man with hepatocellular carcinoma accompanied by main portal vein invasion. A. CT scan of portal venous phase obtained at initial presentation shows ill-defined tumor (arrows) in liver parenchyma and thrombus (arrowhead) in main portal vein. Expansion of portal vein and enhancement of thrombus are evident. B. One month after initial chemoembolization, tumor (arrow) was spotted with iodized oil in liver parenchyma and tumor thrombus (arrowhead) laden along with iodized oil in right anterior portal vein on portal phase. C. Also noted is decreased extent and diameter of thrombus (arrowhead) in portal vein on same CT scan as B. D. CT scan of portal venous phase obtained 34 months after last chemoembolization shows small thrombus (arrow) in right anterior portal vein.

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