title: Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection.
abstract: OBJECTIVE
  To retrospectively evaluate the arterial blood supply to the posterior aspect of segment IV of the liver with computed tomography (CT) after transcatheter arterial chemoembolization (TACE) with iodized oil through the caudate arterial branch of the liver for treatment of hepatocellular carcinoma (HCC).
  
  
  METHODS
  Institutional review board approval and patient informed consent were not required for this retrospective study. Twenty-four patients (11 men and 13 women; mean age, 68 years) with HCC originating in the caudate lobe (n = 23) or posterior aspect of segment IV (n = 1) were selected. TACE of the caudate arterial branch was performed in all patients, including one patient with HCC in the posterior aspect of segment IV who underwent TACE of the caudate arterial branch after CT helped confirm that iodized oil was not distributed in the tumor after TACE of the medial segmental artery. The distribution of iodized oil in the posterior aspect of segment IV was analyzed with CT 1 week after TACE. The number and origin of all arteries supplying the caudate lobe and the number of arteries embolized were determined.
  
  
  RESULTS
  Thirty-three caudate arterial branches were embolized. Twenty-nine branches were derived from the right hepatic artery and four were derived from the left hepatic artery. A single branch was seen in 17 patients, two branches were seen in five, and three branches were seen in two. Eight patients simultaneously underwent additional TACE of branches of the right hepatic artery (n = 6) or right inferior phrenic artery (n = 2). At CT, iodized oil was seen to be distributed entirely (n = 19) or partially (n = 5) in the caudate lobe. Distribution of iodized oil at the posterior aspect of segment IV was observed in 16 patients (67%), including 13 (54%) whose caudate arterial branches were derived entirely from the right hepatic artery.
  
  
  CONCLUSIONS
  The results of this study suggest that the caudate arterial branch, which is mainly derived from the right hepatic artery, frequently supplies the posterior aspect of segment IV. This knowledge is important for managing HCC in the posterior aspect of segment IV by means of TACE.
authors.affiliation: Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan. s-miyayama@fukui.saiseikai.or.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyayama
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Taki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Minami
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Ryu
authors.forename: Chiharu
authors.initials: C
authors.lastname: Ito
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Dai
authors.initials: D
authors.lastname: Inoue
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Takamatsu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage*; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007459:Iodized Oil