Nitroglycerine use in transcatheter arterial (chemo)embolization in patients with hepatocellular carcinoma and dual-energy CT assessment of Lipiodol retention

Objectives To investigate whether the addition of nitroglycerine to transcatheter arterial (chemo)embolization (TAE/ TACE) can increase the delivery and effectiveness of TAE/ TACE in patients with hepatocellular carcinoma (HCC) by dual-energy CT. Methods HCC patients (BCLC stage A or B) were randomized to (n=51) or not to (n=50) receive nitroglycerine and an emulsion of Lipiodol with or without doxorubicin, followed by embolization with Gelfoam pledgets. Dual-energy CT was performed pre- and 1 to 3 months post-embolization to assess changes in tumour diameter and Lipiodol levels in tumours. Results Median tumour diameter decreased from baseline in both groups with and without nitroglycerine (7.11 % vs. 12.5 %, respectively), and was statistically significant in the group receiving nitroglycerine (P=0.023). There was no difference between the two groups in disease response (P=0.237). The concentration and percentage of Lipiodol retained in tumours were significantly greater in patients treated with nitroglycerine compared to those without (median concentration 15.05 mg/mL vs. 4.40 mg/mL, respectively, P<0.001; median percentage 82.01 % vs. 36.75 %, respectively, P<0.001).