Abdominal and GI imaging: mechanism of chemoembolisation: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Abdominal and GI imaging: mechanism of chemoembolisation

Sample item

Transarterial chemoembolisation is used for an unresectable multinodular hepatocellular carcinoma with preserved liver function. Why does hepatic artery embolisation spare the normal liver relatively well?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. The tumour is supplied mainly by the hepatic artery while normal liver gets most blood from the portal vein

Normal liver receives about three quarters of its blood from the portal vein, whereas hepatocellular carcinoma develops arterial neovascularisation. Delivering chemotherapy with embolic particles into the hepatic artery therefore causes ischaemia and high drug concentration in the tumour while the portal supply sustains normal tissue. Portal vein thrombosis is a contraindication because that protection is lost.

Option by option

  • A. The tumour is supplied mainly by the hepatic artery while normal liver gets most blood from the portal vein (correct)

    Correct. The arterial dependence of the tumour is the basis of chemoembolisation.

  • B. The tumour has no arterial supply and drains into the hepatic vein

    The tumour has abundant arterial supply, which is why it enhances in the arterial phase.

  • C. The tumour is supplied mainly by the portal vein while normal liver gets blood from the hepatic artery

    This reverses the vascular supplies of the tumour and normal liver.

  • D. Normal hepatocytes are resistant to ischaemia and tumour cells are not

    Hepatocytes have no special resistance, and the selectivity comes from the blood supply.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, The tumour is supplied mainly by the hepatic artery while normal liver gets most blood from the portal vein. Normal liver receives about three quarters of its blood from the portal vein, whereas hepatocellular carcinoma develops arterial neovascularisation.

Why is "The tumour has no arterial supply and drains into the hepatic vein" not the answer?

The tumour has abundant arterial supply, which is why it enhances in the arterial phase.

Why is "The tumour is supplied mainly by the portal vein while normal liver g…" not the answer?

This reverses the vascular supplies of the tumour and normal liver.

Why is "Normal hepatocytes are resistant to ischaemia and tumour cells are not" not the answer?

Hepatocytes have no special resistance, and the selectivity comes from the blood supply.

What concept does this question test?

It tests Abdominal and GI imaging: mechanism of chemoembolisation in Radiology. Delivering chemotherapy with embolic particles into the hepatic artery therefore causes ischaemia and high drug concentration in the tumour while the portal supply sustains normal tissue. Portal vein thrombosis is a contraindication because that protection is lost.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdominal and GI imaging: mechanism of chemoembolisation?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.