Ｍｕｌｔｉ Ｄｅｔｅｃｔｏｒ Ｒｏｗ−ＣＴによる右下横隔動脈描出に関する基礎的および臨床的検討

Abstract

To perform transcatheter arterial embolization (TAE) successfully, it is important to obtain information about parasitic arterial supply to the hepatocellular carcinoma (HCC). Among these extrahepatic collateral vessels, the right inferior phrenic artery (RIPA) is the most frequent and important extrahepatic collateral artery supplying the HCC. In the present study, we obtained multi-planar reformation (MPR) images of RIPA using multi detector row computed tomography (MDCT), assessed the ability of MDCT to demonstrate the origin of RIPA, and then analyzed the morphology of the origin. In a basic study using an original phantom simulating vessel origin, the origin was poorly visualized depending on the phantom diameter and angle of the origin to the scanned section. A clinical study was performed in 28 patients with HCC who underwent both MDCT and angiography within a short period. In 19 of 28 patients, RIPA originated at the celiac artery. In 3 patients, RIPA originated at the right renal artery, and in 6, directly at the abdominal aorta. The origin of RIPA was categorized into four patterns according to the inclination of the origin on transverse sections of MDCT. RIPA that originated at the right renal artery and showed an upward course perpendicular to the scan section of MDCT were most clearly visualized at the origin. In addition, RIPA could be observed in an optional direction on the workstation. Pre-angiographic visualization of the origin of RIPA may save angiographic time, curtail contrast medium, and reduce radiation exposure.