Hepatic artery infusion (HAI) It is well established

that neoplasms within the liver receive a majority of their blood supply via the hepatic artery (7). This anatomic fact has been selleck inhibitor exploited to deliver chemotherapy directly to the hepatic artery by surgically implanted catheters and pumps. Multiple trials of arterial infusion of floxuridine (FUDR) in patients with unresectable hepatic Inhibitors,research,lifescience,medical colorectal metastases have been performed with objective response rates of 50-80% (8-11). Indications for HAI therapy have expanded to include adjuvant treatment following hepatic resection (12) and neoadjuvant therapy to allow resectability (13). Although not widely practiced, primarily due to the expertise required for pump placement, maintenance and chemotherapy management, HAI therapy is associated with promising results and is used frequently in some centers. In planning for hepatic artery pump placement, a complete survey of the hepatic arterial anatomy is needed. Inhibitors,research,lifescience,medical This is best accomplished with CT angiography with multiplanar and 3D reconstructions. In the normal hepatic arterial anatomy, the common hepatic artery branches from the celiac trunk (Figure 1 A) and gives rise to the gastroduodenal artery (GDA). It Inhibitors,research,lifescience,medical is through this branch that the hepatic

arterial catheter is placed with the tip at the GDA orifice. This allows for infusion into the proper Inhibitors,research,lifescience,medical and subsequently the right and left hepatic arteries. Variations in arterial anatomy occur in approximately 25% of patients (14) and can have a dramatic impact on pump placement and subsequent function. The most common variation is a replaced right or accessory left hepatic artery (Figure 1 B, C) that originates from the superior mesenteric or left gastric artery, respectively. Other anatomic anomalies such as a late takeoff of the right gastric artery are important to recognize as this can lead to inappropriate delivery of toxic chemotherapy to the stomach. Figure 1 Aberrant hepatic arterial anatomy. Cross-sectional imaging can help identify

anomalous Inhibitors,research,lifescience,medical arterial anatomy prior to placement of hepatic artery infusion pumps. (A) depicts a normal hepatic artery originating from the celiac trunk, white arrows in (B) and … Modalities of hepatic imaging As previously stated, there are a variety of imaging TCL techniques that can be used to identify lesions within the liver parenchyma, each with their own sensitivity, specificity and resolution. Multiple modalities are often used in the same patient, taking advantage of strengths that one may have over the other. The following is specific information for each imaging technology including strengths and weaknesses: Computed tomography (CT) Multidetector computed tomography (MDCT) is routinely used for follow-up of oncology patients, providing robust and rapid imaging of the chest, abdomen and pelvis for detection of liver and extrahepatic metastases.