Fig. 3

Local progression of an HCC showing a complete response according to mRECIST with incomplete lipiodol retention in a 59 yr-old female with HCV related cirrhosis. a baseline CT image obtained during hepatic arterial phase (HAP) shows a hyperehanced HCC in the right liver lobe. b and c first follow-up CT images showing the lesion presenting with incomplete lipiodol retention on a precontrast image (b), while images obtained during HAP (c) show no residual enhancement of the lesion. Millimetric lipiodol depositions were depicted in the right liver, suggesting the presence of pre-existing yet undetected small tumor foci. This CT showed the appearance of a lesion in the left liver lobe (not shown in the figure), for which the patient underwent a second TACE session targeting only the left liver lobe. d-f 3 months follow-up CT images obtained during precontrast (d), HAP (e) and delayed (3′) phase (f) show the reappearance of a hyperenhancing nodular portion on HAP (e) with washout on delayed (3′) phase (f) consistent with local progression (arrow)