fig1

Figure 1. Hepatitis C cirrhosis in an 88-year-old woman complicated by HCC. Initial alpha fetoprotein (AFP) tumor marker was 9736. (A) Venous phase contrast-enhanced CT liver shows a nodular HCC with vascular invasion, expanding the segment 3 portal vein (black arrowheads). (B) C-arm computed tomography image during Y90 mapping angiography shows arterial enhancement of the HCC involving the portal vein (white arrowheads). (C) Single-photon emission computed tomography image fused with computed tomography image shows preferential deposition of Tc-99m MAA radiotracer in the tumor compared to the normal parenchyma. (D) Planar images show Tc-99m MAA deposition, primarily in the liver. Regions of interest are created over the lungs and liver to determine the lung shunt fraction (2% in this case). (E) Following radioembolization of the left hepatic artery, venous phase contrast-enhanced CT liver shows complete necrosis of the tumor (asterisk), and the AFP normalized to 4. MAA: Macroaggregated albumin; AFP: alpha-fetoprotein.