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 2

Subsegmental level liver infarction after RAIB-TACE. On arterial phase CT, a large nodule (white arrow, A) and multiple intrahepatic metastases (black arrows, A) were seen. On portal phase CT, dilatation of biliary tract in subsegment 7 (black arrow, B) was seen due to compression of proximal Glisson sheath by the large nodule. RAIB-TACE for the bi-lobe of the liver was done. Post-TACE DSA depicted patent cystic (black arrow, C) and right gastric arteries (white arrow, C) while occlusion of all hepatic arterial branches was achieved. Grade 4 increase of serum ALT level was seen on the next day after RAIB-TACE, and CT obtained 3 days after RAIB-TACE showed low density area (black arrows, D) that was compatible with liver infarction. On CT 3 months after RAIB-TACE, CR of the large nodule (black arrow, E) and disappearance of intrahepatic metastases were also shown. Dimpling of the liver surface (black arrow, F) was seen in the region of liver infarction. On CT 21 months after RAIB-TACE, CR of the large nodule was maintained (black arrow, G), but portal venous tumor thrombosis (black arrow, H) and rib metastases (not shown) were also seen.

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