Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma

Connolly, Gregory C.; Chen, Rui; Hyrien, Ollivier; Mantry, Parvez S.; Bozorgzadeh, Adel; Abt, Peter L.; Khorana, Alok A.

doi:10.1016/j.thromres.2007.10.009

Cited by 105 publications

(90 citation statements)

References 51 publications

(53 reference statements)

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“…Subsequent diagnostic contrast-enhanced CT was able to locate the tracer accumulation in the portal vein, indicating tumor invasion as a common finding in patients with advanced HCC (22). In these 3 patients, the exclusion of extrahepatic MAA deposition was important to enable radioembolization with 90 Y microspheres.…”

Section: Discussionmentioning

confidence: 99%

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer

Hamami¹,

Poeppel²,

Müller³

et al. 2009

J Nucl Med

103

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Radioembolization with 90 Y microspheres is a novel treatment for hepatic tumors. Generally, hepatic arteriography and 99m Tc-macroaggregated albumin (MAA) scanning are performed before selective internal radiation therapy to detect extrahepatic shunting to the lung or the gastrointestinal tract. Whereas previous studies have used only planar or SPECT scans, the present study used 99m Tc-MAA SPECT/CT scintigraphy (SPECT with integrated low-dose CT) to evaluate whether SPECT/CT and additional diagnostic contrast-enhanced CT before radioembolization with 90 Y microspheres are superior to SPECT or planar imaging alone for detection of gastrointestinal shunting. Methods: In a prospective study, we enrolled 58 patients (mean age, 66 y; SD, 12 y; 10 women and 48 men) with hepatocellular carcinoma who underwent hepatic arteriography and scintigraphy with 99m Tc-MAA using planar imaging, SPECT, and SPECT with integrated low-dose CT of the upper abdomen (acquired with a hybrid SPECT/CT camera). The ability of the different imaging modalities to detect extrahepatic MAA shunting was compared. Patient follow-up of a mean of 180 d served as the standard of reference. Results: Gastrointestinal shunting was revealed by planar imaging in 4, by SPECT in 9, and by SPECT/CT in 16 of the 68 examinations. For planar imaging, the sensitivity for detection of gastrointestinal shunting was 25%, the specificity 87%, and the accuracy 72%. For SPECT without CT, the sensitivity was 56%, the specificity 87%, and the accuracy 79%. SPECT with CT fusion had a sensitivity of 100%, a specificity of 94%, and an accuracy of 96%. In 3 patients, MAA deposits in the portal vein could accurately be attributed to tumor thrombus only with additional information from contrast-enhanced CT. The follow-up did not show any gastrointestinal complications. Conclusion: SPECT with integrated low-dose CT using 99m Tc-MAA is beneficial in radioembolization with 90 Y microspheres because it increases the sensitivity and specificity of 99m Tc-MAA SPECT when detecting extrahepatic arterial shunting. The overall low risk of gastrointestinal complications in radioembolization may therefore be further reduced by SPECT/CT. Radi oembolization with 90 Y microspheres via hepatic arterial administration is emerging as a promising treatment for patients with primary and metastatic liver cancer (1-4). 90 Y microspheres are currently approved in the United States for the treatment of hepatocellular carcinoma (TheraSphere; MDS Nordion) and colorectal cancer (SIR-Spheres; Sirtex Medical). 90 Y microspheres are injected into the arterial supply of the liver, where they preferentially flow into hypervascularized tumor areas, resulting in a significantly higher irradiation of tumor tissue than of normal liver parenchyma (5). With improvements in technology permitting smaller vessels to be catheterized and refinements in imaging techniques, the safety and efficacy of 90 Y microsphere delivery has improved significantly (6-10).Liver-directed therapy with 90 Y provides several advantag...

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Section: Discussionmentioning

confidence: 99%

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer

Hamami¹,

Poeppel²,

Müller³

et al. 2009

J Nucl Med

103

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“…Advanced stage, higher CTP class, major vessel involvement, low serum albumin and high AFP levels are predictive of PV obstruction in patients with HCC. 180 In a study on thrombophilic genetic factors in 94 patients with HCC with & without PV obstruction, the Odds Ratio was 3.85 for MTHFR C6777TT with HCC versus healthy controls. Prothrombin gene G20210A mutation was also more frequent among HCC patients mainly with PV obstruction thereby concluding that all cirrhotics should be looked for thrombophilic genetic factors to individualize patients at risk for PV obstruction in HCC.…”

Section: Portal Vein Obstruction In Hccmentioning

confidence: 99%

Portal Vein Thrombosis

Chawla

Bodh

2015

Journal of Clinical and Experimental Hepatology

149

147

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Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. ( J CLIN EXP HEPATOL 2015;5:22-40)

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“…[5] It was also observed that patients with PVT also suffered from a higher incidence of systemic VTE (as in this patient) suggesting an underlying common haemostatic activation that predisposes to both local and systemic thrombotic events in patients with HCC. Expression of tissue factor by HCC has been implicated for both the local and systemic hypercoagulable state of HCC.…”

Section: Discussionmentioning

confidence: 60%

Mobile right atrial thrombus with pulmonary thromboembolism in a patient with advanced hepatocellular carcinoma and disseminated tumor thrombosis

et al. 2011

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We report a 61-year-old male patient who presented with one month history of exertional dyspnea, persistent dry cough, abdominal pain with distension, poor appetite, and weight loss. This case illustrates a rare presentation of hepatocellular carcinoma with mobile right atrial thrombus and pulmonary embolism along with disseminated tumor thrombosis at multiple sites. Furthermore, this case reiterates that an early detection and diagnosis may have increasing importance in the advent of new therapies for treating advanced hepatocellular carcinoma

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Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma

Cited by 105 publications

References 51 publications

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer

Portal Vein Thrombosis

Mobile right atrial thrombus with pulmonary thromboembolism in a patient with advanced hepatocellular carcinoma and disseminated tumor thrombosis

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Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma

Cited by 105 publications

References 51 publications

SPECT/CT with 99mTc-MAA in Radioembolization with 90Y Microspheres in Patients with Hepatocellular Cancer

SPECT/CT with 99mTc-MAA in Radioembolization with 90Y Microspheres in Patients with Hepatocellular Cancer

Portal Vein Thrombosis

Mobile right atrial thrombus with pulmonary thromboembolism in a patient with advanced hepatocellular carcinoma and disseminated tumor thrombosis

Contact Info

Product

Resources

About

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer

SPECT/CT with ^99mTc-MAA in Radioembolization with ⁹⁰Y Microspheres in Patients with Hepatocellular Cancer