Using Slow-Infusion MR Arteriography and an Implantable Port System to Assess Drug Distribution at Hepatic Arterial Infusion Chemotherapy

Abstract

We believe that slow-infusion MR arteriography reflects the actual distribution of infused drugs more accurately than CT arteriography. When clinical complications occur during treatment, slow-infusion MR arteriography should be used to assess perfusion abnormalities.

Usefulness of tumor perfusion on cone-beam CT after hepatic arterial infusion port implantation for evaluating tumor response to hepatic arterial infusion chemotherapy in hepatocellular carcinoma treatment

“…This method accurately determined chemotherapeutic agent distribution throughout the liver parenchyma. 10 , 11 Seki et al 16 utilized slow-infusion MR arteriography to reflect the actual distribution of infused drugs. Meanwhile, CBCT can be performed following port implantation to check the port’s function and detect the recanalization of embolized arteries and new anastomoses that could prevent chemotherapeutic agents from spreading to the surrounding organs, especially the stomach.…”

Hepatic arterial infusion chemotherapy with a coaxial reservoir system using a non-braided spiral tip microcatheter

“…The following should be monitored after implanting a reservoir system: emerging stenosis or occlusion of a hepatic artery, recanalization of embolized vessels, catheter disconnection, catheter occlusion, and drug distribution [4]. Drug distribution can also be evaluated by CT or magnetic resonance imaging (MRI) by injecting contrast medium (30-50% dilution) at 0.5-1.5 mL/s for CT and 10 mL/h for MRI [4,10]. Similarly, chemotherapy infusion, such as continuous infusion of 5-fluorouracil or 5-fluorodeoxyuridine, requires a flow rate B1 mL/min [1].…”

Dual-phase CT angiography through the port-catheter system for hepatic arterial infusion chemotherapy using multislice CT: assessment of system dysfunction and impact on predicting clinical problems

“…When extrahepatic perfusion reaching the stomach beyond the duodenum was observed on perfusionphase CT imaging with extension of many vessels into the stomach and duodenum on vascular-phase MIP imaging, system dysfunction potentially caused by gastroduodenal ulcer or gastroduodenitis was presumed. When extrahepatic perfusion was seen only in part of the duodenum on perfusion-phase CT imaging, it was not considered to be system dysfunction, as such perfusion was not necessarily associated with gastroduodenal toxicity (30). These interpretations were correlated with clinical symptoms and imaging findings of DSA through the port-catheter system, additional angiography via the transfemoral route, and endoscopy, all of which were performed to investigate catheter system dysfunction and to resolve any problems.…”