Role of C-Arm CT in Identifying Caudate Arteries Supplying Hepatocellular Carcinoma

Purpose: To evaluate the role of C-arm computed tomography (CT) performed at the proper hepatic artery or equivalent in patients with caudate-lobe hepatocellular carcinoma (HCC) for the detection of tumor-feeding arteries during chemoembolilation. Materials and Methods: From July 2009 to June 2012, 1,785 patients received initial chemoembolization at a single institution. Among, them, 52 patients with caudate HCC under Went initial,chemoembolization with the use of C-arm CT. C-arm CT images were obtained at the proper hepatic artery or equivalent. Two radiologists reviewed the C-arm CT Scans and angiograms in consensus. The cumulative local recurrence rate wag Calculated, by the kaplan-Meier method. Results: Tumor-feeding arteries were Single (n = 31), double (n = 12), triple (n = 6), and quadruple (n = 3). Seventy-nine tumor-feeding arteries and their origing in 48 patients were demonstrated on C-arm CT. In four patients (7.7%), five tumor-feeding arteries were not clearly indicated on C-arm CT because of poor image quality caused by failure of the patients to hold their breath. Selective chemoemboliztion via tumor-feeding arteries was successful in 45 patients (87%). The cumulative local recurrence rates at 6 months, 1 year, and 3 years were 19.4%; 32.8%, and 35.8%, respectively. Nonselective chemoembolization of tumor-feeding atteries of caudate-lobe HCC was a significantly important factor in higher cumulative local recurrence rates (hazard ratio, 3.916; 95% confidence interval; 1.367-11.216; P = .011). Conclusion: C-arm CT obtained at the proper hepatic artery or equivalent level can demonstrate most tumor-feeding arteries supplying HCCs in the caudate lobe.