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Radiology
Interventional Management of Hepatic Malignancies General Concepts from Anatomy to Practice
Built from Fundamentals of Diagnostic Radiology
What’s inside
6 sections · 126 slides
Introduction
How liver-directed therapy is used and why it matters
- What liver-directed therapy does
- How the field has changed
- Where these therapies fit in treatment
- The road map of this deck
Vascular Anatomy of the Liver
Segmental and arterial anatomy that guides treatment
- Liver segmentation systems over time
- Why Couinaud segments matter
- What sits at each segment's center and edge
- The planes that divide the liver
- The eight Couinaud segments
- Couinaud segmental liver anatomy
- Couinaud segmental anatomy with ultrasound correlation
- Why tumor blood supply matters
- Conventional hepatic arterial pathway
- The conventional arrangement
- Celiac angiogram showing conventional anatomy
- Replaced versus accessory arteries
- Replaced common hepatic artery from the superior mesenteric artery
- Left hepatic artery variants
- Replaced left hepatic artery from the left gastric artery
- Right hepatic artery variants
- Replaced right hepatic artery from the superior mesenteric artery
- Segment IV and caudate supply
- Middle hepatic artery arising as a trifurcation
- Nontarget vessels: why they matter
- Gastroduodenal artery
- Right hepatic angiogram with gastroduodenal artery coil
- Right gastric artery
- Right gastric artery coil embolization
- Supraduodenal and retroduodenal arteries
- Right hepatic artery from the celiac with posterosuperior pancreaticoduodenal artery
- Accessory left gastric artery
- Accessory left gastric arteries
- Falciform artery
- Falciform artery with cutaneous radiation injury
- Cystic artery
- Cystic artery coil embolization
- Parasitized collateral vessels
- Parasitized flow from intercostal, renal, and adrenal arteries
- Right inferior phrenic artery
- Parasitized right inferior phrenic artery flow
- Omental and cystic collaterals
Intra-Arterial Therapies
Chemoembolization and radioembolization
- Why the artery is the delivery route
- Available intra-arterial therapies
- What TACE does and when it is used
- Why tumors can survive embolization
- How to get the best TACE result
- When to keep arteries open
- How conventional TACE is done
- Conventional TACE case
- Where TACE came from
- What ethiodized oil is
- Chemotherapy and embolic agents in TACE
- Choosing embolic particle size
- Transarterial approaches
- What the variations teach
- Advantages and disadvantages of each transarterial embolization method
- Drug-eluting bead TACE
- DEB-TACE versus conventional TACE
- Drug-eluting bead TACE case
- Who benefits from TACE
- Examples of different hepatocellular carcinoma appearances
- Tumor features that predict worse response
- Prognostic factors for favorable TACE outcome
- Choosing patients with liver disease
- Absolute contraindications to TACE
- Relative contraindications to TACE
- How the TACE procedure is performed
- TACE complications
- Chronic cholecystitis following drug-eluting bead TACE
- Why external beam radiation falls short
- What SIRT is
- SIRT versus TACE: how they kill
- Who gets SIRT
- Radiation segmentectomy
- Radiation segmentectomy
- Radiation lobectomy mechanism
- Why radiation lobectomy is used
- Radiation lobectomy
- Yttrium-90 basics
- The two microsphere products
- Comparison of available SIRT particles
- Why dosimetry is hard to predict
- Contraindications to SIRT
- The MAA rehearsal
- SIRT side effects
Percutaneous Therapies
Chemical and energy-based ablation
- Ethanol ablation
- Percutaneous ethanol ablation
- Acetic acid ablation
- How radiofrequency ablation heats tissue
- What shapes the RFA ablation zone
- Lesion size and RFA success
- Location and the heat-sink effect
- RFA versus resection and transplant
- RFA safety
- Microwave ablation
- Percutaneous microwave ablation
- Radiofrequency versus microwave ablation
- Cryoablation
- Irreversible electroporation
- Laser ablation
- Advantages and disadvantages of each ablation method
- Advantages and disadvantages of each ablation method (continued)
Assessing Treatment Response
How imaging measures success
- Why RECIST fails after TACE and SIRT
- How response is assessed instead
- Available follow-up criteria
- How anatomic criteria measure
- Available anatomic criteria
- When to repeat or switch therapy
- Beyond size: functional imaging
- The limits of alpha-fetoprotein
Key Takeaways
Putting the concepts into practice
- Key takeaways
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- Brant and Helms' Fundamentals of Diagnostic Radiology