Hemodynamic Changes on Cone-Beam Computed Tomography during Balloon-Occluded Transcatheter Arterial Chemoembolization Using Miriplatin for Hepatocellular Carcinoma: A Preliminary Study

Abstract

Background/Aim: Balloon-occluded transcatheter arterial chemoembolization (B-TACE) using miriplatin (MPT) is anticipated as a new strategy for hepatocellular carcinoma (HCC). This study was aimed at evaluating the hemodynamic changes with/without balloon occlusion of the hepatic artery, correlation of cone-beam CT (CBCT) pixels, and CT value after B-TACE for HCC. Methods: A total of 52 patients with HCC, who underwent B-TACE using MPT in addition to the balloon-occluded CBCT hepatic arteriography, were studied. Results: After balloon occlusion, CBCT pixel values increased in 37 lesions, whereas it decreased in 15 lesions. Intratumoral CT values after B-TACE were lower with decreased CBCT pixel values than with increased CBCT pixel values. Conclusion: Hemodynamic changes on CBCT during balloon occlusion can be used to predict the efficacy of B-TACE using MPT.

Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma

“…Three reports[ 30 - 32 ] have explored the hemodynamic changes assessed by balloon occlusion using CBCT and angiography-assisted CT. Ishikawa et al[ 30 ] reported that the CBCT pixel values of tumor enhancement increased after balloon occlusion in 37 of the 52 nodules, whereas it decreased in the remaining 15 nodules. Yoshimatsu et al[ 31 ] showed that the degree of tumor enhancement on selective CT during hepatic angiography (CTHA) increased after balloon occlusion in 3 of the 27 nodules, while it decreased in 11 nodules.…”

“…Asayama et al[ 32 ] also reported that 15 of the 35 nodules showed decreased enhancement or perfusion defects on CTHA with balloon occlusion. While the percentage of decreased tumor enhancement varied markedly among those studies, it remained a negative predictive factor for a dense LE accumulation[ 30 , 31 ] and short-term therapeutic effect[ 32 ]. It can be presumed that the blood flow from the occluded artery reduced and the blood flow from the collateral arteries relatively increased[ 31 , 32 ].…”

“…Since no definitive indications of B-TACE have been established to date, we explored potential factors and conditions supporting the performance of B-TACE. Summarizing the findings of the previous studies mentioned above, the following factors and conditions are known to be related to a dense LE accumulation in targeted HCC nodules and the therapeutic effect of B-TACE: a BOASP ≥ 64 mmHg[ 10 ]; microballoon occlusion at A1, A4, A8, anterior segment artery, RHA or LHA[ 26 ]; decreased tumor enhancement on CBCT and CTHA[ 30 - 32 ]; no decrease in the tumorous portal perfusion defect on CTAP[ 31 ]; tumor location on the subcapsular portion[ 40 ]; successful subsegmental feeding artery embolization[ 40 ]; the presence of portal vein visualization[ 40 ]; a high CT value just after B-TACE[ 44 ]; solitary tumor[ 43 ] and a low serum α-fetoprotein level[ 43 ]. Based on studies[ 13 - 15 ] showing that patients with fewer tumor nodules experienced a better therapeutic effect with B-TACE than with C-TACE, B-TACE might be a better indication than C-TACE in patients with fewer tumor nodules.…”

Microballoon Interventions for Liver Tumors: Review of Literature and Future Perspectives

“…Kakuta et al [22] demonstrated that flow redistribution occurs immediately after balloon occlusion, since no significant differences were found in BOASP values measured immediately after and 5 min after balloon occlusion (p = 0.124). Hemodynamic changes were investigated also with contrast enhanced ultrasound (CEUS) in a case series of two patients [23] and with CT or CBCT post contrast acquisition with balloon deflated and inflated [24][25][26][27]. Inoue in 2019 [27] proposed the employment of a double balloon (a 5.2 Fr balloon inflated in proper hepatic artery and a selective 1.8 Fr in the tumor's feeder) in order to ensure a flow redistribution in those patients in which the target BOASP of >64 mmHg is not achieved by the sole microballoon occlusion.…”

New Era of the Management of Liver Diseases and Liver Cancer: State-of-the-Art Progress in 2017

“…Ishikawa et al [16] described that balloon-occluded transcatheter arterial chemoembolization (B-TACE) using miriplatin is a new strategy for HCC. Therefore, they attempted to evaluate the hemodynamic changes with/ without balloon occlusion of the hepatic artery and correlation of cone-beam CT (CB-CT) pixels and CT value after B-TACE for HCC.…”