Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks

Abstract

Percutaneous hepatic interventions are generally safe given the fact that liver closely abuts the abdominal wall and hence it is easily accessible. However, the superior portion of liver, adjacent to the diaphragm, commonly referred as the “hepatic dome”, presents unique challenges for interventionists. Percutaneous access to the hepatic dome may be restricted by anatomical factors and special considerations may be required to avoid injury to the surrounding organs. The purpose of this review article is to discuss certain specific maneuvers and techniques that can enhance the success and safety of interventions in the hepatic dome.

Percutaneous thermal ablation of hepatocellular carcinomas located in the hepatic dome using artificial carbon dioxide pneumothorax: retrospective evaluation of safety and efficacy

“…However, this procedure cannot be performed in $30% of patients with HCC who are candidates for PTA because of a high-risk location of the tumor, a high-risk patient, or because the targeted nodule is not visible on ultrasound (US) [2]. Thanks to the real-time visualization and guidance of the needle(s) and target, accurate and precise positioning of the needle(s) and because it is easily accessible, US remains the modality of choice for needle guidance during PTA [3,4].…”

MRI‐guided targeted needle placement during motion using hydrostatic actuators

“…Since direct visualization is not possible, percutaneous interventions depend on other imaging methods for guidance, such as ultrasound (US) and computed tomography (CT) . Although US and CT are both practical and widely available, there are fundamental limitations to their capabilities which limit the overall effectiveness and widespread adoption, restricting their availability for many patients.…”

“…ultrasound (US) and computed tomography (CT). [6][7][8] Although US and CT are both practical and widely available, there are fundamental limitations to their capabilities which limit the overall effectiveness and widespread adoption, restricting their availability for many patients.…”

Right inferior phrenic artery; Don't miss on MDCT before chemoembolization of hepatic dome HCC

“…1). On the medial aspect, the hepatic dome is related to the gastric cardia and inferior vena cava (IVC) anteriorly and the vertebral column posteriorly [1].…”

“…Definite lesion localization within the hepatic dome is critical, especially during management to optimize the diagnostic yield and provide perfect tumor destruction. Accurate characterization of lesions on multidetector computed tomography (MDCT) can be attained by either use of anatomic landmarks, contrast administration, or additional methods as maximum intensity projection (MIP) and multiplanar reformation (MPR) [1].…”