Clinical study
Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Prospective Assessment of the Right Inferior Phrenic Artery with C-arm CT

https://doi.org/10.1016/j.jvir.2009.03.036Get rights and content

Purpose

To assess the usefulness of C-arm computed tomography (CT) of the right inferior phrenic artery (RIPA) in transcatheter arterial chemoembolization of patients with hepatocellular carcinoma (HCC).

Materials and Methods

From December 2007 to April 2008, C-arm CT of the RIPA was prospectively performed in 32 patients with HCC. Two interventional radiologists who performed C-arm CT assessed the additional information provided with C-arm CT as grade 1 (no additional information), grade 2 (added information without an effect on the treatment plan), or grade 3 (added information with an effect on the treatment plan). Tumor feeders and feeders of a systemic-to-pulmonary shunt were recorded.

Results

The information provided by C-arm CT was classified as grade 1 for nine of the 32 patients (28%), grade 2 for 20 patients (63%), and grade 3 for three patients (9%). The most common additional information from C-arm CT scans of the RIPA was the differentiation between the tumor and the systemic-to-pulmonary shunt. A systemic-to-pulmonary shunt from the RIPA was observed in 22 patients (69%), and the most common feeder of a systemic-to-pulmonary shunt was the azygoesophageal branch.

Conclusions

C-arm CT of the RIPA provides additional imaging information for the differentiation of a tumor from a nontumorous condition during chemoembolization for HCC with a suspected blood supply from an RIPA.

Section snippets

Patients

Our institutional review board approved this prospective study, and informed consent was obtained from all patients. From December 2007 to April 2008, C-arm CT of the RIPA was prospectively performed in 32 patients with HCCs that were suspected of having a blood supply from the RIPA. The patient population consisted of 27 men and five women (age range, 48–80 years; mean age, 64 years). A diagnosis of HCC was determined based on results of percutaneous needle biopsy (n = 4), surgical resection (n

Results

Tumor sizes ranged from 1.1 to 14 cm (mean size, 3.8 cm). Tumors were located in segment VII (n = 16), segment VIII (n = 12), segment IV (n = 3), and segment II (n = 1). Nine tumors were classified as single nodular, 20 as multinodular, and three as infiltrative. Tumor thrombi within the inferior vena cava were noted in four patients. All hepatic tumors abutted the liver surface or the diaphragm. Right inferior phrenic angiography was performed during the first to the 19th (mean, 6.1 sessions;

Discussion

The combination of vascular and soft tissue depiction of C-arm CT has potential benefits in the performance of chemoembolization, as the relationship of the targeted tumor with its arterial supply can be clearly identified (11, 12, 13, 14). Our results showed that C-arm CT of the RIPA provided additional information for 23 of 32 patients (72%) and resulted in a change in the procedure for three (9%). In this series, interestingly, a systemic-to-pulmonary shunt from the RIPA was observed in 22

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    None of the authors have identified a conflict of interest.

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    Copyright © 2009 SIR. Published by Elsevier Inc. All rights reserved.