| PurposeThe purpose of this study is to investigate the anatomic variation incidence rate of the inferior phrenic artery (IPA) in patients with Hepatocellur Carcinoma (HCC), the incidence rate of IPA as tumor-feeding vessel in HCC and to explore the clinical significance of IPA in transcatheter arterial chemoembolization (TACE)Materials and methodsBetween March 2006 and June 2009, digital subtraction angiography (DSA) was performed in one thousand patients who underwent TACE for treatment of HCC. IP As were demonstrated in fifty-nine patients(33 men,26 women;mean age,43 years). Origns,course and distribution of IP As of the most patients were identified clearly with DSA.Plain and enhanced computed tomography (CT) scanning and computed tomography angiography (CTA) were performed to diagnose IP As origins which can not be identified using DSA. IP As origin rate of all patients and the rate of IPAs which participated extrahepatic arterial blood supply for HCC and the success rate of TACE were recorded. CT examinations were performed with a 64-detector row CT scanner after TACE to access the deposition degree of lipiodol. CTA was performed to identify the origins of IPAs and to confirm if it has participated extrahepatic arterial blood supply for HCC or not.The tumor location and complications after chemoembolization through IPAs were observed. Several DSA and CT sign indications of IPAs that participated extrahepatic arterial blood supply for HCC were summarized. A digital subtraction angiography unit was used (Siemens Medical Solutions, Germany). The DSA images consisted of three phases (ie,hepatic arterial, parenchymal and portal venous). Two and three dimensional reconstructions of CT images were generated using multiplanar reformation of the arterial phase images,maximum intensity projection(MIP),volume rendering(VR). All patients who received IPA chemoembolization in our institution were followed with routine blood,liver function,kidney function and AFP tests a month after treatnent of IPAs, as well as CT plain and (or) contrast enhanced scan.ResultsThe origins of the IPAs are variable.The the right inferior phrenic artery (RIPA) origin was detected in 54 cases (91.5%), while the left inferior phrenic artery (LIPA) origin was detected in 52cases (88.1%). RIPA originated from celiac trunk (72.2%), the aorta (7.4%), right renal artery (16.6%), left gastric artery (3.7%);LIPA originated from celiac trunk (84.6%), the aorta (3.8%), left gastric artery (3.8%) and RIPA (7.6%). Twenty-six of the 54 RIPAs (48.1%) participated extrahepatic collateral artery supply,of which the RIPAs originated from celiac trunk (73.1%), the aorta (3.8%), right renal artery (19.2%) and left gastric artery (3.8%);seven of 52 LIP As (13.4%) participated extrahepatic collateral artery supply, of which the LIPAs originated from celiac trunk (57.1%), left gastric artery(14.3%) and RIPAs(28.6%);Nineteen HCC masses located in the right liver dome and seven masses in the left;Seventeen RIPAs were embolized successly(65.3%,17/26).On the contrary, only three LIPAs successed. Complications after TACE:pulmonary oil embolization and hiccup was noted in one patient respectively, a few patients who received chemoembolization via the IPA complained of a various degree of burning pain in hypochondria during the procedures.ConclusionThe IPA anatomic variation of patients with Hepatocellur carcinoma is characterized and complicated, in which the incidence rate of IPA which participated extrahepatic arterial blood supply for HCC is more especially. Interventional radiologists should be familiar with this kind of anatomic variation of IPA, and master the symbolic factor of it.There was important clinical significances for interventional approach. |
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