Transarterial chemoembolization

Transarterial chemoembolization(TACE, 경동맥 화학색전술, 간암 화학색전술, 간동맥 화학색전술)는 HCC의 인터벤션 치료임.

Post TACE MRI features

• Following TACE therapy, sufficiently treated tumors usually are replaced by necrosis.
• On T2-weighted images, the necrotic area appears moderately hypo- or isointense
• In addition to residual tumor, T2hyperintensity can represent hemorrhage, liquefactive necrosis, or inflammatory infiltrate.
• Similar to the necrotic area following ablative therapy, the necrotic area following TACE does not show enhancement on contrast-enhanced series

Collateral arterial supply

• Right inferior phrenic artery(m/c)
• Omental artery(2nd)
• left inferior phrenic artery, adrenal artery, intercostal artery, cystic artery, internal mammary artery, renal capsular artery 등
• main origin site: celiac axis>aorta>renal artery>left gastric artery
• Falciform a. intercostal a., intermal thoracic a.는 embolization 시 skin complication 가능

Anatomic variation of hepatic artery

• Replaced right hepatic a. of SMA
• Aberrant left hepatic a. of left gastric a
• accessory right or left hepatic artery
• Left gastric artery의 변이는 fissure for ligamentum venosum을 지나고, right heaptic artery의 변이는 porto caval space를 지남
  • 변이 간동맥 외에 accessory/aberrant left gastric a. or v., left inferior phrenic a.도 fissure for ligamentum venosum 지날 수 있음

Complication

• Post-chemoembolization syndrome
• ischemia: ischemic cholangiopathy

기타

• Oily portogram