الفهرس 
Anatomy of the Liver and its Vascular SupplyOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm in the world and its incidence is increasing worldwide. Overall, HCC is associated with liver cirrhosis in 80% of cases and it is the leading cause of death among cirrhotic patients .The treatment of patients with HCC has evolved in the last few years. However, curative treatments such as liver resection, liver transplantation or percutaneous ablation [percutaneous ethanol injection (PEI) and radiofrequency ablation (RF)] are applicable in only 30%-40% of cases. Since transarterial chemoembolization (TACE) was introduced as a palliative treatment in patients with unresectable HCC, it has become one of the most common forms of interventional therapy. Recently, it has been demonstrated that TACE improves survival compared with best supportive care in meta-analyses of randomized trials and in two individual clinical trial .
In our study we used articles which discuss ameta- analysis of monitoring the effectiveness of TACE in patients with unresectable HCC by CT.
Hyo Soon Lim, Yong Yeon Jeong et al 2006 found that CT is the standard imaging technique for monitoring the effectiveness of TACE .
Sanjeev Katyal et al 2000 found that patients with unresectable hepatocellular carcinoma who have a predominant pattern of hypervascular enhancing lesions on hepatic arterial phase helical CT are more likely to show a response to transcatheter arterial chemoembolization and, more important, that these responders are statistically more likely to live longer. In addition, the greatest survival benefit is offered to patients with only purely hypervascular enhancing lesions on hepatic arterial phase helical CT when compared with patients with predominantly hypervascular or hypovascular enhancing lesions. Also better response and survival rates for patients with hypervascular tumors as determined on angiography.
Seong Hyun Kim,et al 2007 found that the evaluation of the presence of viable tumour in HCC treated with TACE by using imaging techniques is important to determine the subsequent treatment or to avoid unnecessary treatment. The results of our study clearly show that the presence of viable tumor is strongly suggested when the attenuation difference of the IODA is higher than 20 HU on at least 1 contrast-enhanced phase. Therefore, the presence of viable tumor of the IODA in HCC treated with TACE can be precisely predicted by using the attenuation value measurement with quadruple-phase helical CT.
We recommend that arterial phase CT vascular enhancement be used before transcatheter arterial chemoembolization therapy to predict which patients are more likely to respond to therapy. This can provide prognostic information to the patient (improved survival rates) and allow the oncologist the ability to better tailor the dose and frequency of chemoembolization treatments. Also for the confirmation of the feeding arteries toward the tumor using CT in addition to (DSA) and / or CTA will improve the accuracy of the selection of arteries that should be embolized and so improving treatment efficacy and survival rates. Also, combination of TACE with simultaneous evaluation of its results using CT will improve the treatment efficacy.
Finally we can emphacise that, contrast enhanced multiphasic helical CT, is the most frequently used imaging technique for predicting, determining the therapeutic efficacy and follow-up after TACE for HCC.