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

Kim, Hyo-Cheol; Chung, Jin Wook; Park, Jae Hyung; An, Sangbu; Son, Kyu Ri; Seong, Nak Jong; Jae, Hwan Jun

doi:10.1016/j.jvir.2009.03.036

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 20, Issue 7 , Pages 888-895, July 2009

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

Hyo-Cheol Kim, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
Jin Wook Chung, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
- Address correspondence to J.W.C.
Jae Hyung Park, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
Sangbu An, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
Kyu Ri Son, MD
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
Nak Jong Seong, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
Hwan Jun Jae, MD
- 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, #28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

Received 9 July 2008; received in revised form 26 March 2009; accepted 30 March 2009. published online 28 May 2009.

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.

Abbreviations: A_z, area under the receiver operating characteristic curve, DSA, digital subtraction angiography, HCC, hepatocellular carcinoma, RIPA, right inferior phrenic artery