Source Department of Radiology, University of Washington, Seattle, WA.
Transarterial chemoembolization (TACE) is one of the standard therapies for bridging patients with hepatocellular carcinoma (HCC) to transplantation. This study aimed to determine which features on pre- and post-TACE imaging are associated with tumor necrosis on pathologic specimens. Records of 105 patients with 132 HCC lesions who underwent liver transplantation following TACE were retrospectively reviewed. Greater than 90% necrosis was achieved in 70% of nodules. Development of greater than 90% lesion necrosis at pathology was associated with avid lesion enhancement (p=0.03) and presence of a feeding vessel larger than 0.9 mm in diameter on the pre-TACE visceral angiogram (p=0.008). Near-complete lesion necrosis was also associated with extensive ethiodized oil accumulation within a lesion during TACE administration (p=0.02). On post-TACE computed tomography , lack of residual contrast enhancement (p<0.0001), decrease in lesion size (p=0.009), high lesion density due to ethiodized oil accumulation (p=0.005), and diffuse distribution of ethiodized oil throughout the lesion (p<0.0001) were also correlated with near-complete lesion necrosis at pathology. In conclusion, this study found multiple pre-TACE and post-TACE imaging characteristics of HCC which were associated with near complete tumor necrosis at histopathology following TACE. These findings may help guide selection of an optimal treatment strategy for bridging patients with HCC to liver transplant.