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PURPOSE: To evaluate the efficacy and safety using CT guided percutaneous cisplatin-lipiodol emulsion injection treat malignant portal vein thrombosis in hepatocellular carcinoma.MATERIALS AND METHODS: The diagnosis of HCC was made by histopathology in all 14 patients,the diagnosis of PVTT was confirmed by histopathologically in three patients and by imaging studies in eleven patients.TACE had been used initially as a treatment for the tumor of intraparenchymal portion.After TACE,a Chiba needle (21-gauge; 15 cm) was introduced percutaneously into the tumor thrombosis under CT guidance.After assure the needle tip was advanced into the thrombosis.The stylet was withdrawn,and cisplatin-lipiodol emulsion was slowly injected while the needle was withdrawn to the upper portion of the thrombosis.The average cisplatin-lipiodol emulsion required 5 ml (range from 3-8 ml) in each session.The treatment was performed twice a week and repeated until all of the thromboses were overlaid or the patient can not tolerate the procedure because of a decline in clinical status.RESULTS: There was no patient lost follow up and the length of follow-up was 1-24 months.All of the 14 patients underwent 1-6 times TACE in each patient (mean,3 times).Twenty-two treatment sessions of PCLEI were performed in all patients and each patient underwent one to three treatment sessions (mean,2 sessions).Of the 14 patients,PR was observed in 8 patients (57.1%),SD in 4 patients (28.6%),and PD in 2 patients (14.3%).The objective response (CR and PR) rate was 57.1%.At the time of follow up,9 patients had died of disease and 5 patients were alive.The median survival duration was 14 months (range,4–24 months) and the 3-month,6-month and 12-month overall survival rates were 78.6%,71.6% and 62.5%,respectively.The most common adverse reaction was nausea and/or loss of appetite (64.3%,9/14).The minor complications were normal liver damage.There was no treatment related death,such as acute hepatic failure and acute massive hemorrhage of gastrointestinal tract.CONCLUSION: TACE and percutaneous cisplatin-lipiodol emulsion Injection combination therapy is safe and effective in HCC patients with marked PVTT.It provides a rapid,low risk and low cost method for this kind of patient.