We evaluated the feasibility, safety, and efficacy of radioembolization (administered from one or two vascular points) after the redistribution of arterial blood flow in the liver in patients with hepatic neoplasms and arterial anatomic peculiarities (AAP). Twenty-four patients with liver neoplasms and AAP (graded according to Michel's classification) were included in the study. During pretreatment angiographic planning, all extrahepatic vessels that could feed the tumor were embolized and the intrahepatic vessels occluded in order to redistribute blood flow. The distribution of microspheres was initially assessed by using technetium-99m-labeled macroaggregated albumin ((99m)Tc-MAA) from one of two vascular points before the administration of yttrium-90 ((90)Y)-radiolabeled resin microspheres. Perfusion of lesions situated in the redistributed segments (L-RS) and nonredistributed segments (L-NRS) were compared by assessing the distribution of (99m)Tc-MAA by SPECT/CT. Perfusion was graded as normal, reduced, or absent. (90)Y resin microspheres were then injected from the same arterial sites as (99m)Tc-MAA and the tumor response recorded 3 months later. The tumor response in L-RS was compared with that in L-NRS and graded as better, similar, or worse. Among 11 patients with type I AAP in whom mainly vessels in segments I-III or IV were occluded, perfusion of L-RS was graded as similar (n = 7) or reduced (n = 4). Among the remaining 13 patients with AAP types III (n = 3), V (n = 4), VIII (n = 3), and others (n = 3) in which aberrant arteries were occluded, perfusion of L-RS was graded as similar (n = 9), reduced (n = 3), or absent (n = 1). Overall, (99m)Tc-MAA was present in the L-RS of 95.8% patients and the distribution of (99m)Tc-MAA in L-RS and L-NRS were graded as similar in 66.6% of patients. Compared with lesions in the L-NRS, tumor response in L-RS was similar in 23 cases and worse in 1 case. No complications were recorded after the administration of (90)Y resin microspheres. Redistribution of flow in L-RS is feasible and enables a safe and effective delivery of (90)Y resin microspheres that are able to be distributed via intrahepatic collaterals and access the microvasculature of L-RS.
The purpose of our study was to evaluate reliability of left ventricular (LV) function and mass quantification in cardiac DSCT exams comparing manual contour tracing and a region-growing-based semiautomatic segmentation analysis software. Thirty-three consecutive patients who underwent cardiac DSCT exams were included. Axial 1-mm slices were used for the semiautomated technique, and short-axis 8-mm slice thickness multiphase image reconstructions were the basis for manual contour tracing. Left ventricular volumes, ejection fraction and myocardial mass were assessed by both segmentation methods. Length of time needed for both techniques was also recorded. Left ventricular functional parameters derived from semiautomatic contour detection algorithm were not statistically different from manual tracing and showed an excellent correlation (p<0.001). The semiautomatic contour detection algorithm overestimated LV mass (180.30+/-44.74 g) compared with manual contour tracing (156.07+/-46.29 g) (p<0.001). This software allowed a significant reduction of the time needed for global LV assessment (mean 174.16+/-71.53 s, p<0.001). Objective quantification of LV function using the evaluated region-growing-based semiautomatic segmentation analysis software is feasible, accurate, reliable and time-effective. However, further improvements are needed to equal results achieved by manual contour tracing, especially with regard to LV mass quantification.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.