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

Images in a 48-year-old man with HCC invading the inferior vena cava. (a) Right inferior phrenic arteriogram obtained at the first session of chemoembolization shows hypervascular tumor staining in the liver dome (solid white arrow) and tumor staining in the inferior vena cava (+) supplied by the RIPA. Note the anterior branch (open white arrow), posterior branch (open black arrow), azygoesophageal branch (open arrowheads), pericardiophrenic branch (solid black arrow), and superior adrenal artery (solid arrowhead). Systemic-to-pulmonary shunts (star) along the lung base supplied by the azygoesophageal branch are noted. (b,c) Contrast-enhanced C-arm CT scans show the enhancing pulmonary arteries and lung parenchyma (solid arrows). Note the anterior branch (open arrows), azygoesophageal branch (solid arrowheads) toward the medial azygoesophageal recess below the diaphragm, and azygoesophageal branch (open arrowheads) toward the lateral costophrenic angle above the diaphragm.

Images in an 80-year-old man with HCC supplied by the RIPA. (a) Transverse CT scan obtained during the hepatic arterial phase shows a small hypervascular tumor (arrowheads) in segment VII. Note the previously infused iodized oil (arrows). (b) Transverse CT scan obtained during the hepatic arterial phase shows a hypervascular retroperitoneal lymph node (arrowhead) suggestive of nodal metastasis. Note the previously infused iodized oil (arrow). (c) Transverse CT scan obtained during the hepatic arterial phase shows a small hypervascular tumor (arrowheads) in segment VI. Note the previously infused iodized oil (arrow). (d) Right inferior phrenic arteriogram obtained at the 8th session of chemoembolization shows hypervascular tumor staining in segment VII (solid black arrow), hypervascular tumor staining beside the inferior vena cava (open white arrow), and retroperitoneal nodal metastasis (arrowhead). Note ill-defined ambiguous staining (open black arrow). Celiac angiography revealed no tumor staining supplied by the hepatic artery (not shown). (e) Contrast-enhanced C-arm CT scan shows enhancement of the tumor in segment VII (arrowhead) and the tumor beside the inferior vena cava (arrow). (f) Contrast-enhanced C-arm CT scan shows enhancement of the retroperitoneal lymph node (arrowhead). Note the previously infused iodized oil (arrow). (g) Contrast-enhanced C-arm CT scan shows enhancement of the tumor in segment VI (arrowhead), which was ambiguous at DSA. Note the previously infused iodized oil (arrow).

Images in a 50-year-old man with HCC supplied by the right hepatic artery. (a) Transverse CT scan obtained during the hepatic arterial phase shows a small exophytic hypervascular tumor (arrowhead) in segment VIII. (b) Right inferior phrenic arteriogram obtained at the first session of chemoembolization shows no hypervascular tumor staining. Note the pulmonary arteries (arrows) within systemic-to-pulmonary shunt staining and the azygoesophageal branch (arrowheads). (c) Contrast-enhanced C-arm CT scan shows no enhancement of tumor in segment VIII. The RIPA (arrowheads) is noted. (d) Contrast-enhanced C-arm CT scan shows enhancement of the pulmonary arteries (arrowheads).