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16
Miscellaneous
PierleoneLucatelli, BiancaRocco, FabrizioBasilico,
StavrosSpiliopoulos, LazarosReppas,
TimoAlexanderAuer, FedericoCollettini,
MartaBurrel, PatriciaBermúdez, RobertoCianni,
GianlucaDe Rubeis, GiulioVallati,
ClaudioTrobiani, RobertoIezzi, RafaelDuran,
Thierryde Baere, LambrosTselikas,
andCarloCatalano
P. Lucatelli (*) · B. Rocco · F. Basilico · C. Catalano
Vascular and Interventional Radiology Unit,
Department of Radiological, Oncological, and
Anatomo-Pathological Sciences, Sapienza University
of Rome, Rome, Italy
e-mail: carlo.catalano@uniroma1.it
S. Spiliopoulos · L. Reppas
2nd Department of Radiology, Interventional
Radiology Unit, National and Kapodistrian
University of Athens, “ATTIKON” University
General Hospital, Athens, Greece
e-mail: stavspiliop@med.uoa.gr
T. A. Auer · F. Collettini
Charitè, Berlino, Germany
e-mail: timo-alexander.auer@charite.de;
federico.collettini@charite.de
M. Burrel · P. Bermúdez
Vascular Radiology Unit, Radiology Department,
Hospital Clinic, Barcelona Liver Cancer Group
(BCLC), Barcelona, Spain
e-mail: MBURREL@clinic.cat; pbermude@clinic.cat
R. Cianni · G. De Rubeis
Dipartimento delle diagnostiche, Azienda Ospedaliera
San Camillo Forlanini, Rome, Italy
e-mail: RCianni@scamilloforlanini.rm.it
G. Vallati · C. Trobiani
Department of Radiology, IRCCS Istituto Nazionale
Tumori Regina Elena, Rome, Italy
e-mail: giulio.vallati@ifo.it; claudio.trobiani@ifo.it
R. Iezzi
Fondazione Policlinico A Gemelli- IRCCS-
Università Cattolica del Sacro Cuore, Rome, Italy
R. Duran
Department of Radiology and Interventional
Radiology, Lausanne University Hospital and
University of Lausanne, Lausanne, Switzerland
e-mail: rafael.duran@chuv.ch
T. de Baere
Département d’Anesthésie, Chirurgie et
Interventionnel (DACI), Gustave Roussy,
Villejuif, France
Gustave Roussy Cancer Campus, Université Paris
Saclay, Saint-Aubin, France
e-mail: Thierry.DEBAERE@gustaveroussy.fr
L. Tselikas
Département d’Anesthésie, Chirurgie et
Interventionnel (DACI), Gustave Roussy,
Villejuif, France
Laboratoire de Recherche Translationnelle en
Immunothérapie (LRTI), INSERM U1015, Gustave
Roussy, Villejuif, France
e-mail: LAMBROS.TSELIKAS@gustaveroussy.fr
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
P. Lucatelli (ed.), Transarterial Chemoembolization (TACE),
https://doi.org/10.1007/978-3-031-36261-3_16
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144
See Figs.16.1, 16.2, 16.3, 16.4, 16.5, 16.6, 16.7,
16.8 and 16.9
ab
Fig. 16.1 (a) Celiac axis DSA depicting a large, high-
ow arterioportal communication. (b) The communica-
tion was embolized using 3mm pushable micro-coils and
DEB-TACE was performed following selective catheter-
ization of the tumor feeding vessel
ab
Fig. 16.2 A case of diffuse right lobe HCC and celiac
artery occlusion. (a) DSA following SMA catheterization
depicting the right hepatic artery (arrow) retrogradely per-
fused via the gastroduodenal artery (arrowhead) and col-
lateral network of the inferior pancreaticoduodenal artery
(IPA). (b) IPA was selectively catheterized with a micro-
catheter and DEB-TACE was performed
P. Lucatelli et al.
t.me/medicina_free
145
a b
c d
Fig. 16.3 Patient with a multifocal HCC in the right liver
lobe treated with DSM-TACE in a lobar fashion. (a) Pre-
procedural MRI (arterial phase) showing two of the mul-
tiple hypervascularized HCC lesions in the right liver lobe
(yellow arrow, lesion in segment V). (b) Celiacography
with a 5-F macrocatheter in the main hepatic artery (yel-
low arrow, tip of the catheter). (c) Place of dose applica-
tion with a 2.5-F microcatheter placed in the proximal
right hepatic artery (yellow arrow, tip of the microcathe-
ter). (d) Control MRI after 3months and two sessions of
DSM-TACE showing a partial response with partially
smaller and devascularized lesions (yellow arrow, lesion
in segment V with a reduced lesion diameter and signi-
cant devascularization)
16 Miscellaneous
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146
Fig. 16.4 A 73-year-old male with HCV-related cirrho-
sis, with VII–VIII segmental liver resection for a single
HCC, that presents with tumor recurrence 1year after sur-
gery. CT scan shows viable tumor activity (a, b, yellow
arrows) adjacent to resected area (c, yellow arrowheads),
and hypervascular infracentimetric nodules nonconclu-
sive of HCC tumors (c, red arrow). Selective angiography
of the hepatic artery is performed conrming local recur-
rence (d, e, f) as well as hypervascular infracentimetric
nodules (g, red arrows). TACE was performed from seg-
mental branches using 100–300 micron DEM, with a total
amount of 100mg of doxorubicin administered, to achieve
a complete tumor devascularization (h, i). The patient pre-
sented with postembolization syndrome during admission
and mild alteration of ALT/AST that returned to normal
within 2weeks. A follow-up CT scan performed 4weeks
later showed complete tumor response but biliary tract
dilatation (j, yellow arrows). After recovering from
fatigue, a second TACE session was scheduled 3months
later
abc
P. Lucatelli et al.
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147
de f
g
l
hi
Fig. 16.4 (continued)
16 Miscellaneous
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148
ab
c d
ef
Fig. 16.5 Transarterial radio-embolization (TARE) treat-
ment for intrahepatic cholangiocarcinoma in a 46-year-
old woman. Preoperative CT images of a large
cholangiocarcinoma in the right hepatic lobe on arterial
(a) and portal (b) phases. Digital subtraction angiography
during TARE (c), with intra-procedural cone-beam CT
scan in arterial phase (d). SPECT-CT exam after TARE
showing intra-tumoral distribution of Y-90 microspheres
(e). CT scan performed 1month after TARE, showing dif-
fuse tumor necrosis (f)
P. Lucatelli et al.
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ab
Fig. 16.6 Pretreatment arterial phase CT showing an
hypervascular HCC in VII liver segment (a). Three
months after SIRT arterial phase CT showing disappear-
ance of all hypervascular tumor components conguring a
complete response according to mRECIST (b)
16 Miscellaneous
t.me/medicina_free
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