Korean J Radiol.  2011 Dec;12(6):693-699. 10.3348/kjr.2011.12.6.693.

Hepatocellular Carcinomas Smaller Than 4 cm Supplied by the Intercostal Artery: Can We Predict Which Intercostal Artery Supplies the Tumor?

• Hur S
• Kim HC
• Chung JW
• Kim MU
• Kim JD
• Kim GM
• Lee IJ
• Kim YI
• Jae HJ
• Park JH

• KMID: 1101923
• DOI: http://doi.org/10.3348/kjr.2011.12.6.693

Abstract

OBJECTIVE
To predict which intercostal artery supplies a tumor by examining the spatial relationship between hepatocellular carcinoma (HCC) and the intercostal artery feeding the tumor on transverse computed tomography (CT) images.
MATERIALS AND METHODS
Between January 2000 and September 2009, 46 intercostal arteries supplying HCCs smaller than 4 cm were noted in 44 patients, and CT scans and angiograms of these patients were retrospectively reviewed. The intercostal artery feeding the tumor was marked on the CT scan showing the center of the tumor. In addition, its spatial relationship with the tumor center was examined. The angle of the tumor location was measured on the transverse CT scan in the clockwise direction from the sagittal line on the virtual circle centered in the right hemithorax. Correlations between the angle of the tumor location and the level of the tumor-feeding intercostal artery were assessed with the Spearman rank coefficient.
RESULTS
Of 46 intercostal arteries feeding HCC, 39 (85%) were the first ones observed from the tumor center in a counterclockwise direction on the transverse CT image containing the tumor center. The level of the tumor-feeding intercostal artery was significantly correlated with the angle of the tumor, as the posteriorly located tumor tends to be supplied by lower intercostal arteries, while the laterally located tumor by upper intercostal arteries (Spearman coefficient = -0.537; p < 0.001).
CONCLUSION
We can predict the tumor feeder with an accuracy of 85% as the first intercostal artery encountered from the tumor center in a counterclockwise direction on a transverse CT image.

Keyword

Hepatocellular carcinoma; Intercostal artery; Computed tomography; TACE; Chemoembolization

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*blood supply/radiography/therapy
Chemoembolization, Therapeutic
Female
Humans
Liver Neoplasms/*blood supply/radiography/therapy
Male
Middle Aged
*Multidetector Computed Tomography

Figure

• 

  Fig. 1 Flowchart of study population enrollment with exclusion criteria. MDCT = multidetector CT

• 

  Fig. 2 68-year-old man with hepatocellular carcinoma who underwent 8 chemoembolization sessions. A. Transverse CT scan in hepatic arterial phase shows small hypervascular tumor (star). Center of virtual circle was drawn using following steps: 1) select CT transverse scan showing center of tumor, 2) horizontal line (-) inscribing posterior margin of thorax is drawn, 3) line is bisected by perpendicular line (=), which is again perpendicularly bisected by another horizontal line (≡); mid-point of line (≡) is defined as center of circle (arrowhead), concentric with hemithorax. B. Radial line passing through tumor center is drawn and its angle from sagittal line is measured as angle of tumor location (197 degrees in this case). Note 11th intercostal artery (arrow) below 11th rib. C. Selective angiography of 11th intercostal artery showing tumor staining (arrow) supplied by tumor feeder (arrowhead).

• 

  Fig. 3 61-year-old man with hepatocellular carcinoma who underwent 7 chemoembolization sessions. A. Transverse CT scan in hepatic arterial phase showing multiple small hypervascular tumors (arrow and open arrowheads). Note 9th intercostal artery below 9th rib. B. Celiac angiography performed during 8th chemoembolization session shows multiple small hypervascular tumor stainings (arrowheads) in liver. Tumor indicated by arrow in A is not evident on this celiac angiogram. C. Selective angiography of 9th intercostal artery shows tumor staining (arrow) supplied by tumor feeder (arrowhead), which makes sharp upward turn at costochondral junction. D. Spot image obtained during chemoembolization shows compact retention of iodized oil within tumor (arrow) and microcatheter tip (arrowhead) within tumor feeder.

• 

  Fig. 4 Relationship between angle of tumor location and level of intercostal artery supplying tumor.

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