CLINICAL STUDY Hepatocellular Carcinoma: Prediction of Blood Supply from an Intercostal Artery with Multidetector Row Computed Tomography Min-Uk Kim, MD, Hyo-Cheol Kim, MD, Jin Wook Chung, MD, Sangbu An, MD, Nak Jong Seong, MD, Hwan Jun Jae, MD, and Jae Hyung Park, MD ABSTRACT Purpose: To evaluate the ability of multidetector row computed tomography (CT) to detect blood supply from the intercostal artery in patients with hepatocellular carcinoma (HCC). Materials and Methods: Between January 2003 and December 2007, angiography of the intercostal artery was performed in 93 patients (76 men and 17 women, mean age 58 years) with HCC who had also undergone multidetector row CT. CT scans and digital subtraction angiograms of these patients were retrospectively reviewed by two investigators in consensus to evaluate tumor feeding vessels. Multiple logistic regression analysis was used to identify factors that predict the presence of an HCC blood supply from an intercostal artery. Results: Tumor staining fed by an intercostal artery was noted in 65 patients (70%; 112 tumor feeding vessels) by intercostal angiography. Readers interpreted that tumor feeding vessels were evident by CT in 35 (54%) of these 65 patients with tumor staining supplied by an intercostal artery by angiography. Multiple logistic regression analysis showed that a visible tumor feeding vessel by CT (P = .003) and hepatic artery attenuation by angiography (P = .014) were significantly related to the presence of a blood supply from an intercostal artery. Conclusions: Visualization of a tumor feeding vessel from the intercostal artery by multidetector row CT is an important sign of parasitic supply to an HCC. ABBREVIATION HCC = hepatocellular carcinoma Chemoembolization is an established treatment method for patients with unresectable hepatocellular carcinoma (HCC) (1,2). When an HCC is advanced or exophytic, various extrahepatic collateral arteries (inferior phrenic artery, omental branch, adrenal artery, intercostal artery, internal mammary artery, renal capsular artery, gastric artery, or lumbar artery) commonly supply tumors (3– 13). Because extrahepatic collateral supplies can inhibit the effectiveness of chemoembolization, radiologists should be familiar with the imaging findings of extrahe- patic collateral vessels to detect them at an early stage. Park et al (5) mentioned that the computed tomography (CT) findings suggestive of a collateral blood supply from the intercostal artery are adhesion or invasion of the ab- dominal wall; delineation of the intercostal artery within the intercostal space; or branching, streaky lines coursing from the abdominal wall to a tumor. However, this previous study included a small number of patients evaluated by single-detector CT, and in this era of multidetector row CT, the normal intercostal artery is always observed within the intercostal space during daily practice. We undertook this study to evaluate the ability of multidetector row CT to detect blood supply from the intercostal artery in patients with HCC. From the Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, # 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea. Received November 19, 2009; final revision received May 13, 2011; accepted May 16, 2011. Address correspondence to J.W.C.; E-mail: chungjw@snu.ac.kr None of the authors have identified a conflict of interest. Table 4 is available online at www.jvir.org. © SIR, 2011 J Vasc Interv Radiol 2011; 22:1403–1408 DOI: 10.1016/j.jvir.2011.05.009