Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment
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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.
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.
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.
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.
KeywordsInterventional oncology Liver/Hepatic Radioembolization
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.
- 7.Couinaud C (1989) Surgical anatomy of the liver revisited: embryology. Masson, Paris 1989Google Scholar
- 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
- 19.Couinaud C (1957) Le Foie Etudes anatomiques et chirurgicales. Masson, ParisGoogle Scholar
- 20.Gans HG (1955) Introduction to hepatic surgery. Elsevier, AmsterdamGoogle Scholar
- 21.Hortsjo CH (1951) The topography of the intrahepatic duct systems. Acta Anat 11:599–615Google Scholar
- 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