Chemoembolization of Hepatocellular Carcinoma with Extrahepatic Supply

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 30, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Abdomen and Pelvis: 1.50

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Neurological, Vascular, and Lymphatic Sections: 2.00

Sonography: 1.50
Procedures: 1.50
Abdomen: 1.50

Vascular-Interventional Radiography: 2.00
Procedures: 2.00
Vascular Interventional Procedures: 2.00

Vascular Sonography: 1.50
Procedures: 1.50
Abdominal/Pelvic Vasculature: 1.50

Outline

1. Introduction
2. Factors Favoring the Development of a Parasitic Blood Supply to HCC
3. Predicting the Presence of a Parasitic Blood Supply to HCC
   1. EHC Arteries Supplying Blood to HCC
   2. Inferior Phrenic Arteries
      1. Right IPA
      2. Left IPA
   3. Omental Arteries
   4. Internal Mammary Artery
   5. Suprarenal Arteries
   6. Right Renal Artery
   7. Intercostal Arteries
   8. Cystic Artery
   9. Gastric Arteries
   10. Lumbar Arteries
   11. Superior Mesenteric Artery
   12. Gastroduodenal Artery
4. Technical Tips
5. Conclusion

Objectives

Upon completion of this course, students will:

1. recall the individual responsible for the Michels classification system
2. document the technical limitations for transarterial chemoembolization
3. state the obsolete treatment for hepatocellular carcinoma
4. list the main factors influencing the development of EHC arterial supplies to HCC
5. list additional factors related to development of EHC arteries
6. discuss tumor size and its effect on the development of EHC arterial supply to HCC
7. list angiographic findings that strongly suggest an EHC arterial supply
8. list factors that should raise suspicion of treatment failure due to the presence of parasitic feeder blood supply to untreated portions of an HCC
9. indicate the arteries that can contribute parasitic blood flow to HCC
10. know which arteries supply the diaphragm
11. explain the anatomy of the inferior phrenic arterial system
12. differentiate between the blood supplies to HCCs
13. describe how to avoid reflux of agents into the suprarenal and diaphragmatic branches during embolization through the right IPA
14. list common complications associated with TACE through the right IPA
15. list the branches of the left inferior phrenic artery
16. state the technical success rate for TACE performed through the left IPA
17. recall the angle from which the omental arteries arise from the right and left gastroepiploic arteries
18. explain the best way to angiographically visualize the omental arteries
19. choose the best angiographic method for detecting a parasitic HCC supply through the omental arteries
20. state the alternative name for the internal mammary artery
21. differentiate between sensitivity and accuracy of CT for IMA parasitic blood supply to HCC
22. know the blood supply for the adrenal gland
23. indicate the origin of the right renal artery
24. list the segments of the liver
25. state the number of intercostal artery pairs
26. express the most common ICA sources of EHC supplies to hepatic tumors
27. state the blood supply for the gallbladder
28. state the number of lumbar arteries branching from the abdominal aorta
29. list the branches of the superior mesenteric artery
30. list complications from non-targeted embolization of the gastroduodenal artery