Although transarterial chemoembolization is a prevalent treatment for hepatocellular carcinoma (HCC), its efficacy is limited by inadequate vascular infiltration, inconsistent embolization, and lack of therapeutic synergy. We developed a multifunctional injectable hydrogel system using strategically combined high- and low-molecular-weight hyaluronic acid and a carbon dot/iron complex (APIO/Fe complex) to overcome these challenges. The dual-molecular-weight approach optimizes both structural integrity and injectability and also enables the homogeneous distribution of therapeutic agents. The APIO carbon dots were produced by a one-pot hydrothermal synthesis using iohexol and 1-(3-aminopropyl) imidazole as dual-purpose precursors for computed tomography (CT) imaging and iron chelation. The APIO/Fe complex was characterized via dynamic light scattering, X-ray photoelectron spectroscopy, and transmission electron microscopy, confirming its nanoscale structure and compositional integrity. The APIO/Fe hydrogel demonstrated shear-thinning and self-healing properties, injectability, and mechanical recovery. The APIO/Fe complex and the hydrogel preserved CT and magnetic resonance imaging contrast capabilities compared with conventional contrast agents. They also catalyzed the Fenton reaction, initiated the formation of reactive oxygen species, and accelerated coagulation upon interaction with blood. In a three-dimensional vascular model, the APIO/Fe complex induced occlusion. This multifunctional platform integrates imaging visibility, oxidative therapy, and embolic function, thus providing a synergistic, minimally invasive approach for HCC treatment.

Prognostic value of the Ki-67 index in patients with early recurrent hepatocellular carcinoma undergoing postoperative transarterial chemoembolization.

Deciphering the significance of tumor necrosis and developing a grading system in combined hepatocellular-cholangiocarcinoma: A multicenter pathological study.

Safety and performance of a Lipiodol-resistant mixing and injection system in conventional trans-arterial chemoembolization: A post-market clinical follow-up.

Survival benefit of resectability determined by multiple surgeons in BCLC-C Stage: A single-center cohort study.

Functional doxorubicin and iron ions dual-loaded carboxymethyl chitin-based microspheres for hepatocellular carcinoma therapy via embolization, ferroptosis, and autophagy-mediated HIF-1α inhibition.

BACKGROUND This study aimed to evaluate the efficacy and safety of bleomycin–lipiodol transarterial chemoembolization in the treatment of giant hepatic hemangiomas based on data from our center and to assess volumetric changes in non-target hemangiomas, as well as the contribution of a coil-assisted superselective approach to procedural safety. METHODS Retrospective data from 23 patients who underwent bleomycin–lipiodol transarterial chemoembolization for the treatment of giant hepatic hemangiomas between October 2018 and December 2024 were analyzed. Target hemangioma volumes were calculated before the procedure and at 6 months of follow-up. Clinical success was defined as ≥ 50% volume reduction on ultrasonography at 6 months. Non-target hemangiomas were evaluated at mid- and long-term follow-up. Detachable mechanical coil embolization was performed for 4 patients to prevent reflux and vasospasm in the non-lesional parenchyma. Complications were classified according to Cardiovascular and Interventional Radiological Society of Europe standards. RESULTS The mean age of the patients was 51.2 ± 8.6 years, and 19 (82.6%) were female. No major complications or mortality were observed; minor complications occurred in 3 patients (13%). At 6 months, the mean volume reduction rate was 54.2 ± 11.3% (p < 0.001). Clinical success was achieved in 20 cases (87.0%). Volume reduction increased with longer follow-up, reaching 83% at 24 months and 94% at ≥ 36 months. Among 10 patients with multiple hemangiomas, non-target lesions demonstrated an average 85% reduction in volume in mid- to long-term follow-up evaluations. CONCLUSION Bleomycin–lipiodol transarterial chemoembolization is a safe and effective treatment for giant hepatic hemangiomas, achieving high efficacy with low morbidity. The treatment provides significant volume reduction not only in target lesions but also in non-target hemangiomas, suggesting a potential locoregional or diffuse pharmacological effect beyond the directly embolized area. Coil-assisted superselective embolization substantially enhances procedural safety. Bleomycin, embolization, eemangioma, lipiodol, liver

BACKGROUND Hepatocellular carcinoma (HCC) is a significant global health issue that is often diagnosed in advanced stages. Transcatheter arterial chemoembolization (TACE) is a standard intervention for unresectable HCC; however, it is frequently followed by tumor recurrence, highlighting the need for reliable prognostic tools. This study evaluated the combined predictive value of contrast-enhanced ultrasound (CEUS) and Doppler ultrasound in assessing the clinical outcomes post-TACE. AIM To develop a comprehensive imaging strategy that can guide personalized treatment planning through an improved assessment of tumor vascularization and liver function, assess the predictive value of CEUS combined with Doppler ultrasound in patients with HCC who underwent TACE. METHODS This retrospective study analyzed 124 patients with HCC who underwent TACE. Based on 1-year outcomes, the patients were stratified into good (n = 86) and poor (n = 38) prognostic groups. We compared the clinical and ultrasound data (CEUS and Doppler parameters) between the groups to identify prognostic factors. Multivariate logistic regression was used to identify independent predictors, and receiver operating characteristic curve was used to evaluate the predictive power of the combined model for post-TACE prognosis. RESULTS Significant differences were observed between the two groups in terms of TNM stage, number of lesions, tumor size, arrival time (AT), washout time (WT), hepatic artery peak systolic velocity (VPs), portal vein velocity, and blood flow grading (P < 0.05). Logistic regression analysis showed that TNM stage, tumor size, number of lesions, hepatic artery VPs, and blood flow grading were risk factors affecting the prognosis of patients with HCC following TACE, whereas AT, WT, and portal vein velocity were protective factors (P < 0.05). Receiver operating characteristic curve analysis demonstrated that the area under the curve values for predicting post-TACE prognosis in patients with HCC were as follows: (1) 0.704 for AT; (2) 0.762 for WT; (3) 0.796 for hepatic artery VPs; (4) 0.796 for portal vein velocity; (5) 0.657 for blood flow grading; and (6) 0.942 for the combined model. CONCLUSION The combination of CEUS and Doppler ultrasound parameters, which reflect tumor vascularization and liver function, has high a predictive value for the prognosis of patients with HCC following TACE.

Hepatocellular carcinoma (HCC) is a cancer type that causes a high rate of cancer death in the world. The standard therapy plan of intermediate and advanced stages of the HCC is transarterial chemoembolization (TACE). The treatment effectiveness is, however, limited because of the heterogeneity of tumors and the resistance to drugs. This paper shows that the HCC patients with TACE resistance alter their tumor immune homeostasis by reducing the secretion of exosomal miR-32-5p, which has a negative relationship with the population of CD68+ macrophages. Both in-cellular and animal studies show that exosomal miR-32-5p leads to ferroptotic cell death in tumor-associated macrophages (TAMs) characterized by augmented lipid oxidation, iron buildup, depletion of glutathione, and mitochondrial malfunction. At the same time, miR-32-5p increases production of M1-type proinflammatory factors such as CD86, CCL2, tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6), thereby enabling macrophage polarization toward tumor-suppressive phenotype. Mechanistically, miR-32-5p activates the cyclic GMP-AMP synthase (cGAS)–stimulator of interferon genes (STING) signaling pathway through ARID1B down-regulation, ultimately remodeling the tumor immune microenvironment. Experimental murine models indicated that the delivery of exosomal miR-32-5p was a strong tumor suppressor and disseminator, increased the recruitments of CD86 + antigen-presenting cells and CD8 + T lymphocytes, and boosted anti-neoplastic immunity. It should be highlighted that exosomal miR-32-5p also increased the levels of PD-L1, which reflected its complementary value to anti-PD-L1 immunotherapy. Such a combined treatment led to excellent tumor control and enhanced survival without loss of acceptable toxicity profiles. The essential role of ferroptosis was confirmed by the use of Fer-1 to inhibit the chemical reactions, which revealed a new approach by which TACE-resistant exosomal miR-32-5p could inhibit the progression of HCC and complement the anti-PD-L1 therapeutic effects through ferroptosis using TAM, providing insights as well as potential therapeutic objectives in the treatment of HCC.

Background The favorable experience with superselective transarterial chemoembolization (TACE) using lipiodol-bleomycin may lead some hepatopancreatobiliary surgery centers to offer it as first-line treatment for symptomatic/enlarging hemangiomas. Patients and methods The charts of 56 patients treated at a university hospital between 2012 and 2018 were reviewed. The results were reported as median (range). Results The indication was abdominal pain in 46 patients (concomitant enlargement in 12, enlargement and fever in 1), asymptomatic enlargement in 8 and possibility of adverse hemodynamic consequences in two. A single session was planned for 48 patients and two-sessions in 8; in addition, four patients required 2 ( n : 2) or 3 ( n : 2) sessions for symptom control. Six patients (11%), experienced post-embolization syndrome lasting longer than one week. Lesion volume decreased from 586 (147–8,435) cm 3 to 332 (24–4,710) cm 3 in 4 (2–8) months after the first session [ p < 0.01; 46% (5–92) regression]. In the 8 patients who underwent two planned sessions, lesion volume decreased from 1,454 (441–8,435) cm 3 to 661 (159–3,716) cm 3 , 5 (3–7) months after the second session [62% (37–78) regression]. Shrinkage in the 95%–99% range was observed in 13 (25%) of the 51 patients who were followed at least one year. Thirty-four (73%) of the 46 symptomatic patients reported resolution/marked amelioration of symptoms. No late complications were observed in 41 patients (73%) followed for at least 5 years; progressive regression was observed in 36 (88%) cases; in two patients (5%), initial regression was followed by regrowth. Conclusion TACE is a successful first-line treatment for patients with symptomatic/enlarging hemangiomas. Better assessment of the quality of life in symptomatic patients and different definitions of success in cases with symptomatic and asymptomatic progressive enlargement are required.

Rationale:Primary hepatic neuroendocrine carcinoma (PHNET) is an exceptionally rare malignancy with limited standardized treatment options.Patient concerns:Two patients presented with incidentally detected hepatic masses and nonspecific gastrointestinal symptoms.Diagnoses:Case 1 was diagnosed as primary hepatic neuroendocrine carcinoma (NEC, G3), and Case 2 as primary hepatic large-cell neuroendocrine carcinoma (LCNEC, G3), based on histopathology and immunohistochemistry after excluding extrahepatic origins.Interventions:Case 1 received transarterial chemoembolization (TACE), etoposide–cisplatin chemotherapy, hepatic arterial infusion chemotherapy (HAIC), and octreotide. Case 2 underwent 3 cycles of drug-eluting bead TACE (d-TACE), HAIC, and long-acting octreotide for symptomatic control of diarrhea.Outcomes:Case 1 experienced progressive disease and died of sepsis. Case 2 achieved significant tumor regression, allowing curative resection. No recurrence was observed at one-month follow-up.Lessons:The combination of d-TACE, HAIC, and octreotide may provide a potential downstaging approach for unresectable PHNET, but evidence remains preliminary and hypothesis-generating.

Conversion therapy remains an uncommon strategy for managing unresectable hepatocellular carcinoma (uHCC) due to limited evidence supporting its efficacy. To address this gap, we initiated a prospective phase 2 multicenter trial (NCT04997850) comparing the LEN-TAP regimen, combining lenvatinib, transarterial chemoembolization (TACE), and PD-1 inhibitors, against TACE alone in uHCC patients. The study's primary outcome was salvage liver resection (SLR) rate; secondary measures included objective response rate (ORR), overall survival (OS), event-free survival (EFS), recurrence-free survival (RFS), and safety profile. From October 2020 to November 2021, 142 eligible participants were assigned to LEN-TAP (n = 71) or TACE monotherapy (n = 71). At a median follow-up of 24.2 months, the LEN-TAP cohort exhibited a significantly higher SLR rate (59.2% vs. 18.3%, P < 0.001) and ORR (78.9% vs. 16.9%, P < 0.001). Median OS, EFS, and RFS were also substantially prolonged in the LEN-TAP cohort (not reached vs. 23.0 months, P < 0.001; 20.03 vs. 6.52 months, P < 0.001; 36.6 vs. 19.0 months, P = 0.048). Although grade 3 treatment-related AEs occurred more frequently with LEN-TAP (60.6% vs. 21.1%, P < 0.001), no grade 4 or higher toxicities were observed. Exploratory biomarker assessments via single-cell sequencing and flow cytometry linked elevated levels of circulating HLA-DR+CD38+CD8+ T cells with improved treatment response. These T cells appear to mediate antitumor activity potentially through the CXCR6-PI3K-AKT signaling axis. In summary, the LEN-TAP protocol demonstrates promising efficacy and acceptable tolerability as a conversion therapy in uHCC, with peripheral HLA-DR+CD38+CD8+ T cell abundance serving as a potential predictor of therapeutic benefit.

Increasing studies have examined the combination of traditional Chinese medicine (TCM) with Transcatheter arterial chemoembolization (TACE) in treating liver cancer. However, these results were inconsistent in immune function. Therefore, our study aimed to conduct a meta-analysis to evaluate the immune function of TCM combined with TACE in liver cancer patients. Seven electronic databases were retrieved from January 1, 2014, to January 6, 2025. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of all the included articles. The primary outcomes were immune-related indicators, which were measured by standard mean difference (SMD) and 95% CI. A random-effects model was used due to the inconsistent units of measurement. Subgroup analysis and sensitivity analysis were used to explore the sources of heterogeneity. Publication bias was systematically assessed using funnel plots and Egger's test. Meta-analysis was performed using the Stata 17.0. Sixty studies involving 5,371 participants were included in this meta-analysis. Our findings indicated that the TCM + TACE group significantly improved immunity compared to the TACE group, including the proportion of CD3+ (SMD = 1.31, 95%CI = 1.08 to 1.53, P < 0.001), CD4+ (SMD = 1.42, 95%CI = 1.18 to 1.66, P < 0.001), CD8+ (SMD=-1.27, 95%CI=-1.63 to -0.92, P < 0.001), and NK cells (SMD = 2.20, 95%CI = 1.66 to 2.74, P < 0.001), as well as the ratio of CD4+/CD8+ (SMD = 1.37, 95%CI = 1.14 to 1.60, P < 0.001). In addition, Combination treatment significantly decreased the level of VEGF (SMD=-2.49, 95%CI=-3.02 to -1.95, P < 0.001) and IL-10 (SMD=-2.38, 95%CI=-3.58 to -1.17, P < 0.001). However, there were no statistical differences in IL-2 and IL-6 levels among treatment groups. TCM combined with TACE for liver cancer can improve immune function. Additionally, the combination treatment can reduce the VEGF levels associated with inhibiting angiogenesis. Therefore, combining TCM with TACE offers advantages over TACE in treating liver cancer. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) (https://www.crd.york.ac.uk/), registration number CRD420251011821.

Advanced hepatocellular carcinoma (HCC) with extensive metastases is associated with a poor prognosis, highlighting the need for individualized, multimodal treatment strategies. We present the case of a 54-year-old male with advanced HCC (cT3NxM1, Child-Pugh B) and spinal as well as bilateral pulmonary metastases who experienced disease progression after multiple lines of therapy. A dynamically adjusted, multidisciplinary regimen was implemented, incorporating transarterial chemoembolization (TACE), surgery, immunotherapy, and targeted therapy. The final regimen - combining nivolumab plus ipilimumab (O+Y) with TACE and lenvatinib - achieved a partial response in lung metastases, with a progression-free survival exceeding one year and overall survival of over 24 months. This case underscores the therapeutic potential of O+Y in later-line settings and demonstrates the clinical value of an integrated, personalized treatment paradigm for advanced HCC.

To develop a nomogram based on low-dose one-stop dual-energy and perfusion computed tomography (LD-DE&PCT) for predicting the efficacy of transcatheter arterial chemoembolization (TACE) combined with lenvatinib and immune checkpoint inhibitors (TACE-LEN-ICIs) in unresectable hepatocellular carcinoma (uHCC) patients. This prospective, multicenter study included uHCC patients who underwent LD-DE&PCT scanning. The relationships between quantitative LD-DE&PCT-derived parameters and the efficacy of TACE-LEN-ICIs were analyzed using logistic regression analysis. A nomogram incorporating the independent predictors was constructed, and its predictive performance was evaluated by the area under the receiver operating characteristic curve (AUROC). A total of 125 lesions from 71 uHCC patients were enrolled, with 71 lesions (56.8%) classified as the objective response (ObR) group and 54 lesions (43.2%) as the non-response (NR) group. Univariate analysis revealed significant differences in tumor size, corona enhancement, tumor location, iodine concentration in the arterial phase (IC-AP), normalized iodine concentration in the arterial phase (NIC-AP), effective atomic number in the arterial phase (Zeff-AP), slope of spectral HU curve in the arterial phase (λHU-AP), and permeability surface area product (PS) between ObR and NR groups. Among these, NIC-AP exhibited the highest predictive value (AUROC = 0.770; 95% confidence interval [CI]: 0.682‒0.858). Multivariate analysis identified tumor size, NIC-AP, and PS as independent predictors. The nomogram showed excellent performance (AUROC = 0.913; 95% CI: 0.858-0.968). The total radiation dose was 19.02 ± 5.39 mSv. The LD-DE&PCT-based nomogram can accurately predict the response to TACE-LEN-ICIs in uHCC patients. Low-dose one-stop dual-energy and perfusion CT provides a noninvasive method to predict response to TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC. Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making. NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers. NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC.

Transarterial chemoembolization (TACE) remains a cornerstone locoregional therapy for hepatocellular carcinoma (HCC), yet post-TACE tumor recurrence remains a critical challenge. Our single-cell RNA analysis reveals that tumor recurrence is mechanistically linked to TACE-induced expansion of PD-L1+ myeloid-derived suppressor cells (MDSCs).To counterbalance these paradoxical effects, we developed a self-degradable microsphere (MS) composed of hyaluronic acid and gelatin for sustained local delivery of the anti-PD-L1 antibody Envafolimab (KN035) to reshape the immunosuppressive tumor microenvironment (TME). Comprehensive characterization validated KN035-MS's spherical morphology, high drug-loading efficiency, and controlled release kinetics. In BALB/c-hPD-L1 murine HCC models, transhepatic arterial embolization with KN035-MS post-TACE achieved superior tumor suppression compared to systemic KN035 administration while demonstrating favorable biocompatibility. Mechanistically, KN035-MS effectively counteracted TACE-induced PD-L1+ MDSC infiltration and reprogrammed the TME by enhancing CD8+/CD4+ T-cell activation, increasing the number of innate lymphocytes (ILC), and polarizing macrophages toward an M1 phenotype. Critically, localized delivery via KN035-MS prolonged intratumoral drug retention, overcoming the rapid systemic clearance observed with conventional administration. These findings establish KN035-MS as a synergistic adjunct to TACE, addressing both inefficient drug delivery and postembolization immune evasion. This dual-mechanism strategy provides a clinically translatable approach to mitigate HCC recurrence, warranting further investigation in combinatorial locoregional-immunotherapy paradigms.

To analyze the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) treatment of unresectable metastatic hepatic leiomyosarcoma. Medical records and imaging of patients with metastatic leiomyosarcoma to the liver who underwent doxorubicin DEB-TACE from December 2014 to September 2024 were retrospectively reviewed to evaluate survival and clinical and biochemical toxicities. The study included 29 patients (9 males, 20 females; average age 60.1 ± 12.7 years). Twenty-three patients (79.3%) had bilobar and 6 patients (20.7%) had unilobar disease. Twenty patients (69%) had extrahepatic metastases at the time of the first DEB-TACE. Twenty-five patients (86%) received systemic therapies before DEB-TACE, and 5 of these patients had hepatic metastasectomy. The median overall survival (OS) from the first DEB-TACE was 16.3 months (95% CI 2.2; 30.4), from diagnosis of liver metastasis was 35.8 months (95% CI 21.0; 50.6), and from primary diagnosis was 67.5 months (95% CI 49.2; 85.8). At 3 months post-DEB-TACE, the objective response was 79% (23 out of 29 patients), and the disease control rate was 96% (28 out of 29 patients), evaluated by mRECIST. The median liver progression-free survival from the first DEB-TACE was 7.8 months (95% CI 4.5; 11.2). There were two grade 3 clinical toxicities, four grade 3 laboratory toxicities, and 20 grade 1 or 2 laboratory toxicities. There was no 30-day mortality and no mortality related to DEB-TACE. DEB-TACE is safe and effective treatment in patients with liver-dominant unresectable leiomyosarcoma with minimal side effects. The 35.8 months median OS from diagnosis of liver metastasis is very promising in this patient population with unresectable, chemotherapy-refractory disease.

Assessment of the clinical feasibility of robot-assisted endovascular visceral interventions to reduce physical strain caused by prolonged standing and enabling remote interventions. Between 05/2024 and 09/2024, 45 patients were included in this prospective, single-center study. Patients scheduled for elective endovascular abdominal and pelvic interventions with superselective catheterization were assigned to manual (27 patients) or robotic-assisted treatment (18 patients). Radiation dose of the interventionalist, examination time (including preparation and follow-up), procedure duration and fluoroscopy time were compared between procedures using the CorPath GRX platform (Corindus, Waltham, MA) and conventional procedures. Technical success of robotic interventions was defined as achieving stable microcatheter positioning at the predefined target treatment point in the target vessel under robotic navigation, allowing execution of the planned therapy without conversion to manual navigation. 18 patients underwent robotic-assisted interventions (mean age 68 ± 12years; 15 male), transarterial chemoembolization (TACE) (n = 9), 99mTc-MAA simulation (MAA)/transarterial radioembolization (TARE) (n = 2) and prostatic artery embolization (PAE) (n = 7). 27 comparable procedures were performed manually (mean age 68 ± 10years; 21 male): TACE (n = 13); MAA/TARE (n = 7); PAE (n = 7). 16/18 (88.9%; 95%-CI (Wilson) 67.3-96.7%) robotic-assisted procedures were technically successful, with manual conversion occurring in 2 patients (11.1%; 95%-CI (Wilson) 3.1-32.8%). Neither median fluoroscopy time nor procedural dose, procedure duration or examination time differed between the robotic and conventional interventions [19min (IQR 19.55) vs. 31min (IQR 19.85); p = .053; 107.85Gycm2 (IQR 164.03) vs. 128.00Gycm2 (IQR 186.20); p = .286; 65min (IQR 35.50) vs. 59min (IQR 49.00); p = .711; 100min (IQR 37.50) vs. 100min (IQR 40.00); p = .853]. In comparison with conventional procedures, the operator's dose was lower in robotic interventions [0.000mSv (IQR 0.000) vs. 0.005mSv (IQR 0.005); p < .001]. Findings from this pilot case series indicate that robotic-assisted endovascular visceral interventions are feasible and demonstrate a high technical success rate, while simultaneously providing the interventionalist zero radiation exposure through remote operation from the control room.

BACKGROUNDThe treatment technology of liver cancer is progressing. In addition to traditional surgical resection, combined therapies of immunotherapy based on immune checkpoint inhibitors, chemotherapy, and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used. Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer. Sonazoid-contrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions, but also has great potential in the diagnosis of histological differentiation of liver cancer.AIMTo assess the differentiation of hepatocellular carcinoma (HCC) by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound (CEUS).METHODSA retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study. These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology. Within the cases, patients were further categorized into well-differentiated and poorly-differentiated group. Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated, allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTSUnivariate analysis showed that the absolute value of enhancement intensity (EIAV), intensity ratio (IR) and intensity difference (ID) in Kupffer phase were statistically different between the groups with different degree (P = 0.015, P = 0.000, P = 0.000). The sensitivity and specificity were 40.2%, 82.4%, 80.4% and 78.1%, 86.9% and 74.5%, respectively, for differentiating HCC lesions with EIAV ≥ 56.384 dB, IR ≥ 1.215 and ID ≥ 9.184 dB. The area under the receiver operating characteristic curve were 0.590, 0.877, 0.815. There was no significant difference in the parameters of arterial phase, including peak time, initial growth time, rise time and the absolute value of peak intensity of lesions between the two groups (P > 0.05). Multivariate analysis showed that the level of alpha-fetoprotein (AFP) and IR were risk factors for poor differentiation (P = 0.001).CONCLUSIONAmong the parameters of Sonazoid-CEUS, IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC. Combined with preoperative AFP level, a more accurate diagnosis will be obtained. Compared with portal vein phase, Kupffer phase showed the ability to identify HCC lesions more sensitive. These findings hold significant guiding implications and reference value for clinical practice.

This study compared the incidence of adverse events in patients with unresectable intrahepatic cholangiocarcinoma (ICC) receiving drug-eluting bead transarterial chemoembolization (DEB-TACE) either alone or in combination with immune checkpoint inhibitors (ICIs). A retrospective analysis was conducted on patients with unresectable ICC who received either DEB-TACE alone or in combination with ICIs treatment from February 2019 to April 2024. Of the enrolled 247 ICC patients, 178 received DEB-TACE combined with ICIs treatment, while 69 patients received DEB-TACE alone. Adverse events were recorded and compared between the two groups. Binary logistic regression analysis was used to determine the significant risk factors of adverse events. The overall incidence of adverse events was 19.1% (34/178) in the DEB-TACE+ICIs group and 13.0% (9/69) in the DEB-TACE group. The DEB-TACE+ICIs group exhibited a statistically significantly higher incidence of liver abscesses than the DEB-TACE group (13.5% vs. 2.9%, P = 0.015). Binary logistic regression analysis showed that combined ICIs treatment (P = 0.027, odds ratio = 5.583, 95% confidence interval: 1.212-25.725) and grade 1 artery occlusion (P = 0.001, odds ratio = 31.380, 95% confidence interval: 4.098-240.263) were independently associated with an increased risk of developing liver abscess. Combined ICIs treatment and grade 1 arterial occlusion were independently associated with an increased risk of liver abscesses. Clinicians should closely monitor for liver abscess formation when administering DEB-TACE in combination with ICIs, particularly in patients with grade 1 arterial occlusions.