Assessment of perfusion patterns during hepatic artery infusion chemotherapy: EOE-13 CT and 99mTc-MAA scintigraphy

Miller, Dana L.; Schneider, Philip D.; Gianola, Fred J.; Willis, Monte S.; Vermess, Michael; Doppman, John L.

doi:10.2214/ajr.143.4.827

Cited by 7 publications

References 11 publications

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Mixing studies during hepatic artery infusion in an in vitro model

Lutz

Miller

1988

Cancer

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A glass model of the hepatic artery network was used to study the effect of infusion rate on the degree of mixing from an end hole catheter placed in the gastroduodenal artery. Red dye solutions were infused at rates ranging from 1 ml/hour to 20 ml/minute. Effluent samples from each of 16 branch arteries were collected and dye concentrations were analyzed by means of a spectrophotometer. Low infusion rates, e.g., up to 5 ml/minute, showed streaming of the dye solutions and a nonhomogeneous dye distribution in the distal branches. At 20 ml/minute, dye distribution was much more uniform. These experiments are designed to simulate intrahepatic infusion of chemotherapeutic drug solutions. Theoretical considerations suggesting a pharmacokinetic advantage of intraarterial delivery implicitly assume uniform distribution of drug solutions to all perfused tissue. The in vitro data in this study suggests that this assumption may not be operative under certain infusion conditions. Slow infusion can lead to streaming and nonuniform distribution of infused drug solutions, which may in part explain the variability in tumor response in different tissue regions and also some observed toxicities, such as bile duct stricturing and fibrosis after intrahepatic infusions.

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Mixing studies during hepatic artery infusion in an in vitro model

Lutz

Miller

1988

Cancer

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Changes in vascularity of liver tumours after hepatic arterial embolization with degradable starch microspheres

Civalleri

Scopinaro

Balletto

et al. 1989

British Journal of Surgery

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The role of vascularity as a prognostic factor was investigated in 35 patients undergoing arterial chemotherapy for liver tumours. Compared with parenchyma, tumour vascularity was classified as hot (18 cases), cold (12 cases), and mixed (12 cases) using 99mTc-macroaggregated albumin (MAA) hepatic arterial scans. The proportion of patients showing complete and partial responses to treatment was higher in the hot group (56 per cent) than in the combined cold and mixed group (12 per cent). In 15 cases (six hot, six cold and three mixed lesions), additional MAA scans were performed immediately after arterial embolization with degradable starch microspheres (DSMs). Either complete or partial reversal of tumour vascularity was observed after DSM-embolization in five and seven cases respectively, two and two of them respectively showing native cold lesions. As tumour vascularity appears to be a prominent prognostic factor, DSM-embolization should improve the efficacy of treatment by improving liver extraction of drugs and causing flow redistribution towards hypovascular areas.

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Results of liver angiography and perfusion scintigraphy do not correlate with response to hepatic artery infusion chemotherapy

Lehner

Kretzschmar

Bubeck

et al. 1988

Journal of Surgical Oncology

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Liver angiography and liver perfusion scintigraphy with Tc-99m-labeled macroaggregated albumin (MAA) were performed in 36 patients with liver metastases from colorectal cancer prior to continuous 5-fluorouracil hepatic artery infusion (HAI) hemotherapy. Of the 26 patients showing metastases on arteriogram, five revealed increased tumor vascularisation, five had normal vascularisation, and 16 showed decreased vascularisation of the metastases relative to liver. In liver perfusion scintigraphy, 15 of the 36 patients showed increased perfusion of the metastases, four had normal perfusion, and 17 had decreased tumor perfusion. The observed differences in survival in the different groups were not statistically significant: patients survived 15 months in the group with increased tumor vascularisation, 8 months for normal vascularisation, and 14 months for decreased tumor vascularisation; survival was 28 months for the group of increased, and 13 and 14 months for the normal and decreased tumor perfusion groups respectively. Also, response rates with 80%, 40%, and 75% responders in the group of increased, normal, and decreased tumor vascularisation, respectively, and 80%, 50%, and 59% responders in the group of increased, normal, and decreased perfusion, respectively, were not significantly different. These results indicate that there is no possibility to discriminate potential responders from nonresponders by results of liver angiography or perfusion scintigraphy.

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Assessment of perfusion patterns during hepatic artery infusion chemotherapy: EOE-13 CT and 99mTc-MAA scintigraphy

Cited by 7 publications

References 11 publications

Mixing studies during hepatic artery infusion in an in vitro model

Mixing studies during hepatic artery infusion in an in vitro model

Changes in vascularity of liver tumours after hepatic arterial embolization with degradable starch microspheres

Results of liver angiography and perfusion scintigraphy do not correlate with response to hepatic artery infusion chemotherapy

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