Super selective transcatheter arterial embolization for treatment of focal nodular hyperplasia of the liver: report of 21 cases

Abstract

To evaluate the efficiency and safety of transcatheter arterial embolization (TAE) for treatment of focal nodular hyperplasia (FNH). From January 2005 to December 2010, super selective TAE was performed for 21 patients with FNH. The patients consisted of 16 men and 5 women with age range of 16 to 44 years (mean age, 28 ± 12). Liver contrast enhancement CT and ultrasonography (US) were performed in all patients, dynamic contrast enhancement MRI was performed in 17 patients. All patients underwent percutaneous needle biopsies and the diagnosis of FNH was proven histologically. The indications for TAE were patients with progressive increase in size of FNH, who were not candidates for surgical treatment, or who refused for surgery. Embolic materials used in this series included emulsion of iodized oil and bleomycin and polyvinyl alcohol particle (PVA). Follow-up examinations included the routine blood tests, liver and renal function tests, US, CT or MRI. Eighteen patients (85.7%) had a single solitary focus and 3 (14.3%) had multiple foci. The diameter of the mass varied from 3.5 cm to 9.5 cm with a mean of 5.5 cm (5.5 ± 3.0 cm). All patients presented angiographically with characteristic findings, such as feeding artery that was distributed with a spinning wheel appearance, an extensive hypervascular mass, without arterio-venous shunt or portal vein invasion. A single session of TAE was performed in all patients. Technical success of TAE was achieved in all cases. No major complications were encountered in any of our patients. All patients were regularly followed up ranging from 1 to 6 years (3.5 ± 2.0) and they were healthy without recurrence. Marked reduction in the size of the FNH without arterial blood supply was found in 16 patients, and almost complete resolution of the FNH was observed in 6 patients. TAE is a safe and effective therapy for the management of patients with FNH. TAE could control FNH very well and even could be considered as a radical treatment.