Hepatic arterial perfusion scintigraphy with Tc-99m-MAA. Use of a totally implanted drug delivery system.

Abstract

Tc-99m-MAA hepatic arterial perfusion scintigraphy ( HAPS ) using a totally implanted drug delivery system was employed for hepatic arterial chemotherapy in 147 patients (335 studies). Complete perfusion of the involved liver was seen in 88% of patients initially [more so in those with normal hepatic vascular anatomy (93%) than those with vascular variants (79%)] and remained good on follow-up. In 67 consecutive patients (95 studies), arteriovenous shunting to the lung ranged from 0.4 to 32% (mean, 6.2% +/- 4.1 S.D.). Uptake at the tip of the catheter was increased in 20% of patients, but good perfusion was usually maintained. A significant decrease in hepatic and/or extrahepatic perfusion associated with a "hot spot" at the tip of the catheter indicated hepatic arterial thrombosis. Extrahepatic perfusion was seen in 14% of cases, usually in the distribution of the stomach, small bowel, and spleen. Significant symptoms of drug toxicity were seen in 70% of patients with extrahepatic perfusion, compared to 19% of those without it.

Differential Device Performances for Hepatic Arterial Chemotherapy: A Technical Report on Totally Implantable Pumps and Ports for Both Continuous and Bolus Infusion

“…Despite our pragmatic approach in cases of atypical anatomy, largely due to our use of chemo-occlusion in cases with misperfusion of the liver, the rates of incomplete perfusion in our patients compare well with those reported by others [15][16][17][18] as regards both the whole series (6-24%) and those patients with ligation of aberrant arteries [18][19][20] (13-35%). More careful but time-consuming techniques have recently allowed complete perfusion in over 95% of patients [21,22].…”

Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts

“…Kido and Ngan et al [5][6] found that AP shunts occur in 60% of patients with HCC, and Okuda et al [7] reported that marked AP shunts of the main, right, or left portal vein occur in 30% of HCC patients. Although the presence of small AP shunts does not necessarily preclude TACE therapy for unresectable HCC, larger AP shunts do interfere with TACE because anticancer drugs, either alone or mixed with iodized oil, easily pass through the shunts [8][9]. Conventional TACE causes extensive embolization of the portal vein and can therefore induce ischemia in extensive areas of nontumorous liver parenchyma in patients with HCC who have marked AP shunts [10].…”

Transcatheter Arterial Chemoembolization Based on Hepatic Hemodynamics for Hepatocellular Carcinoma

“…Kojiro [50] analyzed 106 resected HCCs less than 2 cm in diameter and found that nodular-type HCC was associated with microscopic portal invasion in up to 25% of cases. Although the presence of small arterioportal shunts does not necessarily preclude TACE therapy for unresectable HCC, larger arterioportal shunts do interfere with TACE because anticancer drugs, either alone or mixed with iodized oil, easily pass through the shunts [47, 48]. Conventional TACE causes extensive embolization of the portal vein and can induce extensive ischemia of nontumorous liver parenchyma in HCC patients with significant arterioportal shunts [46].…”