Hypertrophied Right Inferior Phrenic Artery in Cirrhotic Patients without Hepatocellular Carcinoma: An Interesting Observation on 256 Slice Multidetector Computed Tomography

Abstract Aim To evaluate whether right inferior phrenic artery (RIPA) is a source of extrahepatic arterial supply to the liver in cirrhotic patients without hepatocellular carcinoma (HCC) using 256 slice computed tomography (CT). Materials and Methods Institutional review board approval was obtained for this retrospective study. A total of 262 consecutive cirrhotic patients (male:female–172:90; mean age 56.45 ± 12.96 years) without HCC and hepatic vascular invasion, and who underwent technically successful multiphase CT, were included in the study. Additionally, 280 noncirrhotic patients (male:female–169:111; mean age 54.56 ± 14.21 years) who underwent abdominal multiphase CT scans for indications other than liver disease and did not have focal liver lesions or hepatic vascular disease were included as a control group. The RIPA and left inferior phrenic artery (LIPA) diameters were measured at the level of the ascending segment of IPA located anterior to the diaphragmatic crus. The relationship between RIPA diameters and Child–Pugh score was assessed. Results The cirrhotic patient group and control group were matched for age (p = 0.11) and gender (p = 0.20). The mean diameter of RIPA in the cirrhotic group (1.93 ± 0.4 mm) was significantly higher than in the control group (1.50 ± 0.5 mm), p < 0.001. The mean diameter of LIPA in the cirrhotic group (1.34 ± 0.5 mm) was not significantly higher than in the control group (1.30 ± 0.5 mm), p = 0.32. We found a statistically linear and moderate degree relationship between RIPA diameter values and Child–Pugh scores (p = 0.002, r = 0.593). Conclusion RIPA is hypertrophied in patients with cirrhosis without HCC. It may be an important contributor to the blood flow to the liver in cirrhotic patients even without HCC, especially with portal hypertension.

Download Full-text

Computed Tomography-Based Patient-Specific Instrumentation Loses Accuracy with Significant Varus Preoperative Misalignment

The Journal of Knee Surgery ◽

10.1055/s-0040-1716381 ◽

2020 ◽

Author(s):

Vicente Jesús León-Muñoz ◽

Mirian López-López ◽

Alonso José Lisón-Almagro ◽

Francisco Martínez-Martínez ◽

Fernando Santonja-Medina

Keyword(s):

Computed Tomography ◽

Deformity Correction ◽

Patient Specific ◽

Control Group ◽

X Rays ◽

Varus Alignment ◽

Patient Specific Instrumentation ◽

Conventional Instrumentation ◽

The Mean ◽

Valgus Alignment

AbstractPatient-specific instrumentation (PSI) has been introduced to simplify and make total knee arthroplasty (TKA) surgery more precise, effective, and efficient. We performed this study to determine whether the postoperative coronal alignment is related to preoperative deformity when computed tomography (CT)-based PSI is used for TKA surgery, and how the PSI approach compares with deformity correction obtained with conventional instrumentation. We analyzed pre-and post-operative full length standing hip-knee-ankle (HKA) X-rays of the lower limb in both groups using a convention > 180 degrees for valgus alignment and < 180 degrees for varus alignment. For the PSI group, the mean (± SD) pre-operative HKA angle was 172.09 degrees varus (± 6.69 degrees) with a maximum varus alignment of 21.5 degrees (HKA 158.5) and a maximum valgus alignment of 14.0 degrees. The mean post-operative HKA was 179.43 degrees varus (± 2.32 degrees) with a maximum varus alignment of seven degrees and a maximum valgus alignment of six degrees. There has been a weak correlation among the values of the pre- and postoperative HKA angle. The adjusted odds ratio (aOR) of postoperative alignment outside the range of 180 ± 3 degrees was significantly higher with a preoperative varus misalignment of 15 degrees or more (aOR: 4.18; 95% confidence interval: 1.35–12.96; p = 0.013). In the control group (conventional instrumentation), this loss of accuracy occurs with preoperative misalignment of 10 degrees. Preoperative misalignment below 15 degrees appears to present minimal influence on postoperative alignment when a CT-based PSI system is used. The CT-based PSI tends to lose accuracy with preoperative varus misalignment over 15 degrees.

Download Full-text

A comprehensive study of right and left inferior phrenic artery variations in 1000 patients with multidetector computed tomography angiography: an important study for HCC

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02805-7 ◽

2021 ◽

Author(s):

Arzu Ekingen ◽

Mehmet Güli Çetinçakmak

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Computed Tomography Angiography ◽

Inferior Phrenic Artery ◽

Important Study ◽

Phrenic Artery ◽

Multidetector Computed Tomography Angiography ◽

Comprehensive Study

Download Full-text

Diaphragmatic Weakness after Transcatheter Arterial Chemoembolization of Inferior Phrenic Artery for Treatment of Hepatocellular Carcinoma

Radiology ◽

10.1148/radiol.2412051209 ◽

2006 ◽

Vol 241 (2) ◽

pp. 581-588 ◽

Cited By ~ 15

Author(s):

Sung Wook Shin ◽

Young Soo Do ◽

Sung Wook Choo ◽

Wei Chiang Lieu ◽

Sung Ki Cho ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transcatheter Arterial Chemoembolization ◽

Inferior Phrenic Artery ◽

Phrenic Artery ◽

Diaphragmatic Weakness ◽

Arterial Chemoembolization

Download Full-text

Yttrium-90 Radioembolization of the Right Inferior Phrenic Artery in 20 Patients with Hepatocellular Carcinoma

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.10.010 ◽

2018 ◽

Vol 29 (4) ◽

pp. 556-563 ◽

Cited By ~ 4

Author(s):

Hyo-Cheol Kim ◽

Yoon Jun Kim ◽

Jin Chul Paeng ◽

Jin Wook Chung

Keyword(s):

Hepatocellular Carcinoma ◽

Inferior Phrenic Artery ◽

Phrenic Artery ◽

The Right ◽

Yttrium 90

Download Full-text

Diaphragmatic weakness after transcatheter arterial chemoembolization of the right inferior phrenic artery for treatment of hepatocellular carcinoma: a comparison of outcomes after N-butyl cyanoacrylate versus gelatin sponge embolization

Acta Radiologica ◽

10.1177/0284185120981771 ◽

2020 ◽

pp. 028418512098177

Author(s):

Seung Yeon Noh ◽

Dong Il Gwon ◽

Suyoung Park ◽

Woo Jin Yang ◽

Hee Ho Chu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Complete Response ◽

Gelatin Sponge ◽

Inferior Phrenic Artery ◽

Gelatin Sponge Particles ◽

Phrenic Artery ◽

The Right ◽

Diaphragmatic Weakness ◽

Arterial Chemoembolization

Background The inferior phrenic artery (IPA) is the most common extrahepatic feeder for hepatocellular carcinoma (HCC) during transhepatic arterial chemoembolization (TACE). Purpose To compare the incidence of diaphragmatic weakness in patients with HCC after TACE of the right IPA conducted using either N-butyl cyanoacrylate (NBCA) or gelatin sponge particles. Material and Methods Medical records of 111 patients who underwent TACE of the right IPA using NBCA were retrospectively reviewed and compared with data from 135 patients with IPA embolization using gelatin sponge particles. Results The incidence of diaphragmatic weakness after the initial TACE procedure did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 20.7%; P = 0.458). Five patients in the NBCA group and 11 in the gelatin sponge group showed spontaneous resolution of diaphragmatic weakness after a mean period of 3.5 months. Diaphragmatic weakness developed after the initial follow-up visit in 17 patients from the gelatin sponge group due to repeated TACE of the right IPA (mean 2.4 sessions; range 2–4 sessions), while it spontaneously developed without additional TACE procedures in one patient from the NBCA group. Permanent diaphragmatic weakness was less common in the NBCA than in the gelatin sponge group (12.6% and 25.2%, respectively; P = 0.017). The complete response rate did not significantly differ between the groups (NBCA group 16.2%; gelatin sponge group 25.9%; P = 0.065). Conclusion Use of NBCA rather than gelatin sponge particles for TACE of the right IPA resulted in a lower incidence of permanent diaphragmatic weakness.

Download Full-text

Hepatocellular carcinoma in patients undergoing orthotopic liver transplantation: radiological findings with anatomopathological correlation in Brazil

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032006000100008 ◽

2006 ◽

Vol 43 (1) ◽

pp. 24-29 ◽

Cited By ~ 3

Author(s):

Antônio Carlos Maciel ◽

Carlos Thadeu Cerski ◽

Roger Klein Moreira ◽

Vinicius Labrea Resende ◽

Maria Lúcia Zanotelli ◽

...

Keyword(s):

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Orthotopic Liver Transplantation ◽

Imaging Techniques ◽

Arterial Phase ◽

Hepatitis C Virus Infection ◽

Cirrhotic Patients

BACKGROUND: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Imaging techniques, specially computed tomography and ultrasound, are among the most useful diagnostic tools, although the accuracy of these methods may have a significant variability. AIMS: To determine the prevalence of hepatocellular carcinoma in cirrhotic patients undergoing orthotopic liver transplantation at "Santa Casa de Misericórdia" of Porto Alegre, RS, Brazil; to estimate the sensitivity of computed tomography and ultrasound in pretransplantation detection of hepatocellular carcinoma in this population; to correlate the radiological characteristics with anatomopathological findings. MATERIALS AND METHODS: Retrospective prevalence study. Population: adult, cirrhotic patients undergoing orthotopic liver transplantation from January 1990 to July 2003. Among the 292 transplanted patients, 31 cases of hepatocellular carcinoma were diagnosed, of which 29 were included in the study. Tumor characteristics in both ultrasound and computed tomography were compared to those observed in anatomopathological examination. RESULTS: Prevalence of hepatitis C virus infection among patients with diagnosis of hepatocellular carcinoma was 93.5%, and the prevalence of hepatocellular carcinoma among transplanted patients was 10.6%. The overall sensitivity of the imaging techniques was 70.3% for computed tomography and 72% for ultrasound. CONCLUSION: The prevalence of hepatocellular carcinoma at our institution, as well as the sensitivity of both ultrasound and computed tomography to detect such tumors at pretransplantation screening were similar to those found by other authors, while the prevalence of hepatitis C virus infection, the most common etiological agent for liver disease in our patients, is one of the highest ever reported in literature. Factors influencing hepatocellular carcinoma detection rates were: time from examination to liver transplantation; acquisition of computed tomography images during arterial phase; lesion size. Arterial phase proved to be the most useful part of computed tomography examination in this study.

Download Full-text

Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

QJM ◽

10.1093/qjmed/hcab097.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohammed Mahfouz Mohammed ◽

Hany Saeed Abdel Basset ◽

Mohammed Abd Almegeed Elsayed ◽

Ahmed Abdel Basset Hegazi

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Laparoscopic Liver Resection ◽

Operative Time ◽

Short Term ◽

Open Liver Resection ◽

Resection Group ◽

Significant Difference ◽

Cirrhotic Patients ◽

The Mean

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

Download Full-text

The Difference between Computed Tomography and Magnetic Resonance Imaging Measurements of Tibial Tubercle–Trochlear Groove Distance for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-analysis

The Journal of Knee Surgery ◽

10.1055/s-0039-1688563 ◽

2019 ◽

Vol 33 (08) ◽

pp. 768-776 ◽

Cited By ~ 3

Author(s):

Si Heng Sharon Tan ◽

Beatrice Ying Lim ◽

Kiat Soon Jason Chng ◽

Chintan Doshi ◽

Francis K.L. Wong ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Patellofemoral Instability ◽

Tibial Tubercle ◽

Control Group ◽

Trochlear Groove ◽

Resonance Imaging ◽

The Mean ◽

Ct And Mri

AbstractThe tibial tubercle–trochlear groove (TT–TG) distance was originally described for computed tomography (CT) but has recently been used on magnetic resonance imaging (MRI) without sufficient evidence demonstrating its validity on MRI. The current review aims to evaluate (1) whether there is a difference in the TT–TG distances measured using CT and MRI, (2) whether both the TT–TG distances measured using CT and MRI could be used to differentiate between patients with or without patellofemoral instability, and (3) whether the same threshold of 15 to 20 mm can be applied for both TT–TG distances measured using CT and MRI. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that compared TT–TG distances either (1) between CT and MRI or (2) between patients with and without patellofemoral instability were included. A total of 23 publications were included in the review. These included a total of 3,040 patients. All publications reported the TT–TG distance to be greater in patients with patellofemoral instability as compared to those without patellofemoral instability. This difference was noted for both TT–TG distances measured on CT and on MRI. All publications also reported the TT–TG distance measured on CT to be greater than that measured on MRI (mean difference [MD] = 1.79 mm; 95% confidence interval [CI]: 0.91–2.68). Pooling of the studies revealed that the mean TT–TG distance for the control group was 12.85 mm (95% CI: 11.71–14.01) while the mean TT–TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04–19.62) when measured on CT. When measured on MRI, the mean TT–TG distance for the control group was 9.83 mm (95% CI: 9.11–10.54), while the mean TT–TG distance for patients with patellofemoral instability was 15.33 mm (95% CI: 14.24–16.42). Both the TTTG distances measured on CT and MRI could be used to differentiate between patients with and without patellofemoral instability. Patients with patellofemoral instability had significantly greater TT–TG distances than those without. However, the TT–TG distances measured on CT were significantly greater than that measured on MRI. Different cut-off values should, therefore, be used for TT–TG distances measured on CT and on MRI in the determination of normal versus abnormal values. Pooling of all the patients included in the review then suggest for 15.5 ± 1.5 mm to be used as the cut off for TT–TG distance measured on CT, and for 12.5 ± 2 mm to be used as the cut-off for TT–TG distance measured on MRI. The Level of evidence for this study is IV.

Download Full-text