Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization

Figure 1 Hepatocellular cancer in the caudate lobe after transcatheter arterial chemoembolization. A: Iodine (water) based image. The effective iodine content of the defect of iodine deposition (154.10 ± 8.07) was significantly higher than that for normal liver parenchyma and the aorta (67.36 ± 4.87), revealing no residual tumor; B: Digital subtraction angiography image revealed no tumor vessels or stain, and obvious iodized oil deposition was visible (arrow).

Figure 2 Giant hepatocellular cancer in the lateral borders of the left and right liver lobes after transcatheter arterial chemoembolization. A: The computed tomography (CT) value of the defect of iodine deposition was comparable to that of normal liver parenchyma in conventional CT image, and there was no obvious enhancement; B: Digital subtraction angiography revealed enlarged tumor blood vessels and tumor stain in the defect of iodine deposition.

Figure 3 Metastasis to the medial segment of the left lobe of the liver after transcatheter arterial chemoembolization for primary hepatocellular cancer. A: Conventional computed tomography revealed that the left lobe metastasis had no obvious enhancement; B: Iodine (water) based image showed a small amount of contrast medium entry to the left lobe metastasis, suggesting slight enhancement; C: Iodine (water) based image showed equidensity of the left lobe metastasis; D: Digital subtraction angiography confirmed tumor stain in the left lobe metastasis in parenchymal phase (arrow).

Figure 4 Recurrence of hepatocellular cancer in the right lobe after transcatheter arterial chemoembolization. A: Sixty-eight keV monochromatic image showed obvious enlargement and enhancement of recurrent lesion in tumor edge (arrow); B: The effective iodine content of the recurrent lesion (29.89 ± 5.83) was significantly higher than that for normal liver parenchyma (10.0 ± 4.45), suggesting obvious enhancement and entry of contrast medium to the lesion; C: Digital subtraction angiography confirmed tumor stain in the recurrent lesion in parenchymal phase (arrow).

Figure 5 Same case as in Figure 4. A: Iodine (water) based image revealed no entry of contrast medium to the lateral segment of the left lobe, which showed hypodensity (arrow); B: Iodine (water) based image showed slight hypodensity (arrow); C: Digital subtraction angiography confirmed tumor stain in the left lobe metastasis in parenchymal phase (arrow).

Figure 6 Metastasis to the right lobe after transcatheter arterial chemoembolization for hepatocellular cancer in the right lobe. A: Placement of regions of interest in the metastatic lesion and surrounding normal parenchyma, respectively; B: Carrier-to-noise ratio curve. The optimal monochromatic images were at 60-70 keV.

Figure 7 Same case as in Figure 6. A: Placement of a region of interest in the primary lesion; B: Placement of a region of interest in the lesion in the right lobe; C: The spectral curves for the two lesions were roughly same, suggesting tumor homogeneity; D: Digital subtraction angiography confirmed multiple tumor stains (arrow).