OBJECTIVETo analyze the angiographic features and factors related to the blood supply from right inferior phrenic artery (RIPA) branches in hepatocellular carcinoma (HCC).

METHODSAngiography images of blood supply from RIPA branches and clinical data from patients with HCC who had undergone tmnscatheter arterial chemoembolization in our hospital between 2009 and 2013 were collected for retrospective analysis. Angiographic features of the RIPA branches were assessed for correlation between treatment number, growth pattern, size, tumor location, and rates of blood supplying RIPA branches. Statistical analyses were carried out using chi-square test, t-test, Fisher's exact test and rank sum test.

RESULTSThe 140 patients included in the analysis were grouped according to primary HCC (n=63; group A) and recurrent HCC (n=77; group B) and no statistically significant differences were found between the two groups for incidence of each nutrient branch or total number of nutrient branches. In group A, tumor size was associated with number of nutrient branches (P=0.047). There were 32 cases with HCC lesions in the bare area of the liver, and among those 26 of the cases were supplied by the posterior branch of RIPA. Each branch of RIPA showed greater firequency for particular blood supply areas; the anterior branch (n=55) and lateral branch (n=98) fed tumor lesions in segments 7 and 8, the posterior branch (n=98) fed tumor lesions in segments 6 and 7, and the supra-renal branch (n=10) fed tumor lesions in segment 6. The diaphragmatic branch always fed HCC partly located in segments 4 and 8 (n=17). Unique features were present on the digitally subtracted angiography (DSA) image for each nutrient branch and may be useful for distinguishing in clinical examination.

CONCLUSIONCases of primary HCC and recurrent HCC are not distinguishable by incidence of each nutrient branch or total numbers of the nutrient branches. However, tumor size is related to the number of RIPA nutrient branches, and each RIPA nutrient branch shows a dominant preference for certain blood supply areas, with unique features on DSA.