Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma

Figure 1 Hepatic angiography - arterial phase - and levels of superselection for administration of the chemoembolic agent. Superelelectivity levels for administration of the chemoembolic agent. 1: Proximal embolization: right/left hepatic artery trunk; 2: Segmental: right/left hepatic artery segmental branch; 3: Subsegmental branch of the right/left hepatic artery.

Figure 2 Representation of feeding vessels and hypervascularization of hepatocellular carcinoma in hepatic angiography. A: Hepatic angiography - arterial phase - showing, in solid line, projection two feeding vessels responsible for the formation of hepatocellular carcinoma who received chemoembolic agent dose; B: Hepatic angiography - arterial phase - showing the presence of a circular area in the projection of hepatocellular carcinoma with contrast medium concentration in relation to the adjacent area, being characterized as a hypervascular hepatocellular carcinoma.

Figure 3 Calculation method for individualization of the dose of the chemoembolic agent received by treated hepatocellular carcinoma in situations of impossibility of the superselective catheterism. A: Magnetic resonance imaging pre-chemoembolization abdomen - post-contrast T1 weighted phase - showing three confluent hypervascular lesions; B: Selective hepatic arteriography in segment VI of the right hepatic artery showing hypervascular lesions characteristic of hepatocellular carcinoma; C: Intraoperative cone beam tomography with selective arterial contrast in segment VI - venous phase - showing three confluent lesions with contrast medium lavage; D: Diameter of hepatocellular carcinomas located in segment VI to be treated; E: Exemplification of the calculation of dose individualization of the chemoembolic agent administered; F: Equation of individualized chemoembolic dose. MRI: Magnetic resonance imaging.

Figure 4 Flowchart of the patients included in the study. HCC: Hepatocellular carcinoma; CT: Computed tomography; MRI: Magnetic resonance imaging; DEB-TACE: Drug-eluting bead transarterial chemoembolization.

Figure 5 Receiver operating characteristics curve of prediction of hepatocellular carcinoma objective response.