[Imaging findings and transarterial therapy of primacy hepatic carcinoma fed by right renal capsular artery].

OBJECTIVE: To evaluate the characteristics of primary hepatic carcinoma (PHC) teed by the right renal capsular artery(RRCA) and to assess the technical success rate,tumor response and complications in patients treated with transcatheter arterial chemoembolization (TACE) via the RRCA with or without other extrahepatic arteries and/or intrahepatic arteries. METHODS: From July 2010 to February 2014,23 patients were treated by TACE via the RRCA. We evaluate the characteristics of tumor, the blood supply situation of RRCA and the technical success rate, complications and tumor response of TACE via the RRCA. RESULTS: Tumor size was 90.60+/-48.23 mm. Of the 23 rumors,3 were located in segment V, 11 in segment VI and 9 in segment VII.8 cases were found to have RRCA supply at the first TACE session. The technical success rate was 100%.No severe complication occurred in 23 patients. Among the 23 patients, CR, PR, SD and PD were achieved in 3(13.0%), 10(43.5%), 2(8.7%), 8(34.8%) respectively. The objective response rate was 56.5%. The overall cumulative 6 month, 1-3-and 5-year survival rates and the median survival time were 82.6%, 52.2%,21.7%, 17.4% and 16.8 months, respectively. CONCLUSION: RRCA can participate in tumor blood supply when it located in the right hepatic lobe and with a larger diameter, or it was small but located in the bare area.Superselective intubation of RRCA with microcatheter and precise TACE via right renal capsular artery is safe ,effective and feasible.

[Imaging features of factors related to blood supply from right inferior hepatic artery branches in hepatocellular carcinoma].

OBJECTIVE: To analyze the angiographic features and factors related to the blood supply from right inferior phrenic artery (RIPA) branches in hepatocellular carcinoma (HCC). METHODS: Angiography images of blood supply from RIPA branches and clinical data from patients with HCC who had undergone tmnscatheter arterial chemoembolization in our hospital between 2009 and 2013 were collected for retrospective analysis. Angiographic features of the RIPA branches were assessed for correlation between treatment number, growth pattern, size, tumor location, and rates of blood supplying RIPA branches. Statistical analyses were carried out using chi-square test, t-test, Fisher's exact test and rank sum test. RESULTS: The 140 patients included in the analysis were grouped according to primary HCC (n=63; group A) and recurrent HCC (n=77; group B) and no statistically significant differences were found between the two groups for incidence of each nutrient branch or total number of nutrient branches. In group A, tumor size was associated with number of nutrient branches (P=0.047). There were 32 cases with HCC lesions in the bare area of the liver, and among those 26 of the cases were supplied by the posterior branch of RIPA. Each branch of RIPA showed greater firequency for particular blood supply areas; the anterior branch (n=55) and lateral branch (n=98) fed tumor lesions in segments 7 and 8, the posterior branch (n=98) fed tumor lesions in segments 6 and 7, and the supra-renal branch (n=10) fed tumor lesions in segment 6. The diaphragmatic branch always fed HCC partly located in segments 4 and 8 (n=17). Unique features were present on the digitally subtracted angiography (DSA) image for each nutrient branch and may be useful for distinguishing in clinical examination. CONCLUSION: Cases of primary HCC and recurrent HCC are not distinguishable by incidence of each nutrient branch or total numbers of the nutrient branches. However, tumor size is related to the number of RIPA nutrient branches, and each RIPA nutrient branch shows a dominant preference for certain blood supply areas, with unique features on DSA.

[The origin of the feeding artery of the retroperitoneal invasion caused by massive hepatocellular carcinoma and the treatment with transcatheter arterial chemoembolization].

OBJECTIVE: To analyze the origin of the feeding artery of the retroperitoneal invasion caused by massive hepatocellular carcinoma (HCC) and the characteristics of DSA. To explore the approaches to completely embolize the tumor blood supply and to assess the technical success rates, the safety and effectiveness with a purpose of improving the patients survival rates and living quality. METHODS: After complete ultraselective arterial embolization via hepatic artery for the 75 patients with retroperitoneal invasion led by massive HCC, those showing lipiodol deposition inconsistance compared with CT or MRI underwent the ultraselective catheterization to find potential tumor feeding arteries and then the subsequent chemoembolization. 3-6 months after operation CT or MRI was used to evaluate the efficacy. RETURNS: Retroperitoneal lesions were supplied by the posterior branch of right inferior phrenic artery (64%, 48/75), the right adrenal artery (33.3%, 25/75) and the right-side first lumbar artery (2.7%, 2/75), respectively. The success rates of ultraselective catheterization to tumor feed arteries was 100% (75/75). 3-6 months after embolization, the cases of complete and most-part iodine oil filling in the lesions were 72 (96%) and 3 (4%) respectively. The sizes of the lesions showed significant reduce (55, 73.3%), reduce (15, 20%) and no change (5,6.7%). Survival rates of 6, 12, 24 and 36 months after TACE were 90.7% (68/75), 81.3% (61/75), 49.3% (37/75) and 40% (30/75) respectively. CONCLUSION: The supply arteries of retroperitoneal invasion led by massive HCC come from the posterior branch of right phrenic artery, the right adrenal artery and the right first lumbar artery. Ultraselective TACE has high technical success rates, hight safety, and excellent effectiveness. The complete embolization of tumor feed artery can significantly increase the survival rates and living quality of these patients.