Early Response of Hepatocellular Carcinoma to Chemoembolization: Volume Computed Tomography Liver Perfusion Imaging as a Short-Term Response Predictor.

OBJECTIVE: The aim of this study was to investigate the efficacy of lesion-oriented whole-liver computed tomography (CT) perfusion for predicting transarterial chemoembolization early treatment response in patients with hepatocellular carcinoma (HCC). METHODS: Volume helical shuttle CT perfusion imaging on the whole liver was prospectively performed on 39 patients with 46 independent HCC lesions before target-selected chemoembolization. The therapeutic effects were assessed: responder group included lesions with a complete and partial response, whereas the nonresponder group contained stable and progressive disease. The perfusion parameter value comparison between 2 groups and receiver operating characteristic analyses were performed. RESULTS: The responders demonstrated higher hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HAPI) and lower hepatic portal perfusion (HPP) compared with the nonresponders among the 34 lesions without Vp3 or Vp4 portal vein thrombosis. In addition, HAP and HAPI had good prognostic values. CONCLUSIONS: Whole-liver CT perfusion allows for hemodynamic evaluation of HCC lesions. The HAP, HAPI, and hepatic portal perfusion values may be useful predictors of short-term therapeutic response after transarterial chemoembolization.

Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation.

AIM: To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction (HVOO) following pediatric liver transplantation. METHODS: A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures (two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data, types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo (range: 1-32). RESULTS: Five children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mmHg before balloon dilatation and 1.1 ± 1.5 mmHg after the procedures, which revealed a statistically significant reduction (P < 0.05). The overall technical success rate among these seven procedures was 100% (7/7), and clinical success was achieved in all five patients (100%). The patients were followed for 4-33 mo (median: 15 mo). No significant procedural complications or procedure-related deaths occurred. CONCLUSION: Balloon dilatation is an effective and safe therapeutic option for HVOO in children undergoing pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.