الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is the sixth most common cancer throughout the world. In the intermediary stages, which make up approximately one third of the patients at the time of diagnosis, the recommended treatment is chemoembolization.
Chemoembolization is based on the principle of intra-arterial injection of an antineoplastic agent, followed by occlusion of the artery or arteries, which supplies the tumor(s). In order for the treatment to be effective, it is essential that it is injected into the artery or arteries, which supply the tumor(s). These arteries must be identified by imaging in the pre-treatment assessment.
DSA was the main imaging method for detecting feeding arteries of HCC including HA and ectopic blood supply. Its application is limited due to the invasivenese, the cost and also the inability to identify all possible blood vessels during the examination.
Modern non invasive diagnostic imaging techniques such as MDCT have replaced conventional angiography for displaying hepatic and perihepatic vessels and determination of the tumor feeding vessels before TACE.
This study included 48 patients presented to radiology department of Alexandria University Hospital with HCC for CECT abdomen assessment.
All patients will subjected to the following: Clinical assessment including history taking, Laboratory study: it includes all the routing laboratory workup with stress on the level of creatine and blood urea and then the CTA examination was done. The CT findings were be correlated with the data of the interventional procedures of this patients.
All patients underwent craniocaudal scanning in the supine position during a single breath hold. The scanning area was from pulmonary hilum level to iliac crest level. CT was performed initially without contrast medium. Then the contrast was injected at a rate of 5 ml/sec. Arterial phase starting 4 seconds after the attenuation in the descending aorta reaching 100 HU. Which takes about 10 seconds the scan starting from the dome of the liver to its caudal end and taking 7seconds. The portal venous phase started 7 seconds after the end of the arterial phase and the scan range stared from the dome and covering all the abdomen and pelvis taking 15 seconds duration. Delayed scans starting 5 minutes after the end of portal venous phase and covering the same range of the portal venous phase.
The current study included 33 male patients and 15 female and their age ranged between 36–81 years old. The number of patients had positive HCV infection was 41 and only seven patients had HBV infection. The majority of patients presented with solitary lesion and only four patients had bifocal lesions while the number of patients with multifocal lesions was 12.
The current study found that 27 patients had tumors located at the right hepatic lobe and twelve patients had tumors located at the left hepatic lobe, while only nine patients had bilobar affection.
The total number of HCC lesions in our study was 81. Among these lesions 62 were restricted to only one segment. Only 13 tumors were smaller than three cm, while the majority were determined to be between three and five cm in size.
Among 48 patients 27 were fed by HA, and nine patients were fed by extra hepatic arteries, while the number of patients having anatomical vascular variants is ten and only one patient with atypical post surgical neovascualrization and also one patient with atypical supply post celiac artery compression.
Among these nine patients with extra hepatic (parasitic) blood supply; two patients were supplied by the inferior phrenic artery and only single patient for each other type of extra hepatic feeders which are (Right inferior phrenic artery, internal mammary artery, intercostal artery, left gastric artery, cystic artery, right lumbar artery, direct branch from the aorta, omental arteries and right renal artery). Among these 10 patients with anatomical vascular variants; six patients had replaced RHA from the SMA and only two patients with replaced LHA from the LGA and only one patient for each of the following (replaced RHA from the GDA, accessory RHA from the SMA).
This study confirms that MDCT is able to determine the feeder vessels of HCC, and these findings would be helpful for the pre-TACE preparation for patients with HCC and prevent any probable complications.