Does TIPS Hide HCC at Angiography: Hepatocellular Carcinoma Visibility during Transarterial Chemoembolization in Patients with Transjugular Intrahepatic Portosystemic Shunts?
Objective: To compare the visibility of hepatocellular carcinoma (HCC) at angiography during transarterial chemoembolization (TACE) in patients with and without transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of patients with HCC and TIPS who underwent TACE between January 2004 and June 2014 was performed resulting in 26 patients. A group of 23 patients with HCC treated with TACE but without TIPS were used as comparison that encompassed the same time period. Both groups had comparable model for end-stage liver disease (MELD) scores. The angiographic tumor blush of the HCC at TACE was graded as poorly visualized, easily visualized, or hyperenhancing by two independent board-certified interventional radiologists. Results: Twenty-six patients with TIPS and 23 patients without TIPS who underwent TACE for HCC were included resulting in a total of 98 grades by the two reviewers. The tumor blush of the HCC was more visible in patients without TIPS than those with TIPS during TACE for both reviewers, (p = 0.0003). In the TIPS group, only 5 of 26 patients (19%) had a hyperenhancing blush at TACE for both reviewers. Hyperenhancing or easily visualized tumor blush was present in 22 of 23 patients (96%) for reviewer 1 and in 17 of 23 patients (74%) for reviewer 2 without TIPS. Of the HCC’s with a poorly visualized tumor blush, 12 of 13 patients (92%) and 14 of 20 patients (70%) had TIPS for reviewer 1 and reviewer 2, respectively. Conclusion: The tumor stain of HCC at TACE may be more difficult to see in patients with TIPS compared with patients without TIPS in place. Patients with TIPS with poor vascular blush may benefit from nonvascular interventions such as radiofrequency or alcohol ablation.