title: Hepatic arterial configuration in relation to the segmental anatomy of the liver; observations on MDCT and DSA relevant to radioembolization treatment.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands, a.f.vandenhoven@umcutrecht.nl.
authors.forename: Andor F
authors.initials: AF
authors.lastname: van den Hoven
authors.forename: Maarten S
authors.initials: MS
authors.lastname: van Leeuwen
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods*; D003287:Contrast Media; D004621:Embolization, Therapeutic; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008099:Liver / Q000000981:diagnostic imaging*; D061330:Multidetector Computed Tomography / Q000379:methods*; D011856:Radiographic Image Enhancement
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide