PMC9633743_01
Baseline arterial phase enhanced T1W axial image of the liver (A) shows a subcapsular enhancing hepatocellular cancer. Venous phase of the same MRI sequence (B) showed contrast washout from the tumor and an enhancing pseudocapsule (arrowheads).
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An abdominal MRI revealed a 2.5 cm subcapsular HCC in segment VII of the liver with arterial hyperenhancement, delayed contrast washout, and pseudocapsule (Fig. 1).
Axial cone-beam CT obtained while performing selective right hepatic arteriogram shows lack of enhancement that corresponds exactly to the tumor shown in Fig. 1. Review of all arteriography obtained from the hepatic arteries failed to show any tumor enhancement.
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Selective hepatic arteriography and contrast-enhanced cone-beam CT demonstrated that the HCC did not receive arterial perfusion from the hepatic arteries (Fig. 2).
Right inferior phrenic arteriogram (A) shows intense enhancement in the expected location of the tumor (arrowheads). The selective right superior adrenal arteriogram and the corresponding cone-beam CT (B and C) confirmed that it was the sole provider of arterial flow to the tumor.
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Right superior adrenal arteriography and cone-beam CT demonstrated hyperenhancement of the entire tumor exclusively from this vessel (Fig. 3).
Image fusion of Bremsstrahlung single-photon emission CT information and baseline T1W axial image of the liver after intravenous administration of intravenous contrast. The radioactivity is distributed sharply in the hepatocellular cancer and a rim of surrounding liver. The brachytherapy with Y90 microspheres was extremely conformal and only reached the intended target tissues.
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The administered activity was highly conformal by Bremsstrahlung single-photon emission CT (Fig. 4) and resulted in a complete response by modified response evaluation criteria in solid tumors (Fig. 5).