Role of C-arm CT in identifying caudate arteries supplying hepatocellular carcinoma

J Vasc Interv Radiol. 2014 Sep;25(9):1380-8. doi: 10.1016/j.jvir.2014.02.028. Epub 2014 Apr 6.

Abstract

Purpose: To evaluate the role of C-arm computed tomography (CT) performed at the proper hepatic artery or equivalent in patients with caudate-lobe hepatocellular carcinoma (HCC) for the detection of tumor-feeding arteries during chemoembolization.

Materials and methods: From July 2009 to June 2012, 1,785 patients received initial chemoembolization at a single institution. Among them, 52 patients with caudate HCC underwent initial chemoembolization with the use of C-arm CT. C-arm CT images were obtained at the proper hepatic artery or equivalent. Two radiologists reviewed the C-arm CT scans and angiograms in consensus. The cumulative local recurrence rate was calculated by the Kaplan-Meier method.

Results: Tumor-feeding arteries were single (n = 31), double (n = 12), triple (n = 6), and quadruple (n = 3). Seventy-nine tumor-feeding arteries and their origins in 48 patients were demonstrated on C-arm CT. In four patients (7.7%), five tumor-feeding arteries were not clearly indicated on C-arm CT because of poor image quality caused by failure of the patients to hold their breath. Selective chemoembolization via tumor-feeding arteries was successful in 45 patients (87%). The cumulative local recurrence rates at 6 months, 1 year, and 3 years were 19.4%, 32.8%, and 35.8%, respectively. Nonselective chemoembolization of tumor-feeding arteries of caudate-lobe HCC was a significantly important factor in higher cumulative local recurrence rates (hazard ratio, 3.916; 95% confidence interval, 1.367-11.216; P = .011).

Conclusion: C-arm CT obtained at the proper hepatic artery or equivalent level can demonstrate most tumor-feeding arteries supplying HCCs in the caudate lobe.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Hepatocellular / blood supply*
  • Carcinoma, Hepatocellular / diagnostic imaging*
  • Carcinoma, Hepatocellular / therapy
  • Chemoembolization, Therapeutic
  • Collateral Circulation*
  • Consensus
  • Female
  • Hepatic Artery / diagnostic imaging*
  • Humans
  • Kaplan-Meier Estimate
  • Liver Neoplasms / blood supply*
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / therapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Republic of Korea
  • Retrospective Studies
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome