Role of MDCT in Prediction of Response to Transcatheter Arterial Chemoembolization in Unresectable Hepatocellular Carcinoma Patients

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common neoplasm in the world and its incidence is increasing worldwide. Overall, HCC is associated with liver cirrhosis in 80% of cases and it is the leading cause of death among cirrhotic patients. The treatment of patients with HCC has evolved in the last few years. However, curative treatments such as liver resection, liver transplantation or percutaneous ablation [percutaneous ethanol injection (PEI) and radiofrequency ablation (RF)] are applicable in only 30%-40% of cases. Since transarterial chemoembolization (TACE) was introduced as a palliative treatment in patients with unresectable HCC, it has become one of the most common forms of interventional therapy. Computed tomography (CT) is an attractive imaging modality for HCC screening because it can detect lesions in the cirrhotic liver, allow lesion characterisation and also assist in clinical staging. Its sensitivity and specificity for HCC are variable. Sensitivity of CT for HCC detection can be enhanced with the use of new helical techniques and the dynamics of intravenous contrast agents. CT and MRI are the best currently available and reproducible methods to measure target lesions selected for response assessment. Conventional CT and MRI should be performed with cuts of 10 mm or less in slice thickness contiguously; better use Spiral CT should be performed using a 5 mm contiguous reconstruction algorithm.