Balloon-Occluded Trans-Arterial Chemo-Embolization Technique with Repeated Alternate Infusion of Cisplatin Solution and Sparse Gelatin Slurry (RAIB-TACE) for Large Hepatocellular Carcinoma Nodules More than 7 cm in Diameter

Figure 1

RAIB-TACE for a large nodule in the liver hilum. Immediately before the first session of RAIB-TACE, MIP image of trans-arterial MDCT angiography via the celiac artery well depicted hepatic arterial branches and the large nodule (large white arrow, A) in the liver hilum. Multiple tiny high density spots were arterioportal shunts. RAIB-TACE was performed for right hepatic (large black arrow, A), medial segmental (small black arrow, A), caudate segmental (small black arrowhead, A), and left hepatic arteries (large black arrowhead, A). Post-TACE DSA showed occlusion of all hepatic arterial branches (black arrows and arrowheads, B) and patent cystic artery (white arrowhead, B). CT 3 months after RAIB-TACE depicted a remaining viable part (white arrow, C), and PR was achieved. The second session of RAIB-TACE was performed 5 months after the first one. MIP image of trans-arterial MDCT angiography via the celiac artery showed patent hepatic arterial branches (black arrow, black arrowhead, D) and tumor vessels in a remaining viable part of the large nodule (white arrow, D). RAIB-TACE could be successfully done via the left hepatic artery (black arrowhead, D). CR of the large nodule (white arrow, E) was achieved after the second session of RAIB-TACE.

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