Before TACE, map the hepatic arterial anatomy (replaced and accessory arteries), the tumour feeders and extrahepatic supply, and confirm portal vein patency and liver function eligibility.
Orient first
- Intermediate-stage HCC (BCLC B) is the classic indication (verify the staging system in use).
- Replaced right hepatic artery from the SMA and replaced left from the left gastric are common variants.
- Main portal vein tumour thrombus and decompensated liver function are relative contraindications.
Acquire the study
- Multiphase CT with arterial-phase thin sections and MIP reformats; cone-beam CT during the procedure.
The manoeuvre
- Arterial phase MIP: coeliac and SMA origins, common and proper hepatic arteries, replaced or accessory hepatic arteries.
- Tumour feeders by segment; extrahepatic feeders (inferior phrenic, internal mammary) for peripheral tumours.
- Portal venous phase: portal vein patency and tumour thrombus.
- Tumour count and size in mm, LI-RADS category, ascites.
What confirms it
- Arterial anatomy and feeders mapped with portal vein patency confirmed.
What licenses you to exclude it
- Not applicable — a planning read; state contraindications if present.
The classic misread
- Missing a replaced artery and under-treating a segment.
- Missing extrahepatic supply to a subcapsular tumour.