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Objective Measurement of Arterial Flow Before and After Transcatheter Arterial Chemoembolization: A Feasibility Study Using Quantitative Color-Coding Analysis

  • Clinical Investigation
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Abstract

Purpose

To quantitatively measure the hemodynamic change of hepatic artery before and after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) by quantitative color-coding analysis (QCA).

Materials and Methods

This prospective study registered 64 consecutive HCC patients who underwent segmental or subsegmental TACE with epirubicin and lipiodol at level 2 or 3 of the subjective angiographic chemoembolization endpoint. QCA was used to determine the maximal density time (T max) of selected intravascular region of interest (ROI). Relative T max (rT max) was defined as the T max at the selected ROI minus the time of contrast medium spurting from the catheter tip. The rT max of hepatic arteries was analyzed before and after embolization.

Results

The pre- and post-treatment rT max of the landmarks at the treated segmental artery were 1.96 ± 0.48 and 3.14 ± 1.77 s, p < 0.001. According to the treated lobe, 30 patients were treated for the right lobe alone, and 8 patients were treated for the left lobe alone. The pre- and post-rT max of treated segmental artery were 2.06 ± 0.54, 3.34 ± 1.63 s, p < 0.001 and 1.89 ± 0.45, 2.68 ± 1.46 s, p = 0.12, respectively. The rT max of the proximal lobar hepatic arteries or proper hepatic artery had no significant change before and after TACE.

Conclusions

The QCA is feasible to quantify embolization endpoints by comparing the rT max in selected hepatic arteries before and after TACE. The rT max of treated segmental artery was significant prolonged after optimized procedures.

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.

    Article  PubMed  Google Scholar 

  2. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.

    Article  CAS  PubMed  Google Scholar 

  3. Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359(9319):1734–9.

    Article  PubMed  Google Scholar 

  4. Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–71.

    Article  CAS  PubMed  Google Scholar 

  5. European Association for the Study of the Liver, European Organisation For Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

  6. Belghiti J, Carr BI, Greig PD, Lencioni R, Poon RT. Treatment before liver transplantation for HCC. Ann Surg Oncol. 2008;15(4):993–1000.

    Article  CAS  PubMed  Google Scholar 

  7. Scatton O, Liddo G, Belghiti J. Liver transplantation for hepatocellular carcinoma: current topics in France. J Hepatobiliary Pancreat Sci. 2010;17(5):567–73.

    Article  PubMed  Google Scholar 

  8. Livraghi T, Meloni F, Morabito A, Vettori C. Multimodal image-guided tailored therapy of early and intermediate hepatocellular carcinoma: long-term survival in the experience of a single radiologic referral center. Liver Transpl. 2004;10(2 Suppl 1):S98–106.

    Article  PubMed  Google Scholar 

  9. Maeda S, Fujiyama S, Tanaka M, Ashihara H, Hirata R, Tomita K. Survival and local recurrence rates of hepatocellular carcinoma patients treated by transarterial chemolipiodolization with and without embolization. Hepatol Res. 2002;23(3):202–10.

    Article  CAS  PubMed  Google Scholar 

  10. Ikeda M, Maeda S, Shibata J, Muta R, Ashihara H, Tanaka M, et al. Transcatheter arterial chemotherapy with and without embolization in patients with hepatocellular carcinoma. Oncology. 2004;66(1):24–31.

    Article  CAS  PubMed  Google Scholar 

  11. Jin B, Wang D, Lewandowski RJ, Riaz A, Ryu RK, Sato KT, et al. Chemoembolization endpoints: effect on survival among patients with hepatocellular carcinoma. Am J Roentgenol. 2011;196(4):919–28.

    Article  Google Scholar 

  12. Gaba RC. Chemoembolization practice patterns and technical methods among interventional radiologists: results of an online survey. Am J Roentgenol. 2012;198(3):692–9.

    Article  Google Scholar 

  13. Lewandowski RJ, Wang D, Gehl J, Atassi B, Ryu RK, Sato K, et al. A comparison of chemoembolization endpoints using angiographic versus transcatheter intraarterial perfusion/MR imaging monitoring. J Vasc Interv Radiol. 2007;18(10):1249–57.

    Article  PubMed  Google Scholar 

  14. Jin B, Wang D, Lewandowski RJ, Ryu RK, Sato KT, Larson AC, et al. Quantitative 4D transcatheter intraarterial perfusion MRI for standardizing angiographic chemoembolization endpoints. Am J Roentgenol. 2011;197(5):1237–43.

    Article  Google Scholar 

  15. Gaba RC, Wang D, Lewandowski RJ, Ryu RK, Sato KT, Kulik LM, et al. Four-dimensional transcatheter intraarterial perfusion MR imaging for monitoring chemoembolization of hepatocellular carcinoma: preliminary results. J Vasc Interv Radiol. 2008;19(11):1589–95.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Larson AC, Wang D, Atassi B, Sato KT, Ryu RK, Lewandowski RJ, et al. Transcatheter intraarterial perfusion: MR monitoring of chemoembolization for hepatocellular carcinoma—feasibility of initial clinical translation. Radiology. 2008;246(3):964–71.

    Article  PubMed  Google Scholar 

  17. Zhang XB, Zhuang ZG, Ye H, Beilner J, Kowarschik M, Chen JJ, et al. Objective assessment of transcatheter arterial chemoembolization angiographic endpoints: preliminary study of quantitative digital subtraction angiography. J Vasc Interv Radiol. 2013;24(5):667–71.

    Article  PubMed  Google Scholar 

  18. Kennedy AS, Kleinstreuer C, Basciano CA, Dezarn WA. Computer modeling of yttrium-90-microsphere transport in the hepatic arterial tree to improve clinical outcomes. Int J Radiat Oncol Biol Phys. 2010;76(2):631–7.

    Article  CAS  PubMed  Google Scholar 

  19. Davis B, Royalty K, Kowarschik M, Rohkohl C, Oberstar E, Aagaard-Kienitz B, et al. 4D digital subtraction angiography: implementation and demonstration of feasibility. Am J Neuroradiol. 2013;34(10):1914–21.

    Article  CAS  PubMed  Google Scholar 

  20. Parry PV, Ducruet AF. Four-dimensional digital subtraction angiography: implementation and demonstration of feasibility. World Neurosurg. 2014;81(3–4):454–5.

    Article  PubMed  Google Scholar 

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Acknowledgments

Taipei Veterans General Hospital-National Yang-Ming University- Excellent Physician Scientists Cultivation Program, No. 103-V-B-056. Taipei Veterans General Hospital and Siemens, No. T1100200.

Conflict of interest

Yi-Yang Lin, Rheun-Chuan Lee, Hsiuo-Shan Tseng, Chien-An Liu, Wan-Yuo Guo, and Cheng-Yen Chang have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Right

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, Taiwan

    Yi-Yang Lin, Rheun-Chuan Lee, Hsiuo-Shan Tseng, Chien-An Liu, Wan-Yuo Guo & Cheng-Yen Chang

  2. School of Medicine, National Yang Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan

    Yi-Yang Lin, Rheun-Chuan Lee, Hsiuo-Shan Tseng, Chien-An Liu, Wan-Yuo Guo & Cheng-Yen Chang

  3. Institute of Clinical Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan

    Yi-Yang Lin

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  1. Yi-Yang Lin
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Correspondence to Rheun-Chuan Lee.

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Lin, YY., Lee, RC., Tseng, HS. et al. Objective Measurement of Arterial Flow Before and After Transcatheter Arterial Chemoembolization: A Feasibility Study Using Quantitative Color-Coding Analysis. Cardiovasc Intervent Radiol 38, 1494–1501 (2015). https://doi.org/10.1007/s00270-015-1111-6

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  • DOI: https://doi.org/10.1007/s00270-015-1111-6

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