© Turkish Society of Radiology 2010 R ecently, there has been much interest in the concept of radia- tion-induced hepatic lobar ablation with marked volumetric loss and contralateral compensatory lobar hypertrophy (1–3). This phenomenon, termed radiation lobectomy, has been described to occur after yttrium-90 ( 90 Y) microsphere radioembolization and has been as- sociated with high rates of tumor response and improved long-term pa- tient survival in preliminary investigations (1). At present, the causative relationship between the administered radiation dose and the volumet- ric change is unknown, and the degree to which vascular embolization contributes to the observed changes remains uncertain. We recently en- countered a striking case of hepatic lobar atrophy-hypertrophy complex formation after transcatheter arterial chemoembolization that suggests a possible contribution of arterial embolization to the volumetric re- sponse, which we present herein. Case report A 50-year-old man with a history of type 2 diabetes mellitus, hyper- tension, and hepatitis B virus liver disease was referred to interventional radiology for liver-directed therapy for the treatment of biopsy-proven hepatocellular carcinoma (HCC). The patient initially presented for as- sessment after screening computed tomography (CT) scan demonstrated a 4-cm right hepatic lobe mass, which was confirmed as HCC by im- age-guided core needle biopsy. Metastatic disease was ruled out with a chest CT and bone scan. The patient evaluation demonstrated an East- ern Cooperative Oncology Group performance status of zero (4), and the lab examination showed normal synthetic liver function (total bilirubin 0.9 mg/dL, albumin 4.2 g/dL, and prothrombin time 10.0 s). The initial -fetoprotein level was only slightly elevated, measuring 15.5 ng/mL. Treatment options were discussed, and transcatheter arterial chemoem- bolization was elected for local tumor control. Subsequently, the patient underwent drug eluting bead chemoemboli- zation using 300–500-micron LC beads (Angiodynamics; Queensbury, New York, USA) loaded with 50 mg doxorubicin and mixed with 50 mg cisplatin and 20 mg mitomycin C in suspension. For chemoemboli- zation, a standard right common femoral artery approach was used to position a 5 French reverse curve catheter in the celiac artery. The chem- oembolic material was administered through a 2.8 French microcatheter placed coaxially in a segmental distribution via a right hepatic artery ascending branch (Fig. a) to a static angiographic endpoint. The patient had an uneventful post-procedure hospital course and was discharged 24 hours after treatment. The patient follow-up included serial CT scans and lab assessment, which were performed initially at one month post-procedure and then at approximately three-month intervals. Although the one-month post- INTERVENTIONAL RADIOLOGY CASE REPORT Diagn Interv Radiol DOI 10.4261/1305-3825.DIR.3166-09.1 Chemoembolic lobectomy: imaging findings of hepatic lobar volume reduction after transcatheter arterial chemoembolization Ron C. Gaba, Jason J. Carroll, James T. Bui, Tami C. Carrillo, M. Grace Knuttinen, Charles A. Owens From the Department of Radiology (R.C.G.  rongaba@yahoo. com), University of Illinois at Chicago, Chicago, IL, USA. Received 12 November 2009; revision requested 22 November 2009; revision received 22 November 2009; accepted 23 November 2009. Published online 3 August 2010 DOI 10.4261/1305-3825.DIR.3166-09.1 ABSTRACT Hepatic lobar atrophy-hypertrophy complex formation is an uncommonly reported sequella of hepatic arterial embolo- therapy procedures. Whereas radiation-induced hepatic lobar ablation has been described after intra-arterial therapy with yttrium-90 microspheres, this phenomenon has not been re- ported after transcatheter arterial chemoembolization. Here, we report a case of prominent hepatic lobar atrophy with contralateral lobar hypertrophy after chemoembolization and suggest a mechanism by which arterial embolization contrib- utes to the volumetric response. Key words:  chemoembolization  liver  atrophy  hypertrophy  lobectomy