In patients with liver malignancies potentially amenable to curative extended right hepatectomy but insufficient size of the future liver remnant (FLR), portal vein embolization (PVE) of the tumor-bearing liver is used to induce contralateral liver hypertrophy but leaves the tumor untreated. Radioembolization (RE) treats the tumor in the embolized lobe along with contralateral hypertrophy induction. We performed a matched-pair analysis to compare the capacity for hypertrophy induction of these two modalities. Patients with right-hepatic secondary liver malignancies with no or negligible left-hepatic tumor involvement who were treated by right-lobar PVE (n 5 141) or RE (n 5 35) at two centers were matched for criteria known to influence liver regeneration following PVE: 1) baseline FLR/Total liver volume ratio (<25 versus 25%); 2) prior platinum-containing systemic chemotherapy; 3) embolization of segments 5-8 versus 4-8; and 4) baseline platelet count (<200 versus 200 Gpt/L).The primary endpoint was relative change in FLR volume from baseline to follow-up. Twenty-six matched pairs were identified. FLR volume increase from baseline to follow-up (median 33 [24-56] days after PVE or 46 [27-79] days after RE) was significant in both groups but PVE produced significantly more FLR hypertrophy than RE (61.5 versus 29%, P < 0.001). Time between treatment and follow-up was not correlated with the degree of contralateral hypertrophy achieved in both groups. Although group differences in patient history and treatment setting were present and some bias cannot be excluded, this was minimized by the matched-pair design, as remaining group differences after matching were found to have no significant influence on contralateral hypertrophy development. Conclusion: PVE induces significantly more contralateral hypertrophy than RE with therapeutic (nonlobectomy) doses. However, contralateral hypertrophy induced by RE is substantial and RE minimizes the risk of tumor progression in the treated lobe, possibly making it a suitable modality for selected patients. (HEPATOLOGY 2014;59:1864-1873 S urgical resection remains the only option for cure in patients with primary or secondary malignant liver tumors. Unfortunately, insufficient size of the liver parenchyma that can be preserved (at least 20%-25% in otherwise healthy and 40% in prediseased livers) may preclude surgery.1 For these cases, preoperative portal vein embolization (PVE) of the tumor-bearing liver lobe has been established over the last 25 years as the standard procedure to induce hypertrophy of the nonembolized liver, resulting in an increase in future liver remnant (FLR) volume of up to 69%.2 It has been demonstrated that a high degree of post-PVE FLR hypertrophy is associated with a decreased rate of postoperative liver dysfunction 3 and that preoperative PVE has a beneficial effect on postoperative morbidity in patients with chronic liverAbbreviations: ANCOVA, analysis of covariance; ANOVA, analysis of variance; FLR, future liver remnant; MRI, magnetic resonance imagin...

Noncirrhotic patients undergoing sequential lobar radioembolization had less hepatic toxicity compared to whole liver embolization. The sequential approach should be the preferred strategy.

<b><i>Background:</i></b> To date, there are inconsistent data about relationships between diffusion-weighted imaging (DWI) and tumor grading/microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Our purpose was to systematize the reported results regarding the role of DWI in prediction of tumor grading/MVI in HCC. <b><i>Method:</i></b> MEDLINE library, Scopus, and Embase data bases were screened up to December 2019. Overall, 29 studies with 2,715 tumors were included into the analysis. There were 20 studies regarding DWI and tumor grading, 8 studies about DWI and MVI, and 1 study investigated DWI, tumor grading, and MVI in HCC. <b><i>Results:</i></b> In 21 studies (1,799 tumors), mean apparent diffusion coefficient (ADC) values (ADC_mean) were used for distinguishing HCCs. ADC_mean of G1–3 lesions overlapped significantly. In 4 studies (461 lesions), minimum ADC (ADC_min) was used. ADC_min values in G1/2 lesions were over 0.80 × 10⁻³ mm²/s and in G3 tumors below 0.80 × 10⁻³ mm²/s. In 4 studies (241 tumors), true diffusion (<i>D</i>) was reported. A significant overlapping of <i>D</i> values between G1, G2, and G3 groups was found. ADC_mean and MVI were analyzed in 9 studies (1,059 HCCs). ADC_mean values of MIV+/MVI− lesions overlapped significantly. ADC_min was used in 4 studies (672 lesions). ADC_min values of MVI+ tumors were in the area under 1.00 × 10⁻³ mm²/s. In 3 studies (227 tumors), <i>D</i> was used. Also, <i>D</i> values of MVI+ lesions were predominantly in the area under 1.00 × 10⁻³ mm²/s. <b><i>Conclusion:</i></b> ADC_min reflects tumor grading, and ADC_min and <i>D</i> predict MVI in HCC. Therefore, these DWI parameters should be estimated for every HCC lesion for pretreatment tumor stratification. ADC_mean cannot predict tumor grading/MVI in HCC.