Utility of Lipiodol CT for Treating Small Hepatocellular Carcinoma

Abstract

Background and Aim: In the past, use of Lipiodol Computerized Tomograhy (CT) has shown high sensitivity in detecting small intrahepatic nodules for preoperative staging. Technique involves an intra-arterial injection of iodized oil (lipiodol) through the hepatic arterial supply following which lipiodol gets deposited within the malignant liver nodule (HCC). This HCC is seen as a hyperattentuating (radiodense) nodule on subsequent CT. We illustrate two representative cases of small HCC (diagnosed on MRI, not seen on ultrasound/CT) that were managed successfully with the use of this technique. Methods: Diagnosed HCC patients were evaluated for treatment allocation. We encountered five patients with single HCC (less than 2 cm), seen only on MRI. These patients had Child's B cirrhosis and were planned for percutaneous ablation. An angiogram through the transfemoral route was done and lipiodol injected through the feeding hepatic artery. On post procedure CT, the tumor retained lipiodol and was seen as a hyperattenuating nodule, which served as a target for subsequent treatment. Results: Case one was a 51 year female who had a small 1.5 cm HCC seen only on MRI. Angiogram depicted the tumor blush following which lipiodol was injected. Post procedure CT depicted lipiodol within the hepatic tumor, which was targeted under CT guidance, and radiofrequency ablation was performed achieving complete response. Case 2 was a 50 year old male who had undergone right extended hepatectomy for HCC and on follow up at eight months was detected with recurrence (less than 1 cm) on only MRI. Angiogram was done and lipiodol injection delineated multiple small hepatic nodules scattered in the remaining right lobe. This led to change in management from ablation to TACE. Conclusion: Lipiodol CT is a very sensitive tool to detect small HCC nodules and hence can be used for treating small HCC not visualized on US/CT.