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The first 25 slides, exactly as they appear. The full deck has 126 content slides.
Radiology
Interventional Management of Hepatic Malignancies General Concepts from Anatomy to Practice
Built from Fundamentals of Diagnostic Radiology
What’s inside
6 sections · 126 slides
Introduction
How liver-directed therapy is used and why it matters
- What liver-directed therapy does
- How the field has changed
- Where these therapies fit in treatment
- The road map of this deck
Vascular Anatomy of the Liver
Segmental and arterial anatomy that guides treatment
- Liver segmentation systems over time
- Why Couinaud segments matter
- What sits at each segment's center and edge
- The planes that divide the liver
- The eight Couinaud segments
- Couinaud segmental liver anatomy
- Couinaud segmental anatomy with ultrasound correlation
- Why tumor blood supply matters
- Conventional hepatic arterial pathway
- The conventional arrangement
- Celiac angiogram showing conventional anatomy
- Replaced versus accessory arteries
- Replaced common hepatic artery from the superior mesenteric artery
- Left hepatic artery variants
- Replaced left hepatic artery from the left gastric artery
- Right hepatic artery variants
- Replaced right hepatic artery from the superior mesenteric artery
- Segment IV and caudate supply
- Middle hepatic artery arising as a trifurcation
- Nontarget vessels: why they matter
- Gastroduodenal artery
- Right hepatic angiogram with gastroduodenal artery coil
- Right gastric artery
- Right gastric artery coil embolization
- Supraduodenal and retroduodenal arteries
- Right hepatic artery from the celiac with posterosuperior pancreaticoduodenal artery
- Accessory left gastric artery
- Accessory left gastric arteries
- Falciform artery
- Falciform artery with cutaneous radiation injury
- Cystic artery
- Cystic artery coil embolization
- Parasitized collateral vessels
- Parasitized flow from intercostal, renal, and adrenal arteries
- Right inferior phrenic artery
- Parasitized right inferior phrenic artery flow
- Omental and cystic collaterals
Intra-Arterial Therapies
Chemoembolization and radioembolization
- Why the artery is the delivery route
- Available intra-arterial therapies
- What TACE does and when it is used
- Why tumors can survive embolization
- How to get the best TACE result
- When to keep arteries open
- How conventional TACE is done
- Conventional TACE case
- Where TACE came from
- What ethiodized oil is
- Chemotherapy and embolic agents in TACE
- Choosing embolic particle size
- Transarterial approaches
- What the variations teach
- Advantages and disadvantages of each transarterial embolization method
- Drug-eluting bead TACE
- DEB-TACE versus conventional TACE
- Drug-eluting bead TACE case
- Who benefits from TACE
- Examples of different hepatocellular carcinoma appearances
- Tumor features that predict worse response
- Prognostic factors for favorable TACE outcome
- Choosing patients with liver disease
- Absolute contraindications to TACE
- Relative contraindications to TACE
- How the TACE procedure is performed
- TACE complications
- Chronic cholecystitis following drug-eluting bead TACE
- Why external beam radiation falls short
- What SIRT is
- SIRT versus TACE: how they kill
- Who gets SIRT
- Radiation segmentectomy
- Radiation segmentectomy
- Radiation lobectomy mechanism
- Why radiation lobectomy is used
- Radiation lobectomy
- Yttrium-90 basics
- The two microsphere products
- Comparison of available SIRT particles
- Why dosimetry is hard to predict
- Contraindications to SIRT
- The MAA rehearsal
- SIRT side effects
Percutaneous Therapies
Chemical and energy-based ablation
- Ethanol ablation
- Percutaneous ethanol ablation
- Acetic acid ablation
- How radiofrequency ablation heats tissue
- What shapes the RFA ablation zone
- Lesion size and RFA success
- Location and the heat-sink effect
- RFA versus resection and transplant
- RFA safety
- Microwave ablation
- Percutaneous microwave ablation
- Radiofrequency versus microwave ablation
- Cryoablation
- Irreversible electroporation
- Laser ablation
- Advantages and disadvantages of each ablation method
- Advantages and disadvantages of each ablation method (continued)
Assessing Treatment Response
How imaging measures success
- Why RECIST fails after TACE and SIRT
- How response is assessed instead
- Available follow-up criteria
- How anatomic criteria measure
- Available anatomic criteria
- When to repeat or switch therapy
- Beyond size: functional imaging
- The limits of alpha-fetoprotein
Key Takeaways
Putting the concepts into practice
- Key takeaways
- Suggested readings
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- Brant and Helms' Fundamentals of Diagnostic Radiology