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Figure 3. DSM-TACE and biliary toxicity. 58 years-old male with viral/alcoholic hepatic cirrhosis, Child B7, MELD 11, portal hypertension. Multinodular HCC relapse after surgical resection of a single nodule of 3 cm in segment III. (A) Selective hepatic DSA before DSM-TACE shows multiple hypervascular small nodules in both lobes. (B) Good response after 2 cycles of DSM-TACE: the HCC nodules are no more visible in the preliminary DSA performed before the third session. (C) CT control at 6 months after the 3rd DSM-TACE revealed delayed formation of small cystic bilomas. (D) MR Cholangiography one year later showed progression of intrahepatic bile duct dilatation in the right lobe and formation of a larger biloma, despite interruption of TACE repetition.