Currently, no standard of care or therapies have been established for patients with advanced HCC. We evaluated the efficacy and safety of conventional transarterial chemoembolization using gelatin sponges or microspheres plus lipiodol-doxorubicin (cTACE) and TACE with doxorubicin-loaded drug eluting beads (DEB-TACE). This retrospective study included 273 patients who received cTACE (n = 201) or DEB-TACE. Tumor response, survival, and adverse events were evaluated over a 5-year follow-up period. During 5-year follow-up, a greater percentage of patients treated with cTACE died than those treated with DEB-TACE (76.1% vs. 66.7%) (P = 0.045). At the last evaluation, all surviving patients had disease progression and no differences were seen between treatment groups. However, the time to disease progression differed between groups; median time to disease progression was 11.0 months for cTACE and 16.0 months for DEB-TACE (P = 0.019). The median survival time was 37 months in both treatment groups. No significant differences were observed between cTACE and DEB-TACE therapies in subgroups of patients with BCLC stage A or stage B + C either in survival time or time to disease progression (P values > 0.05). No significant differences were observed in survival status or disease progression between cTACE and DEB-TACE in patient subgroups with either tumor number > 5 or with the sum of the diameter of largest five HCC tumors being > 7 cm. DEB-TACE demonstrates greater long-term benefits than cTACE in treating treatment-naïve patients with HCC. Results of this long-term study support the use of DEB-TACE in treating HCC.

Variations in the origin of vertebral arteries (VA) and its entrance level into the transverse foramen are common and important when planning neck and cervical spine interventions.The aim of this study was to investigate the prevalence of anatomical variations in the origin of vertebral arteries, and anomalous course of the extracranial vertebral artery using dual energy CT angiography.Retrospectively, we reviewed head and neck dual energy computed tomography (DECT) angiographies of 1218 consecutive patients during 2010 - 2014. The images were evaluated with exceptional attention to the origin of VA and its level of entrance into and exit out of the transverse foramen of the cervical spine, specific variations of VA including fenestration and intradural course of C1 - C2 VA.We found a rare case of double origin of left VA with bifid origins (one from the aortic arch and the other from the left subclavian artery) and entering the transverse foramen at C6 and C5 levels. The majority of left VA (1173/1219, 96.2%) originated from the left subclavian artery. Most of them (1159/1173, 98.8%) entered the C6 transverse foramen. Forty - six of left VA (46/1219, 3.8 %) originated from the aortic arch and thirty - seven (80.4%) of them entered the C5 transverse foramen. When the left VA arose from the aorta, there was a significant higher rate of anomalous entrance level (C4 or C5) to normal C6 entrance level (P < 0.001). The majority of right VA (1209/1218, 99.3%) originated from the right subclavian artery. Eight (0.7 %) of right VA arose from the aberrant right subclavian artery (ARSA). One rare case of right VA from right common carotid artery (CCA) entered the transverse foramen at C4 level with coexisting ARSA. Five cases had atlanto - axial fenestration of the VAs and five cases had intradural course of left C1 - C2 VAs.The study showed anatomical variations of the VA in its origin and extracranial course. A pre - operative CT angiography is useful to identify the anomalous extracranial VA course. It reduces the risk of intra - procedure VA injury.