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Zandieh G, Yazdaninia I, Afyouni S, Shaghaghi M, Borhani A, Mohseni A, Shaghaghi S, Liddell R, Kamel IR. Spectrum of Imaging Findings and Complications After Hepatic Transarterial Chemoembolization for Liver Tumors. J Comput Assist Tomogr 2024; 48:701-712. [PMID: 38595176 DOI: 10.1097/rct.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
ABSTRACT This study reviews the spectrum of imaging findings and complications after transarterial chemoembolization (TACE) for the treatment of primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma) and liver metastases. The review encompasses a spectrum of imaging criteria for assessing treatment response, including the modified Response Evaluation Criteria in Solid Tumors guidelines, tumor enhancement, and apparent diffusion coefficient alterations.We discuss the expected posttreatment changes and imaging responses to TACE, describing favorable and poor responses. Moreover, we present cases that demonstrate potential complications post-TACE, including biloma formation, acute cholecystitis, abscesses, duodenal perforation, arterial injury, and nontarget embolization. Each complication is described in detail, considering its causes, risk factors, clinical presentation, and imaging characteristics.To illustrate these findings, a series of clinical cases is presented, featuring diverse imaging modalities including computed tomography, magnetic resonance imaging, and digital subtraction angiography.
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Affiliation(s)
- Ghazal Zandieh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Iman Yazdaninia
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shadi Afyouni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Mohamadreza Shaghaghi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Ali Borhani
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Alireza Mohseni
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
| | - Shiva Shaghaghi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Robert Liddell
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD
| | - Ihab R Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, John's Hopkins University, Baltimore, MD
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Yee C, McCoy D, Yu J, Losey A, Jordan C, Moore T, Stillson C, Oh HJ, Kilbride B, Roy S, Patel A, Wilson MW, Hetts SW. Endovascular Ion Exchange Chemofiltration Device Reduces Off-Target Doxorubicin Exposure in a Hepatic Intra-arterial Chemotherapy Model. Radiol Imaging Cancer 2019; 1:e190009. [PMID: 32300759 DOI: 10.1148/rycan.2019190009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Accepted: 07/25/2019] [Indexed: 01/08/2023]
Abstract
Purpose To determine if endovascular chemofiltration with an ionic device (ChemoFilter [CF]) can be used to reduce systemic exposure and off-target biodistribution of doxorubicin (DOX) during hepatic intra-arterial chemotherapy (IAC) in a preclinical model. Materials and Methods Hepatic IAC infusions were performed in six pigs with normal livers. Animals underwent two 10-minute intra-arterial infusions of DOX (200 mg) into the common hepatic artery. Both the treatment group and the control group received initial IAC at 0 minutes and a second dose at 200 minutes. Prior to the second dose, CF devices were deployed in and adjacent to the hepatic venous outflow tract of treatment animals. Systemic exposure to DOX was monitored via blood samples taken during IAC procedures. After euthanasia, organ tissue DOX concentrations were analyzed. Alterations in systemic DOX exposure and biodistribution were compared by using one-tailed t tests. Results CF devices were well tolerated, and no hemodynamic, thrombotic, or immunologic complications were observed. Animals treated with a CF device had a significant reduction in systemic exposure when compared with systemic exposure in the control group (P <.009). Treatment with a CF device caused a significant decrease in peak DOX concentration (31%, P <.01) and increased the time to maximum concentration (P <.03). Tissue analysis was used to confirm significant reduction in DOX accumulation in the heart and kidneys (P <.001 and P <.022, respectively). Mean tissue concentrations in the heart, kidneys, and liver of animals treated with CF compared with those in control animals were 14.2 μg/g ± 1.9 (standard deviation) versus 26.0 μg/g ± 1.8, 46.4 μg/g ± 4.6 versus 172.6 μg/g ± 40.2, and 217.0 μg/g ± 5.1 versus 236.8 μg/g ± 9.0, respectively. Fluorescence imaging was used to confirm in vivo DOX binding to CF devices. Conclusion Reduced systemic exposure and heart bioaccumulation of DOX during local-regional chemotherapy to the liver can be achieved through in situ adsorption by minimally invasive image-guided CF devices.© RSNA, 2019.
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Affiliation(s)
- Colin Yee
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - David McCoy
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Jay Yu
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Aaron Losey
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Caroline Jordan
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Terilyn Moore
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Carol Stillson
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Hee Jeung Oh
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Bridget Kilbride
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Shuvo Roy
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Anand Patel
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging (C.Y., D.M., J.Y., A.L., C.L., T.M., C.S., B.K., A.P., M.W.W., S.W.H.) and Department of Bioengineering and Therapeutic Sciences (S.R.), University of California, San Francisco, 505 Parnassus Ave, L-351, San Francisco, CA 94143-0628; and Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, Calif (H.J.O.).,For members of the ChemoFilter Consortium, please see the Acknowledgments
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