Chemoembolization of Caudate Lobe Hepatocellular Carcinoma—Anatomy and Procedures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 27, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.25
Procedures: 1.25
Abdomen and Pelvis: 1.25

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Neurological, Vascular, and Lymphatic Sections: 1.75

Sonography: 1.25
Procedures: 1.25
Abdomen: 1.25

Vascular-Interventional Radiography: 1.75
Procedures: 1.75
Vascular Diagnostic Procedures: 1.25
Vascular Interventional Procedures: 0.50

Vascular Sonography: 1.25
Procedures: 1.25
Abdominal/Pelvic Vasculature: 1.25

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