The purpose of this study was to evaluate the clinical course of main bile duct stricture at the hepatic hilum after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Among 446 consecutive patients with HCC treated by TACE, main bile duct stricture developed in 18 (4.0%). All imaging and laboratory data, treatment course, and outcomes were retrospectively analyzed. All patients had 1 to 2 tumors measuring 10 to 100 mm in diameter (mean ± SD 24.5 ± 5.4 mm) near the hepatic hilum fed by the caudate arterial branch (A1) and/or medial segmental artery (A4) of the liver. During the TACE procedure that caused bile duct injury, A1 was embolized in 8, A4 was embolized in 5, and both were embolized in 5 patients. Nine patients (50.0%) had a history of TACE in either A1 or A4. Iodized oil accumulation in the bile duct wall was seen in all patients on computed tomography obtained 1 week later. Bile duct dilatation caused by main bile duct stricture developed in both lobes (n = 9), in the right lobe (n = 3), in the left lobe (n = 4), in segment (S) 2 (n = 1), and in S3 (n = 1). Serum levels of alkaline phosphatase and γ-glutamyltranspeptidase increased in 13 patients. Biloma requiring drainage developed in 2 patients; jaundice developed in 4 patients; and metallic stents were placed in 3 patients. Complications after additional TACE sessions, including biloma (n = 3) and/or jaundice (n = 5), occurred in 7 patients and were treated by additional intervention, including metallic stent placement in 2 patients. After initial TACE of A1 and/or A4, 8 patients (44.4%), including 5 with uncontrollable jaundice or cholangitis, died at 37.9 ± 34.9 months after TACE, and 10 (55.6%) have survived for 38.4 ± 37.9 months. Selective TACE of A1 and/or A4 carries a risk of main bile duct stricture at the hepatic hilum. Biloma and jaundice are serious complications associated with bile duct strictures.

The purpose of this study was to evaluate the detectability of corona enhancement around the hypervascular hepatocellular carcinoma (HCC) by dual-phase cone-beam computed tomography during hepatic arteriography (CBCTHA). Dual-phase CBCTHA was performed for 71 HCC lesions (mean ± SD 1.7 ± 0.9 cm), including seven presenting a nodule-in-nodule appearance and nine hypervascular pseudolesions. The first scan was performed during injection of 30-40 ml half-diluted contrast material at a rate of 1.5-2 ml/s through the hepatic artery. Scanning was initiated 7 s after the beginning of contrast material injection. The second scan was started 30 s after the end of the first scan. Detectability of corona enhancement on second-phase CBCTHA was evaluated. Thickness of corona enhancement was also analyzed as thin (≤2 mm) or thick (>2 mm). Corona enhancement was detected in 63 (88.7%) of 71 tumors (1.8 ± 0.9 cm), but it was not detected in eight tumors (1.0 ± 0.2 cm). Thin corona enhancement was seen in 18 tumors (1.2 ± 0.5 cm), and thick corona enhancement was seen in 45 tumors (2.0 ± 0.9 cm). There was a significant difference in tumor diameter between tumors with and those without corona enhancement (P = 0.0157) and between thin and thick corona enhancement (P = 0.001). In all seven early-stage tumors, corona enhancement was demonstrated around the hypervascular focus within the hypovascular tumor portion. None of the nine pseudolesions showed any corona enhancement. Dual-phase CBCTHA depicted corona enhancement in 88.7% of hypervascular HCC lesions. This technique may improve the diagnostic accuracy of HCC.

There are usually multiple caudate arteries arising from the right, left, and middle hepatic arteries, and they are frequently connected to each other. Therefore, hepatocellular carcinoma (HCC) in the caudate lobe is frequently fed by multiple branches arising from different origins. HCC located in the Spiegel lobe is usually fed by the caudate arteries derived from the right and/or left hepatic artery. HCC in the paracaval portion is mainly fed by the caudate artery derived from the right hepatic artery; with low frequency, it is fed by the caudate artery derived from the left hepatic artery. HCC in the caudate process is usually fed by the caudate artery derived from the right hepatic artery. Because of the complexity and overlap of vascular territories, the tumor-feeding branch of a recurrent HCC lesion in the caudate lobe frequently changes on follow-up arteriograms. In addition, several extrahepatic collateral vessels supply the recurrent tumor. To perform effective transcatheter arterial chemoembolization (TACE) for HCC in the caudate lobe, radiologists should have sufficient knowledge of vascular anatomy supplying HCC in the caudate lobe.

We conclude that the accumulation of a certain amount of LPO in the content of comedones may play an important role in the progression of comedogenesis and the excessive accumulation of LPO may be involved in inflammatory changes in comedones.

We report a female case of sinusoidal obstruction syndrome (SOS) diagnosed pathologically after chemotherapy (Pmab+m-FOLFOX6) for ascending colon cancer with multiple liver metastases, focusing on the findings of gadoxetic acid-enhanced MRI (EOB-MRI) and the organic anion transporting polypeptide 1B3 (OATP1B3) expression of in the liver. The patient was a 75-year-old female. She had received chemotherapy (Pmab+m-FOLFOX6) as six cycles for preoperative chemotherapy. After the preoperative chemotherapy, tumor sizes of hepatic metastases were reduced and hepatobiliary phase of EOB-MRI clearly depicted diffuse reticular hypointensity in the background liver. On the other hand, dynamic CT and/or other sequences of EOB-MRI did not show definite abnormality in the background liver. After the operation, this patient was pathologically confirmed as SOS demonstrating centrilobular congestion, sinusoidal dilatation, and perisinusoidal fibrosis. In normal liver parenchyma, OATP1B3 (uptake transporter of the EOB-MRI) expression is observed predominantly in centrilobular hepatocytes (zone 3). On the other hand, OATP1B3 expression was remarkably reduced because of the damages in the centrilobular (zone 3) hepatocytes in this SOS case. This indicated that EOB-MRI might be extremely sensitive in diagnosing SOS in its early stage.