MSCT evaluation of lipiodol uptake in predicting recurrence of hepatocellular carcinoma after TACE

Abstract Objective To investigate the clinical application value of multi-slice spiral CT (MSCT) in predicting tumor recurrence in patients with liver cancer after transcatheter arterial chemoembolization (TACE). Methods The clinical and imaging data of 120 patients with liver cancer treated with TACE from January 2020 to December 2025 were retrospectively analyzed. All patients underwent MSCT enhanced scan one month after TACE. Two imaging physicians with high professional titles independently evaluated the uptake of lipiodol in the tumor. According to the shape and scope of lipiodol deposition, they were divided into complete filling type, partial filling type and small filling type. The recurrence rate at 6 months and 12 months after TACE was recorded. Kaplan Meier method was used to analyze the survival rate. Log rank test was used to compare the recurrence free survival (RFs) of patients with different degrees of lipiodol intake. Cox proportional hazards regression model was used to analyze the risk factors for recurrence of liver cancer after TACE. Results Among the 120 patients, 32 cases (26.7%) were completely filled with Lipiodol, 58 cases (48.3%) were partially filled with Lipiodol, and 30 cases (25.0%) were slightly filled with lipiodol. 28 cases recurred after 6 months of follow-up, 56 cases recurred after 12 months. Kaplan - Meier survival analysis and log - rank test showed that the 6-month RFs rates of patients with complete filling, partial filling and small filling were 87.5% (28g32), 60.3% (35/58) and 26.7% (8/30), respectively, and the 12-month RFs rates were 71.9% (23/32), 39.7% (23/58) and 20.0% (6/30), respectively. The median recurrence free survival was 14.5 months, 9.2 months and 5.8 months, respectively. There were significant differences in RFs among the three groups (log-rank χ²=18.752, P  < 0.001).2). The RFs of patients with complete filling was significantly longer than that of patients with partial filling and small filling (both P  < 0.05), and the RFs of patients with partial filling was significantly longer than that of patients with small filling ( P  < 0.05). Cox multivariate analysis showed that the degree of lipiodol intake (small filling type vs complete filling type: 0 HR  = 3.026,95% CI : 1.608–5.692, P  < 0.001; Partial filling vs complete filling: HR  = 1.872, 95% CI : 1.025–3.416, P  = 0.041) and maximum tumor diameter ≥ 5 cm ( HR  = 2.135, 95% CI : 1.247–3.658, P  = 0.006) were independent risk factors for postoperative recurrence (all P  < 0.05). Conclusion MSCT evaluation of lipiodol uptake after TACE for liver cancer can effectively predict the risk of tumor recurrence. The less lipiodol uptake, the higher the risk of recurrence, and the shorter the recurrence free survival time. At the same time, the maximum tumor diameter (≥ 5 cm) is also an important independent risk factor for recurrence. In order to improve the prognosis of patients with liver cancer after TACE, individualized follow-up and adjuvant therapy can be formulated in combination with the results of MSCT lipiodol uptake assessment and tumor size.