Department of Radiology, University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
Radiographics. 2009 Nov;29(7):1-22. doi: 10.1148/rg.291085232. Epub 2009 Sep 4.
Hepatic transarterial interventional therapies such as chemoembolization and radiation embolization are important treatment options for hepatocellular carcinoma. Understanding the anatomy of individual arterial branches and hepatic segments is critical for selecting the correct embolization technique for treatment and to avoid complications. The authors describe the morphologic characteristics of hepatic arterial branches (and their mimickers) and hepatic segments on conventional angiograms. These vessels and segments include the celiac artery, the common and proper hepatic arteries, the left and right hepatic arteries and branches, the caudate lobe, and the portal vein and branches. Mimickers of hepatic arteries include the cystic, accessory left gastric, and right gastric arteries, as well as branches of the left gastric artery that resemble segmental branches of the replaced left hepatic artery. The authors describe how each segmental branch of the hepatic artery and the area it supplies correlates at computed tomography (CT) and angiography. Finally, the authors demonstrate how the vascular anatomy changes with the respiratory cycle by creating a virtual movie from calculations with dynamic CT data, in which the arterial and venous phases are acquired at end expiration and inspiration, respectively. Each segmental branch of the hepatic artery has morphologic characteristics that help distinguish it from mimickers. The location of each hepatic segment can be estimated if the artery supplying the segment can be correctly identified on angiograms. Notably, morphologic differences in the hepatic artery system caused by respiration should be recognized.
肝动脉介入治疗，如化疗栓塞和放射栓塞，是肝细胞癌的重要治疗选择。了解肝动脉分支和肝段的解剖结构对于选择正确的栓塞技术治疗和避免并发症至关重要。作者描述了常规血管造影中肝动脉分支（及其模拟物）和肝段的形态特征。这些血管和节段包括腹腔动脉、肝总动脉和肝固有动脉、左肝动脉和右肝动脉及其分支、尾状叶以及门静脉及其分支。肝动脉的模拟物包括胆囊动脉、副左胃动脉和右胃动脉，以及左胃动脉的分支，这些分支类似于替代左肝动脉的节段性分支。作者描述了肝动脉的每个节段性分支及其供应区域在 CT 和血管造影中的相关性。最后，作者通过从动态 CT 数据的计算中创建一个虚拟电影，展示了血管解剖结构如何随呼吸周期而变化，其中动脉期和静脉期分别在呼气末和吸气末获得。肝动脉的每个节段性分支都有形态特征，可以帮助将其与模拟物区分开来。如果可以在血管造影上正确识别供应肝段的动脉，则可以估计每个肝段的位置。值得注意的是，呼吸引起的肝动脉系统形态差异应得到识别。
