Dual Energy CT Imaging of Hepatocellular Carcinoma Using Lipiodol in Intermediate-Stage Chemotherapy Treatment

Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer, with transarterial chemoembolization (TACE) being a standard treatment for intermediate-stage disease. During TACE, Lipiodol, an iodine-based contrast agent, serves as both a drug carrier and an imaging agent. However, residual Lipiodol can create artifacts on follow-up imaging, potentially mimicking tumor enhancement and complicating diagnostic interpretations.This study investigates the role of dual-energy computed tomography (DECT) in differentiating between Lipiodol-induced artifacts and true tumor enhancement during post-TACE surveillance of HCC. We present a case of a 62-year-old female patient with HCC who underwent TACE, followed by DECT imaging for monitoring. DECT imaging revealed a lesion in the liver that appeared to enhance in the arterial phase, raising concerns for tumor recurrence. However, virtual non-contrast (VNC) imaging showed no enhancement, and the iodine map confirmed the presence of residual Lipiodol, rather than active malignancy. This case illustrates the diagnostic challenge of distinguishing between Lipiodol and tumor lesions, particularly when residual Lipiodol mimics tumor enhancement. DECT was critical in identifying residual Lipiodol and distinguishing it from true tumor recurrence. This study highlights the utility of DECT in enhancing diagnostic accuracy for patients undergoing TACE, minimizing unnecessary interventions, and ensuring appropriate follow-up care. By providing detailed tissue characterization and iodine mapping, DECT improves differentiation between artifacts and pathological findings in post-treatment liver imaging, ultimately contributing to better patient management and outcomes.