Chemoembolization of Caudate Lobe Hepatocellular Carcinoma—Anatomy and Procedures

A review of the anatomy of the caudate artery and a description of considerations in selective chemoembolization for caudate lobe hepatocellular carcinoma.

Course ID: Q00594 Category:
Modalities: , ,

2.0

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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Abdominal Section: 0.50
Neurological, Vascular, and Lymphatic Sections: 0.75

Vascular-Interventional Radiography: 2.00
Procedures: 2.00
Vascular Diagnostic Procedures: 1.25
Vascular Interventional Procedures: 0.75

Vascular Sonography: 0.75
Procedures: 0.75
Abdominal/Pelvic Vasculature: 0.75

Outline

  1. Introduction
  2. Anatomy of the Caudate Lobe
  3. C-Arm CT
  4. Caudate Artery
  5. HCCs in the Caudate Lobe
    1. HCC in the Spiegel Lobe
    2. HCC in the Paracaval Portion
    3. HCC in the Caudate Process
    4. Recurrent Tumors in the Caudate Lobe
    5. HCCs with Portal Vein or Bile Duct Invasion
  6. Chemoembolization through the Caudate Artery
    1. Bile Duct Stricture
  7. Conclusion

Objectives

Upon completion of this course, students will:

  1. be familiar with the difficulties of performing chemoembolization and percutaneous ablation on patients with HCCs located in the caudate lobe
  2. identify the modality that assists interventional radiologists when performing transarterial chemoembolization in tumors of the caudate lobe
  3. be familiar with the anatomy of the caudate artery
  4. be familiar with the anatomy of the caudate lobe of the liver
  5. be familiar with the anatomy and location of the caudate process
  6. identify the proper catheter for use in the common hepatic artery
  7. be familiar with the injection rate of undiluted contrast material when imaging the caudate lobe with C-arm CT
  8. be familiar with the ability for C-arm CT to identify tumor-feeding arteries of the caudate lobe
  9. identify the location of the Spiegel lobe in the caudate of the liver
  10. be familiar with the hepatic arteries
  11. be familiar with the vascular network of the hepatic ducts
  12. identify the location of the two marginal arteries located along the common bile duct
  13. be familiar with the common origins of the caudate artery
  14. identify the Spiegel lobe during the axial portal venous phase CT
  15. be familiar with the paracaval portion of the caudate lobe
  16. identify the middle hepatic artery as an origin for the caudate artery
  17. identify the accumulation of iodized oil in an axial CT image
  18. be familiar with the arteries supplying an HCC in the paracaval portion of the caudate lobe
  19. be familiar with the role the right hepatic artery plays in supplying blood to HCCs located in the caudate process.
  20. be familiar with the most common extrahepatic collateral artery supplying recurrent tumors in the caudate lobe
  21. identify the less common vessels that supply recurrent tumors in the caudate lobe
  22. be familiar with the effective and safe treatment of HCCs with chemoembolization
  23. be familiar with the sloughing of the biliary tumor thrombus after selective chemoembolization
  24. be familiar with the materials employed when treating HCCs with chemoembolization
  25. be familiar with the inadvertent embolization that can occur when embolic materials are forcefully injected into one caudate artery
  26. be familiar with techniques used to perform selective catheterization on the caudate artery
  27. be familiar with successful microcatheter techniques used in chemoembolization
  28. be familiar with the reported incidence of bile duct stricture due to chemoembolization through the caudate artery
  29. identify the location of the paracaval portion of the liver
  30. identify the factors that enable safe and effective treatment of caudate lobe HCCs