Nitroglycerine use in transcatheter arterial (chemo)embolization in patients with hepatocellular carcinoma and dual-energy CT assessment of Lipiodol retention.

OBJECTIVES: To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/TACE) can increase the delivery and effectiveness of TAE/TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT. METHODS: HCC patients (BCLC stage A or B) were randomized to (n = 51) or not to (n = 50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3 months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours. RESULTS: Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11 % vs. 12.5 %, respectively), and was statistically significant in the group receiving nitroglycerine (P = 0.023). There was no difference between the two groups in disease response (P = 0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05 mg/mL vs. 4.40 mg/mL, respectively, P < 0.001; median percentage 82.01 % vs. 36.75 %, respectively, P < 0.001). CONCLUSIONS: Nitroglycerine increased delivery of the Lipiodol emulsion via TAE/TACE to HCC tumours with significant tumour reduction. Dual-energy CT can accurately quantify the amount of Lipiodol deposited in tumours. KEY POINTS: • Nitroglycerine improves delivery of tumour-targeted therapy via enhanced permeability and retention. • In hepatocellular carcinoma, nitroglycerine added to TAE/TACE showed greater tumour reduction. • Dual-energy CT can reliably quantify the amount of Lipiodol in TAE/TACE.

The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma--the influence of sampling time and hepatolithiasis.

BACKGROUND/AIMS: This study was conducted to assess the clinical value of biliary CA 19-9, CA 125 and CEA sampled in different situations for the diagnosis of cholangiocarcinoma. METHODOLOGY: Bile was obtained from patients with bile duct obstruction on the day of biliary drainage and 3 days later separately. The etiology of biliary obstruction included choledocholithiasis (N = 51), hepatolithiasis (N = 19) and cholangiocarcinoma (N = 28). Patients of the former two conditions were all complicated with cholangitis. RESULTS: The sensitivity of biliary CEA, CA 19-9 and CA 125, whenever checked were all less than 70%. The biliary CEA and CA 19-9 were elevated in the presence of cholangitis. In addition, the biliary CEA was also increased in the patients with hepatolithiasis. The specificity of CA 125 was better than those of CEA and CA 19-9 (75.7% vs. 33.3% and 60%, respectively) on the day of biliary drainage. The diagnostic efficiency was slightly improved when combining biliary CA 125 and CEA. CONCLUSIONS: As the biliary CA 125 was less affected by inflammation and hepatolithiasis, it is more useful than CEA and CA 19-9 in the diagnosis of cholangiocarcinoma. The single tumor marker test of CA 125 or combined tumor marker test of CEA and CA 125 may be used as a useful complement to other investigative methods to differentiate benign from malignant causes of the bile duct obstruction.