CardioVascular and Interventional Radiology

, Volume 39, Issue 6, pp 865–874 | Cite as

Change in Imaging Findings on Angiography-Assisted CT During Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

  • Rika Yoshimatsu
  • Takuji YamagamiEmail author
  • Masaki Ishikawa
  • Kenji Kajiwara
  • Hiroshi Aikata
  • Kazuaki Chayama
  • Kazuo Awai
Clinical Investigation



To evaluate changes in imaging findings on CT during hepatic arteriography (CTHA) and CT during arterial portography (CTAP) by balloon occlusion of the treated artery and their relationship with iodized oil accumulation in the tumor during balloon-occluded transcatheter arterial chemoembolization (B-TACE).


Both B-TACE and angiography-assisted CT were performed for 27 hepatocellular carcinomas. Tumor enhancement on selective CTHA with/without balloon occlusion and iodized oil accumulation after B-TACE were evaluated. Tumorous portal perfusion defect size on CTAP was compared with/without balloon occlusion. Factors influencing discrepancies between selective CTHA with/without balloon occlusion and the degree of iodized oil accumulation were investigated.


Among 27 tumors, tumor enhancement on selective CTHA changed after balloon occlusion in 14 (decreased, 11; increased, 3). In 18 tumors, there was a discrepancy between tumor enhancement on selective CTHA with balloon occlusion and the degree of accumulated iodized oil, which was higher than the tumor enhancement grade in all 18. The tumorous portal perfusion defect on CTAP significantly decreased after balloon occlusion in 18 of 20 tumors (mean decrease from 21.9 to 19.1 mm in diameter; p = 0.0001). No significant factors influenced discrepancies between selective CTHA with/without balloon occlusion. Central area tumor location, poor tumor enhancement on selective CTHA with balloon occlusion, and no decrease in the tumorous portal perfusion defect area on CTAP after balloon occlusion significantly influenced poor iodized oil accumulation in the tumor.


Tumor enhancement on selective CTHA frequently changed after balloon occlusion, which did not correspond to accumulated iodized oil in most cases.


Balloon-occluded transcatheter arterial chemoembolization CT during hepatic arteriography CT during arterial portography 


Compliance with Ethical Standards

Conflict of Interest

Dr. Chayama receives honoraria (more than 1,000,000 yen) or research funding (more than 2,000,000 yen) from MSD Co., Ltd., Tanabe Co., Ltd., Roche Co., Ltd., Toray Co., Ltd., Chugai Co., Ltd., Sumitomo Co., Ltd., Otuka Co., Ltd., and Daiichi-Sankyo Co., Ltd. Dr. Awai receives research funding (more than 2,000,000 yen) from Toshiba Medical Systems Co., Ltd. The other authors have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37(2):429–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–71.CrossRefPubMedGoogle Scholar
  3. 3.
    Yamashita T, Kaneko S. Treatment strategies for hepatocellular carcinoma in Japan. Hepatol Res. 2013;43(1):44–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Mondazzi L, Bottelli R, Brambilla G, Rampoldi A, Rezakovic I, Zavaglia C, et al. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology. 1994;19(5):1115–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Takayasu K, Muramatsu Y, Maeda T, Iwata R, Furukawa H, Muramatsu Y, et al. Targeted transarterial oily chemoembolization for small foci of hepatocellular carcinoma using a unified helical CT and angiography system: analysis of factors affecting local recurrence and survival rates. Am J Roentgenol. 2001;176(3):681–8.CrossRefGoogle Scholar
  6. 6.
    Irie T, Kuramochi M, Takahashi N. Dense accumulation of lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure. Cardiovasc Intervent Radiol. 2013;36(3):706–13.CrossRefPubMedGoogle Scholar
  7. 7.
    Ishikawa T, Abe S, Inoue R, Sugano T, Watanabe Y, Iwanaga A, et al. Predictive factor of local recurrence after balloon-occluded TACE with Miriplatin (MPT) in hepatocellular carcinoma. PLoS One. 2014;9(7):e103009.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sze DY, Razavi MK, So SK, Jeffrey RB Jr. Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma. Am J Roentgenol. 2001;177(6):1339–45.CrossRefGoogle Scholar
  9. 9.
    Takayasu K, Maeda T, Iwata R. Sensitivity of superselective arteriography for small hepatocellular carcinoma compared with proximal arteriography and computed tomography during superselective arteriography. Jpn J Clin Oncol. 2002;32(6):191–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Fujita T, Ito K, Tanabe M, Yamatogi S, Sasai H, Matsunaga N. Iodized oil accumulation in hyper vascular hepatocellular carcinoma after transcatheter arterial chemoembolization: comparison of imaging findings with CT during hepatic arteriography. J Vasc Interv Radiol. 2008;19(3):333–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Ishikawa M, Yamagami T, Kakizawa H, Hieda M, Toyota N, Fukumoto W, et al. Transarterial therapy of hepatocellular carcinoma fed by the right renal capsular artery. J Vasc Interv Radiol. 2014;25(3):389–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Matsumoto T, Endo J, Hashida K, Ichikawa H, Kojima S, Takashimizu S, et al. Balloon-occluded transarterial chemoembolization using a 1.8-French tip coaxial microballoon catheter for hepatocellular carcinoma: technical and safety considerations. Minim Invasive Ther Allied Technol. 2015;24(2):94–100.CrossRefPubMedGoogle Scholar
  13. 13.
    Matsuo M, Kanematsu M, Inaba Y, Matsueda K, Yamgami T, Kondo H, et al. Pre-operative detection of malignant hepatic tumors: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography. Clin Radiol. 2001;56(2):138–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Yamagami T, Nakamura T, Kin Y, Nishimura T. Non-tumorous enhancement caused by cholecystic venous inflow shown on biphasic CT hepatic arteriography: comparison with hepatocellular carcinoma. Br J Radiol. 2000;73(876):1275–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Tohma T, Cho A, Okazumi S, Makino H, Shuto K, Mochiduki R, et al. Communicating arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology. 2005;237(1):361–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Nakashima Y, Ikeno H, et al. Main bile duct stricture occurring after transcatheter arterial chemoembolization for hepatocellular carcinoma. Cardiocasc Intervent Radiol. 2010;33(6):1168–79.CrossRefGoogle Scholar
  17. 17.
    Matumoto T, Endo J, Hashida K, Mizukami H, Nagata J, Ichikawa H, et al. Balloon-occluded arterial stump pressure before balloon-occluded transarterial chemoembolization. Minim Invasive Ther Allied Technol. 2015;1–7.Google Scholar
  18. 18.
    Sugimoto K, Saguchi T, Saito K, Imai Y, Moriyasu F. Hemodynamic changes during balloon-occluded transarterial chemo embolization (B-TACE) of hepatocellular carcinoma observed by contrast-enhanced ultrasound. J Med Ultrasonics. 2014;41:209–15.CrossRefGoogle Scholar
  19. 19.
    Cho KJ, Lunderquist A. The peribiliary vascular plexus: the microvascular architecture of the bile duct in the rabbit and in clinical cases. Radiology. 1983;147(2):357–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Demachi H, Matsui O, Takashima T. Scanning electron microscopy of intrahepatic microvasculature casts following experimental hepatic artery embolization. Cardiovasc Interv Radiol. 1991;14(3):158–62.CrossRefGoogle Scholar
  21. 21.
    Ekataksin W. The isolated artery: an intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers. Hepatology. 2000;31(2):269–79.CrossRefPubMedGoogle Scholar
  22. 22.
    Miyayama S, Yamashiro M, Hattori Y, Orito N, Matsui K, Tsuji K, et al. Efficacy of cone-beam computed tomography during transcatheter arterial chemoembolization for hepatocellular carcinoma. Jpn J Raiol. 2011;29(6):371–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Rika Yoshimatsu
    • 1
    • 2
  • Takuji Yamagami
    • 2
    • 1
    Email author
  • Masaki Ishikawa
    • 1
  • Kenji Kajiwara
    • 1
  • Hiroshi Aikata
    • 3
  • Kazuaki Chayama
    • 3
  • Kazuo Awai
    • 1
  1. 1.Department of Diagnostic Radiology, Institute and Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Department of RadiologyKochi UniversityNankoku, KochiJapan
  3. 3.Department of Gastroenterology and Metabolism, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan

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