Gregor Martin Dunham MD, Presenter: Nothing to Disclose

Blake Carlson MD, Abstract Co-Author: Nothing to Disclose

Christopher Robert Ingraham MD, Abstract Co-Author: Nothing to Disclose

Mariam Moshiri MD, Abstract Co-Author: Consultant, Reed Elsevier Author, Reed Elsevier

Douglas S. Katz MD, Abstract Co-Author: Nothing to Disclose

Puneet Bhargava MD, Abstract Co-Author: Editor, Reed Elsevier

Jabi E. Shriki MD, Abstract Co-Author: Nothing to Disclose

James Burnett Gardner MD, Abstract Co-Author: Nothing to Disclose

1. Malignant vascular invasion is a major prognostic factor and historically considered an absolute contraindication to hepatic resection 2. Imaging signs such as “thread and streak sign” and “striated appearance” are key to the early detection in tumor thrombus 3. New surgical techniques and multimodality treatments are increasingly being employed in the setting of vascular invasion

1. Demonstrate vascular invasion appearance: US, MDCT, MRI, and angiography; with laparoscopic correlation 2. Imaging helps to direct the most appropriate management strategy and surgical approach: hepatic vs. portal vein extension; assessing segmental involvement; vascular variants; and the future liver remnant 3. Surgical options: right and left Hepatectomy; partial resection; two stage hepatectomy - portal vein embolization with delayed resection vs. associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Correlation with medical illustrations, gross pathology, and imaging will be provided 4. Role of interventional radiology: palliative vs. adjunct to surgery. Newer studies indicate expanded role for catheter-directed therapy, Yttrium-90, cryoablation-assisted resection, portal vein embolization, and irreversible electroporation 5. Current recommendations and future directions

http://abstract.rsna.org/uploads/2014/14014692/14014692_o19d.pdf

Dunham, G, Carlson, B, Ingraham, C, Moshiri, M, Katz, D, Bhargava, P, Shriki, J, Gardner, J, It’s all Relative! Vascular Invasion in Hepatocellular Carcinoma: Current Recommendations and Future Directions.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014692.html