Advertisement

CardioVascular and Interventional Radiology

, Volume 38, Issue 1, pp 100–111 | Cite as

Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

  • Andor F. van den Hoven
  • Maarten S. van Leeuwen
  • Marnix G. E. H. Lam
  • Maurice A. A. J. van den Bosch
Clinical Investigation

Abstract

Purpose

Current anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification.

Methods

The hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA.

Results

The hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four.

Conclusions

The hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification.

Keywords

Interventional oncology Liver/Hepatic Radioembolization 

Notes

Conflict of interest

Andor F. van den Hoven has no conflict of interest. Maarten S. van Leeuwen has no conflict of interest. Marnix G.E.H. Lam has no conflict of interest. Maurice A.A.J. van den Bosch has no conflict of interest.

References

  1. 1.
    Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347PubMedCrossRefGoogle Scholar
  2. 2.
    Hiatt JR, Gabbay J, Busuttil RW (1994) Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 220:50–52PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Gruttadauria S, Foglieni CS, Doria C, Luca A, Lauro A, Marino IR (2001) The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases. Clin Transplant 15:359–363PubMedCrossRefGoogle Scholar
  4. 4.
    Koops A, Wojciechowski B, Broering DC, Adam G, Krupski-Berdien G (2004) Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat 26:239–244PubMedCrossRefGoogle Scholar
  5. 5.
    Abdullah SS, Mabrut JY, Garbit V et al (2006) Anatomical variations of the hepatic artery: study of 932 cases in liver transplantation. Surg Radiol Anat 28:468–473PubMedCrossRefGoogle Scholar
  6. 6.
    Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT (2002) Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 224:542–547PubMedCrossRefGoogle Scholar
  7. 7.
    Couinaud C (1989) Surgical anatomy of the liver revisited: embryology. Masson, Paris 1989Google Scholar
  8. 8.
    Jin GY, Yu HC, Lim HS et al (2008) Anatomical variations of the origin of the segment 4 hepatic artery and their clinical implications. Liver Transpl 14:1180–1184PubMedCrossRefGoogle Scholar
  9. 9.
    Healey JE, Schroy PC, Sorensen RJ (1953) The intrahepatic distribution of the hepatic artery in man. J Int Coll Surg 20:133–148PubMedGoogle Scholar
  10. 10.
    Uliel L, Royal HD, Darcy MD, Zuckerman DA, Sharma A, Saad NE (2012) From the angio suite to the gamma-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization–a comprehensive pictorial review. J Nucl Med 53:1736–1747PubMedCrossRefGoogle Scholar
  11. 11.
    van den Hoven AF, Smits ML, de Keizer B, van Leeuwen MS, van den Bosch MA, Lam MG (2014) Identifying aberrant hepatic arteries prior to intra-arterial radioembolization. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-014-0845-x
  12. 12.
    Wang S, He X, Li Z et al (2010) Characterization of the middle hepatic artery and its relevance to living donor liver transplantation. Liver Transpl 16:736–741PubMedGoogle Scholar
  13. 13.
    Suzuki T, Nakayasu A, Kawabe K, Takeda H, Honjo I (1971) Surgical significance of anatomic variations of the hepatic artery. Am J Surg 122:505–512PubMedCrossRefGoogle Scholar
  14. 14.
    Winter TC 3rd, Freeny PC, Nghiem HV et al (1995) Hepatic arterial anatomy in transplantation candidates: evaluation with three-dimensional CT arteriography. Radiology 195:363–370PubMedCrossRefGoogle Scholar
  15. 15.
    Erbay N, Raptopoulos V, Pomfret EA, Kamel IR, Kruskal JB (2003) Living donor liver transplantation in adults: vascular variants important in surgical planning for donors and recipients. AJR Am J Roentgenol 181:109–114PubMedCrossRefGoogle Scholar
  16. 16.
    Winston CB, Lee NA, Jarnagin WR et al (2007) CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol 189:W13–W19PubMedCrossRefGoogle Scholar
  17. 17.
    Saba L, Mallarini G (2011) Anatomic variations of arterial liver vascularization: an analysis by using MDCTA. Surg Radiol Anat 33:559–568PubMedCrossRefGoogle Scholar
  18. 18.
    Onishi H, Kawarada Y, Das BC et al (2000) Surgical anatomy of the medial segment (S4) of the liver with special reference to bile ducts and vessels. Hepatogastroenterology 47:143–150PubMedGoogle Scholar
  19. 19.
    Couinaud C (1957) Le Foie Etudes anatomiques et chirurgicales. Masson, ParisGoogle Scholar
  20. 20.
    Gans HG (1955) Introduction to hepatic surgery. Elsevier, AmsterdamGoogle Scholar
  21. 21.
    Hortsjo CH (1951) The topography of the intrahepatic duct systems. Acta Anat 11:599–615Google Scholar
  22. 22.
    Fainsinger MH (1950) The radiology of the intrahepatic biliary tract. S Afr J Med Sci 15:51–66PubMedGoogle Scholar
  23. 23.
    Elias H, Petty D (1952) Gross anatomy of the blood vessels and ducts within the human liver. Am J Anat 90:59–111PubMedCrossRefGoogle Scholar
  24. 24.
    Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–9PubMedCrossRefGoogle Scholar
  25. 25.
    Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R (2012) Radioembolization for the treatment of liver tumors general principles. Am J Clin Oncol 35:91–99PubMedCrossRefGoogle Scholar
  26. 26.
    Kao YH, Hock Tan AE, Burgmans MC et al (2012) Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization. J Nucl Med 53:559–566PubMedCrossRefGoogle Scholar
  27. 27.
    Strunk H, Stuckmann G, Textor J, Willinek W (2003) Limitations and pitfalls of Couinaud’s segmentation of the liver in transaxial imaging. Eur Radiol 13:2472–2482PubMedCrossRefGoogle Scholar
  28. 28.
    van Leeuwen MS, Noordzij J, Fernandez MA, Hennipman A, Feldberg MA, Dillon EH (1994) Portal venous and segmental anatomy of the right hemiliver: observations based on three-dimensional spiral CT renderings. AJR Am J Roentgenol 163:1395–1404PubMedCrossRefGoogle Scholar
  29. 29.
    Fasel JH, Gailloud P, Grossholz M, Bidaut L, Probst P, Terrier F (1996) Relationship between intrahepatic vessels and computer-generated hepatic scissurae: an in vitro assay. Surg Radiol Anat 18:43–46PubMedCrossRefGoogle Scholar
  30. 30.
    Ohashi I, Ina H, Okada Y et al (1996) Segmental anatomy of the liver under the right diaphragmatic dome: evaluation with axial CT. Radiology 200:779–783PubMedCrossRefGoogle Scholar
  31. 31.
    Rieker OMP, Hintze C, Shunk K, Otto G, Thelen M (2000) Segmentanatomie der Leber in der Computertomographie: Lokalisieren wir die Läsionen richtig. Fortschr Röntgenstr 172:147–152CrossRefGoogle Scholar
  32. 32.
    Louie JD, Kothary N, Kuo WT et al (2009) Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 20:606–613PubMedCrossRefGoogle Scholar
  33. 33.
    van den Hoven AF, Prince JF, Samim M, Arepally A, Zonneberg BA, Lam MG, van den Bosch MA (2013) Posttreatment PET-CT-confirmed intrahepatic radioembolization performed without coil embolization, by using the antireflux surefire infusion system. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-013-0674-3
  34. 34.
    Abdelmaksoud MH, Louie JD, Kothary N et al (2011) Consolidation of hepatic arterial inflow by embolization of variant hepatic arteries in preparation for yttrium-90 radioembolization. J Vasc Interv Radiol 22(1364–1371):e1PubMedGoogle Scholar
  35. 35.
    Bilbao JI, Garrastachu P, Herraiz MJ et al (2010) Safety and efficacy assessment of flow redistribution by occlusion of intrahepatic vessels prior to radioembolization in the treatment of liver tumors. Cardiovasc Intervent Radiol 33:523–531PubMedCrossRefGoogle Scholar
  36. 36.
    Lam MG, Banerjee S, Louie JD et al (2013) Root cause analysis of gastroduodenal ulceration after yttrium-90 radioembolization. Cardiovasc Intervent Radiol 36(6):1536–1547PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Andor F. van den Hoven
    • 1
  • Maarten S. van Leeuwen
    • 1
  • Marnix G. E. H. Lam
    • 1
  • Maurice A. A. J. van den Bosch
    • 1
  1. 1.Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands

Personalised recommendations