Sequential tumor-directed and lobar radioembolization before major hepatectomy for hepatocellular carcinoma

Figure 1 Preoperative imaging. A and B: Baseline contrast-enhanced magnetic resonance imaging (MRI). Contrast-enhanced MRI demonstrated a 40 mm mass in segment IV of the liver with arterial wash-in (A) and wash-out on the portal venous phase (B) and features of cirrhosis (irregular surface, relative hypertrophy of segment I); C and D: Selective intra-tumor deposition of 90Y microspheres after first SIRT session (C) and deposition of 90Y microspheres to segments II and III after the second SIRT session (D).

Figure 2 Intra- and postoperative images. A: Intraoperative view showing the cirrhosis and the post-selective internal radiotherapy (SIRT) relative atrophy of the left liver; B: Resected specimen showing small residual cancer cells foci with the necrotic and fibrotic zone targeted by segment IV high-dose SIRT; C: Pathological view showing massive necrosis and fibrosis together with the presence of microspheres; D: Pathological view showing a residual hepatocellular carcinoma focus, surrounded by necrosis and fibrosis together with the presence of microspheres.