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Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter

  • Cornelia L. A. Dewald
  • Timo C. Meine
  • Hinrich M. B. Winther
  • Roman Kloeckner
  • Sabine K. Maschke
  • Martha M. Kirstein
  • Arndt Vogel
  • Frank K. Wacker
  • Bernhard C. Meyer
  • Julius Renne
  • Jan B. HinrichsEmail author
Clinical Investigation Imaging
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Part of the following topical collections:
  1. Imaging

Abstract

Purpose

To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for detecting leakage of the double-balloon catheter used for chemosaturation percutaneous hepatic perfusion (CS-PHP).

Materials and Methods

Overall, 112 CS-PHP (09/2015-09/2018) in 52 patients were retrospectively screened for leakage alongside the double-balloon catheter on standard venograms. Finally, 18 procedures with visually detected leakage were included. Fifteen consecutive procedures without leakage served as control. To evaluate 2D-PA for leakage detection, the acquired digital subtraction venograms were post-processed. For each balloon, two different target ROIs were evaluated to assess a possible impact of localization and shape of the ROIs. Time to peak (TTP), peak density (PD), area under the curve (AUC), and ratios of target ROI/reference ROIs (PDtROI/PDREF; AUCtROI/AUCREF; and TTPtROI/TTPREF) were calculated.

Results

Leakages were located as follows: 15/18 cranial and 3/18 caudal. At the cranial balloon both ROIs showed a significant decrease in PDtROI/PDREF and AUCtROI/AUCREF (ROI1: p < 0.0001; p < 0.0001; ROI2: p < 0.0001; p < 0.0001) and a significant increase in TTPtROI/TTPREF (ROI1: p = 0.0009; ROI2: p = 0.0003) after double-balloon correction. Following balloon adjustment, the 2D-PA ratios (PD and AUC) of the tested ROIs differed significantly (p < 0.05). The inter-individual comparison of the 2D-PA parameters of the group with leakage before balloon correction and the non-leakage group showed significantly different 2D-PA values for the cranial balloon in both ROIs (p < 0.05). No significant differences were found for the caudal balloon.

Conclusion

2D-PA provides a feasible tool for detecting leakages alongside the cranial portion of the double-balloon catheter used in CS-PHP. The shape and position of the ROIs used to assess perfusion and flow have an impact on the measurements.

Keywords

2D-perfusion angiography Chemosaturation Percutaneous hepatic perfusion Double-balloon catheter Leakage 

Abbreviations

2D-PA

2D-perfusion angiography

ACT

Activated clotting time

AUC

Area under the curve

AUCtROI/AUCREF

Ratio of the target ROI to the reference ROI for AUC

CS-PHP

Chemosaturation percutaneous hepatic perfusion

DSA

Digital subtraction angiography

IVC

Inferior vena cava

PD

Peak density

PDtROI/PDREF

Ratio of the target ROI to the reference ROI for PD

ROI

Region of interest

REF

Reference region of interest

TACE

Transarterial chemoembolization

TIPS

Transjugular intrahepatic portosystemic shunt

tROI

Target region of interest

TTP

Time to peak

TTPtROI/TTPREF

Ratio of the target ROI to the reference ROI for TTP

Notes

Author’s Contribution

All authors significantly contributed to the design and composition, data analysis, and data interpretation for this study. Furthermore, all of the authors drafted the article or substantially revised it due to the important intellectual content. All of the authors gave their final consent for this version of the manuscript to be published.

Compliance with Ethical Standards

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Siemens Healthcare and ProMedicus (Bernhard Meyer and Frank Wacker, outside the submitted work). The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Ethical Approval

Our local ethics committee approved our protocol, and written informed consent was obtained from each study patient. The study follows the ethical standards of the Declaration of Helsinki. The article includes no identifying information.

Human and Animal Rights

This study follows the ethical standards of the Declaration of Helsinki. Animal studies are not part of this article (does not apply to this article).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Cornelia L. A. Dewald
    • 1
  • Timo C. Meine
    • 1
  • Hinrich M. B. Winther
    • 1
  • Roman Kloeckner
    • 2
  • Sabine K. Maschke
    • 1
  • Martha M. Kirstein
    • 3
  • Arndt Vogel
    • 3
  • Frank K. Wacker
    • 1
  • Bernhard C. Meyer
    • 1
  • Julius Renne
    • 1
  • Jan B. Hinrichs
    • 1
    Email author
  1. 1.Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
  2. 2.Department of Diagnostic and Interventional RadiologyJohannes Gutenberg-University Medical CentreMainzGermany
  3. 3.Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany

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