PMC8366023_01
A computed tomography (CT) image showing a mass (arrows) in the caudate lobe of the liver (A). Maximum intensity projection CT images taken in the arterial phase [(B): axial; (C): coronal] showing the feeding vessels of the tumor (arrows).
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F1
An intra-abdominal mass originating from the caudate lobe of the liver was confirmed (Figure 1A). In the arterial phase, the caudate branch of the hepatic artery was identified as the main vessel feeding the mass (Figures 1B,C).
CT images of the hepatic tumor (circles) and surrounding liver parenchyma in the arterial (A) and portal (B) phases. Tumor vessels (arrow) are clearly visible only in the arterial phase. In the portal phase, the tumor area shows a lower CT value than the surrounding areas.
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F2
In the portal vein phase, lower CT values were observed for the liver mass (90-100 HU) than for the normal liver parenchyma (210-220 HU), and portal blood flow was not confirmed in the liver mass (Figure 2).
Fluoroscopic images obtained during the transcatheter arterial embolization (TAE) procedure. (A) Angiography of the celiac artery (arrows). Arrowhead indicates the 4.2-Fr RIM-S catheter. (B) Angiography of the nutritional vessels (arrows). Arrowhead indicates the 1.7-Fr microcatheter. (C) Embolization of the tumor through the caudate branch of the common hepatic artery. The presence of contrast-enhanced emboli can be seen throughout the tumor area (circle).
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F3
The catheter was advanced beyond the celiac artery in the abdominal aorta and the celiac artery was isolated by slowly pulling back with the catheter tip directed ventrally, and the catheter tip was placed proximal to the celiac artery for angiography (Figure 3A). RIM-S guiding catheter. Referring to the blood vessel running obtained by the angiography (Figure 3A), the common hepatic artery was isolated, the microcatheter was advanced to the front of this branch, and angiography was performed to identify tumor feeding vessels in the caudate lobe region. Angiography of the vicinity of the tumor revealed that the entire tumor was stained intensely (Figure 3B). Care was taken to prevent the flow of the embolization agent into vessels other than the target vessel (Figure 3C).
CT images showing that TAE reduced the size of the hepatic tumor (arrows) [(A): before TAE, (B): 66 days after TAE].
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F4
CT performed before resection revealed a reduction in the mass's longest diameter from 32 x 45 x 52 mm to 22 x 43 x 32 mm (a partial response) (Figure 4).