PMC3036648_01
Baseline CT examination: 1a, arterious phase; 1b, portal phase; 1c, late phase. Between III and IV hepatic segment is possible to observe the presence of a solid lesion with poorly defined margins and infiltrative nature; the lesion is hyperdense in arterial phase and hypodense in the portal phase and late, and it invades the left main portal vein which is thrombosed.
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Splenomegaly (16 cm DL) and gallbladder microlithiasis were also pointed out (Figure 1).
three-months follow-up with CT: 2a, arterious phase; 2b, portal phase; 2c, late phase. The three months CT scan document an apparent reduction in the size of lesion, which is associated with partial recanalization of the left portal branch.
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The three-phase multidetector CT (Light Speed Plus) with contrast medium highlighted a marked dimensional reduction of infiltrating focality at the segment III-IV (from 6 cm to 3 cm) (Figure 2).
Six months follow up with MRI before and after injection of Primovist: 3a, T1-weighted; 3b, T2-weighted; 3c, arterial phase; 3d, portal venous phase; e, hepatobiliary phase. At six months of treatment, the liver injury is no longer recognizable at MRI examination and the left portal branch is fully recanalized, as with almost complete response to treatment.
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The MRI (Signa HDx; GE Healthcare, Milwaukee, WI) with liver-specific contrast medium (Primovist, Bayer Schering) (figure 3) did not identify at all the lesion at segment III and IV.
Twelve-months follow up with MRI before and after after injection of Primovist: 5a, T1-weighted; 5b, T2-weighted:On baseline T1w.i and T2w.i no sign of changes of signal intensity within the liver parenchyma is appreciable, not even at the level of the previous lesion of segment III.
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4rd assessment (after twelve months) - By the twelfth month the patient performed a new MRI with liver-specific contrast medium (Primovist, Bayer Schering) (figure 4 and 5).
Twelve-months follow up with MRI before and after after injection of Primovist: 6a, arterial phase; 6b portal venous phase; 6c portal venous phase delayed; 6d hepatobiliary phase. On post contrastographic dynamic study, there is no focal enhancement on arterial phase 6a, nor signs of portal branches invasion on portal venous phase 6b, nor areas of hypointensity on delayed phase 6c. On hepatobiliary phase 6d, homogeneous enhancement of the previous neoplastic parenchyma of segment III is now appreciable.
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4rd assessment (after twelve months) - By the twelfth month the patient performed a new MRI with liver-specific contrast medium (Primovist, Bayer Schering) (figure 4 and 5).
Analysis of metallo-proteinase 9 serum level: A clear reduction of marker serum level is observed after three months of treatment
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Analysis available on the third month, showed a marked reduction of metallo-proteinase 9 level during the treatment with sorafenib. (Figure 6).