In Reply to: Re: Case 0100_05 -- Hepatocellular Carcinoma with Multifocal Simultaneous Adenomas posted by Jim Lutz, M.D. on January 18, 19100 at 22:21:54:
Adenomas and FNH do tend to be hypervascular as are HCCs although a small percent of HCCs are hypovascular. I am not sure that the hypovascular lesions are in fact adenomas. Could they be hemangiomas? Delayed scanning should have shown filling in if they were hemangiomas. RBC scan can also help to r/o hemangioma as is MR with hyper T2 weighting.
The embolic materials used in chemoembolization vary quite a bit but the commonest used are PVA, gelfoam and lipiodol. I am not sure that anyone has clearly demonstrated an advantage of one embolization agent versus another. We are currently using gelfoam powder for all our patients. It is easy to prepare and cheap.
The issue of hepatic functional reserve is very important and there is a new agent called TcGSA that binds to asialoglycoprotein receptors in the liver. I think it will be the next generaiton nuclear medicine agent to assess liver function. It is going through the FDA right now. Commonly used in Japan and Europe.