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Identification of the feeding arteries of hepatocellular carcinomas by performing dual arterial phase CT during pre-transarterial chemoembolization angiography. Abdom Radiol (NY) 2019; 44:2276-2282. [PMID: 30788560 DOI: 10.1007/s00261-019-01950-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the usefulness of performing dual arterial phase computed tomography (CT) during pre-transarterial chemoembolization (TACE) angiography for identifying the feeding arteries of hepatocellular carcinomas (HCC). MATERIALS AND METHODS Dual arterial phase CT was performed during pre-TACE angiography in 73 patients with 139 HCC. Ten HCC underwent this procedure twice, so the total number of examined HCC was 149. Early and late arterial phase images were obtained 6 seconds after injection of an iodinated contrast material serially during a single breath-hold. The feeding artery was defined as the branch of the hepatic artery that was connected to the enhanced areas of the tumor. For HCC that could not be visualized on the early arterial phase images, fusion images superimposing the early and late arterial phase images were constructed. Furthermore, technical success defined as successful catheterization of the subsegmental or more distal feeding artery was evaluated. RESULTS The feeding artery was correctly identified on dual arterial phase CT in 146 of the 149 tumors (98.0%). In two HCC, the feeding arteries could not be identified due to severe motion artifacts, and in one, due to the presence of anastomosis between the right and left hepatic arteries. Catheterization of the subsegmental feeding artery was successful in all TACE procedures (technical success rate: 100%). CONCLUSION Performing dual arterial phase CT during angiography appears to be useful for identifying the feeding arteries of HCC.
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Moustafa AS, Abdel Aal AK, Ertel N, Saad N, DuBay D, Saddekni S. Chemoembolization of Hepatocellular Carcinoma with Extrahepatic Collateral Blood Supply: Anatomic and Technical Considerations. Radiographics 2017; 37:963-977. [PMID: 28362557 DOI: 10.1148/rg.2017160122] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Transarterial chemoembolization (TACE) is considered a standard local-regional treatment for intermediate-stage hepatocellular carcinoma (HCC) and the most common bridging therapy. This treatment is offered to more than 70% of patients who are on the waiting list for liver transplantation in the United States. HCC typically receives its blood supply from the hepatic artery; however, it can recruit a parasitic supply from extrahepatic collateral (EHC) arteries. The development of an EHC arterial blood supply can interfere with the therapeutic efficacy of TACE and result in treatment failure and poor outcome. Cross-sectional imaging-specifically computed tomography and magnetic resonance imaging-has some limitations in depicting the presence or absence of an EHC arterial supply during the pre-TACE evaluation. Catheterization and angiography of every possible EHC artery during a routine TACE procedure would be time consuming and technically challenging and would not always be feasible. Therefore, the prediction of a potential EHC arterial supply on the basis of tumor location before, during, and after TACE is fundamental to achieving optimal therapeutic efficacy. To perform TACE through EHC arteries, special considerations are necessary to avoid potentially serious complications. The authors review the factors influencing the development of an EHC arterial blood supply to HCC and describe a systematic approach to enhance the ability to predict the presence of EHC arteries. They also describe the proper technique for TACE of each EHC artery and how to avoid potential technique-related complications. ©RSNA, 2017.
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Affiliation(s)
- Amr Soliman Moustafa
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Ahmed Kamel Abdel Aal
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Nathan Ertel
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Nael Saad
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Derek DuBay
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
| | - Souheil Saddekni
- From the Department of Radiology, University of Arkansas for Medical Science, Little Rock, Ark, and Department of Radiology, Zagazig University, Zagazig, Egypt (A.S.M.); Departments of Radiology (A.K.A.A., N.E., S.S.) and Surgery (D.D.), University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249; Department of Radiology, University of Cairo, Cairo, Egypt (A.K.A.A.); and Department of Radiology, Washington University School of Medicine, St Louis, Mo (N.S.)
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Woo S, Kim HC, Chung JW, Jung HS, Hur S, Lee M, Jae HJ. Chemoembolization of extrahepatic collateral arteries for treatment of hepatocellular carcinoma in the caudate lobe of the liver. Cardiovasc Intervent Radiol 2014; 38:389-96. [PMID: 24934735 DOI: 10.1007/s00270-014-0929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/21/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE This study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe. METHODS Between January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization. RESULTS In 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response. CONCLUSIONS HCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, # 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea
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The origin of the cystic artery supplying hepatocellular carcinoma on digital subtraction angiography in 311 patients. Cardiovasc Intervent Radiol 2013; 37:1268-82. [PMID: 24196272 DOI: 10.1007/s00270-013-0773-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/01/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE This study was designed to investigate the prevalence and patterns of origin of the cystic artery using selective angiography images obtained during chemoembolization. METHODS Between March 2007 and January 2012, 326 patients with hepatocellular carcinoma supplied by the cystic artery were treated by chemoembolization through the cystic artery. Fifteen patients were excluded due to the difficulty in determining the origin of their cystic arteries. Thus, a total of 311 patients were included in this study. Digital subtraction angiography images were reviewed retrospectively by consensus. RESULTS A total of 112 (36 %) patients had a total of 121 variant hepatic arteries. Double cystic arteries were present in 46 (14.8 %) patients, and total 357 cystic arteries were observed. The origin sites of the cystic artery were the following: the right hepatic artery (n = 248), the anterior sectional artery (n = 44), the segment IV artery (n = 21), the posterior sectional artery (n = 10), the left hepatic artery (n = 8), the proper hepatic artery (n = 8), the gastroduodenal artery (n = 4), and others (n = 14). In total, 103 (33 %) patients had at least one cystic artery arising from arteries other than the right hepatic artery. In patients with right hepatic artery variations, the cystic artery more frequently originated from arteries other than the right hepatic artery (p = 0.003). CONCLUSIONS The most and second most common origins of the cystic artery are the right hepatic artery and the anterior sectional artery. In addition, the origin site of the cystic arteries is influenced by variations of hepatic arteries.
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Gao S, Yang RJ, Dong JH. Hepatocellular carcinoma with blood supply from parasitized omental artery: angiographic appearance and chemoembolization. Chin J Cancer Res 2013; 24:207-12. [PMID: 23359452 DOI: 10.1007/s11670-012-0207-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/19/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. METHODS A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. RESULTS Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. CONCLUSION Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.
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Affiliation(s)
- Song Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Interventional Therapy Department, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Safety of chemotherapeutic infusion or chemoembolization for hepatocellular carcinoma supplied exclusively by the cystic artery. Cardiovasc Intervent Radiol 2012; 36:1313-9. [PMID: 23262478 DOI: 10.1007/s00270-012-0542-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/22/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was designed to evaluate the safety of chemotherapeutic infusion or chemoembolization by way of the cystic artery in patients with hepatocellular carcinoma (HCC) supplied exclusively by the cystic artery. METHODS Between Jan 2002 and Dec 2011, we performed chemotherapeutic infusion or chemoembolization using iodized oil for the treatment of 27 patients with HCC supplied exclusively by the cystic artery. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. RESULTS The cystic artery originated from the main right hepatic artery in 24 (89 %) patients, from the right anterior hepatic artery in 2 (7 %) patients, and from the left hepatic artery in 1 (4 %) patient. Selective catheterization of the cystic artery was achieved in all patients. Superselection of tumor-feeding vessels from the cystic artery was achieved in 7 patients (26 %). Chemotherapeutic infusion was performed in 18 patients (67 %), and chemoembolization was performed in 9 patients (33 %). There were no major complications and only 2 minor complications, including vasovagal syncope and nausea with vomiting. Individual tumor response supplied exclusively by the cystic artery at the follow-up enhanced CT scan were complete response (n = 16), partial response (n = 3), and stable disease (n = 8). CONCLUSION HCC supplied exclusively by the cystic artery can be safely treated without severe complications by chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.
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Burgmans MC, Kao YH, Irani FG, Dames EL, Teo TKB, Goh ASW, Chow PK, Tay KH, Lo RHG. Radioembolization with Infusion of Yttrium-90 Microspheres into a Right Inferior Phrenic Artery with Hepatic Tumor Supply Is Feasible and Safe. J Vasc Interv Radiol 2012; 23:1294-301. [DOI: 10.1016/j.jvir.2012.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/03/2012] [Accepted: 07/07/2012] [Indexed: 10/28/2022] Open
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Hur S, Kim HC, Chung JW, Kim MU, Kim JD, Kim GM, Lee IJ, Kim YI, Jae HJ, Park JH. Hepatocellular carcinomas smaller than 4 cm supplied by the intercostal artery: can we predict which intercostal artery supplies the tumor? Korean J Radiol 2011; 12:693-9. [PMID: 22043151 PMCID: PMC3194773 DOI: 10.3348/kjr.2011.12.6.693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 06/17/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images. MATERIALS AND METHODS Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient. RESULTS Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p < 0.001). CONCLUSION We can predict the tumor feeder with an accuracy of 85% as the first intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.
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Affiliation(s)
- Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Min-Uk Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Ji Dae Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Gyoung Min Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - In Joon Lee
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Young Il Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
| | - Jae Hyung Park
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Chemoembolization Via Branches from the Splenic Artery in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2011; 35:90-6. [DOI: 10.1007/s00270-011-0109-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/12/2011] [Indexed: 11/25/2022]
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