1
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Huesa-Berral C, Withrow JD, Dawson RJ, Beekman C, Bolch WE, Paganetti H, Wehrenberg-Klee E, Bertolet A. MIDOS: a novel stochastic model towards a treatment planning system for microsphere dosimetry in liver tumors. Eur J Nucl Med Mol Imaging 2024; 51:1506-1515. [PMID: 38155237 PMCID: PMC11043005 DOI: 10.1007/s00259-023-06567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/08/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE Transarterial radioembolization (TARE) procedures treat liver tumors by injecting radioactive microspheres into the hepatic artery. Currently, there is a critical need to optimize TARE towards a personalized dosimetry approach. To this aim, we present a novel microsphere dosimetry (MIDOS) stochastic model to estimate the activity delivered to the tumor(s), normal liver, and lung. METHODS MIDOS incorporates adult male/female liver computational phantoms with the hepatic arterial, hepatic portal venous, and hepatic venous vascular trees. Tumors can be placed in both models at user discretion. The perfusion of microspheres follows cluster patterns, and a Markov chain approach was applied to microsphere navigation, with the terminal location of microspheres determined to be in either normal hepatic parenchyma, hepatic tumor, or lung. A tumor uptake model was implemented to determine if microspheres get lodged in the tumor, and a probability was included in determining the shunt of microspheres to the lung. A sensitivity analysis of the model parameters was performed, and radiation segmentectomy/lobectomy procedures were simulated over a wide range of activity perfused. Then, the impact of using different microspheres, i.e., SIR-Sphere®, TheraSphere®, and QuiremSphere®, on the tumor-to-normal ratio (TNR), lung shunt fraction (LSF), and mean absorbed dose was analyzed. RESULTS Highly vascularized tumors translated into increased TNR. Treatment results (TNR and LSF) were significantly more variable for microspheres with high particle load. In our scenarios with 1.5 GBq perfusion, TNR was maximum for TheraSphere® at calibration time in segmentectomy/lobar technique, for SIR-Sphere® at 1-3 days post-calibration, and regarding QuiremSphere® at 3 days post-calibration. CONCLUSION This novel approach is a decisive step towards developing a personalized dosimetry framework for TARE. MIDOS assists in making clinical decisions in TARE treatment planning by assessing various delivery parameters and simulating different tumor uptakes. MIDOS offers evaluation of treatment outcomes, such as TNR and LSF, and quantitative scenario-specific decisions.
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Affiliation(s)
- Carlos Huesa-Berral
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Julia D Withrow
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Robert J Dawson
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Chris Beekman
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wesley E Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alejandro Bertolet
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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2
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Bomberna T, Vermijs S, Lejoly M, Verslype C, Bonne L, Maleux G, Debbaut C. A Hybrid Particle-Flow CFD Modeling Approach in Truncated Hepatic Arterial Trees for Liver Radioembolization: A Patient-specific Case Study. Front Bioeng Biotechnol 2022; 10:914979. [PMID: 35711632 PMCID: PMC9197434 DOI: 10.3389/fbioe.2022.914979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. At its intermediate, unresectable stage, HCC is typically treated by local injection of embolizing microspheres in the hepatic arteries to selectively damage tumor tissue. Interestingly, computational fluid dynamics (CFD) has been applied increasingly to elucidate the impact of clinically variable parameters, such as injection location, on the downstream particle distribution. This study aims to reduce the computational cost of such CFD approaches by introducing a novel truncation algorithm to simplify hepatic arterial trees, and a hybrid particle-flow modeling approach which only models particles in the first few bifurcations. A patient-specific hepatic arterial geometry was pruned at three different levels, resulting in three trees: Geometry 1 (48 outlets), Geometry 2 (38 outlets), and Geometry 3 (17 outlets). In each geometry, 1 planar injection and 3 catheter injections (each with different tip locations) were performed. For the truncated geometries, it was assumed that, downstream of the truncated outlets, particles distributed themselves proportional to the blood flow. This allowed to compare the particle distribution in all 48 "outlets" for each geometry. For the planar injections, the median difference in outlet-specific particle distribution between Geometry 1 and 3 was 0.21%; while the median difference between outlet-specific flow and particle distribution in Geometry 1 was 0.40%. Comparing catheter injections, the maximum median difference in particle distribution between Geometry 1 and 3 was 0.24%, while the maximum median difference between particle and flow distribution was 0.62%. The results suggest that the hepatic arterial tree might be reliably truncated to estimate the particle distribution in the full-complexity tree. In the resulting hybrid particle-flow model, explicit particle modeling was only deemed necessary in the first few bifurcations of the arterial tree. Interestingly, using flow distribution as a surrogate for particle distribution in the entire tree was considerably less accurate than using the hybrid model, although the difference was much higher for catheter injections than for planar injections. Future work should focus on replicating and experimentally validating these results in more patient-specific geometries.
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Affiliation(s)
- Tim Bomberna
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Saar Vermijs
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Maryse Lejoly
- Department of Radiology and Medical Imaging, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Chris Verslype
- Department of Clinical Digestive Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Charlotte Debbaut
- IBiTech-Biommeda, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
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3
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Talaie R, Torkian P, Amili O, Aboufirass Y, Rostambeigi N, Jalaeian H, Golzarian J. Particle Distribution in Embolotherapy, How Do They Get There? A Critical Review of the Factors Affecting Arterial Distribution of Embolic Particles. Ann Biomed Eng 2022; 50:885-897. [PMID: 35524027 DOI: 10.1007/s10439-022-02965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.
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Affiliation(s)
- Reza Talaie
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Pooya Torkian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA.
| | - Omid Amili
- Department of Mechanical, Industrial and Manufacturing Engineering (MIME), University of Toledo, Toledo, OH, USA
| | | | - Nassir Rostambeigi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jafar Golzarian
- Department of Vascular and Interventional Radiology, University of Minnesota, Minneapolis, MN, USA
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4
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Ortega J, Antón R, Ramos JC, Rivas A, S. Larraona G, Sangro B, Bilbao JI, Aramburu J. Computational study of a novel catheter for liver radioembolization. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3577. [PMID: 35094497 PMCID: PMC9286848 DOI: 10.1002/cnm.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
Radioembolization (RE) is a medical treatment for primary and secondary liver cancer that involves the transcatheter intraarterial delivery of micron-sized and radiation-emitting microspheres, with the goal of improving microsphere deposition in the tumoral bed while sparing healthy tissue. An increasing number of in vitro and in silico studies on RE in the literature suggest that the particle injection velocity, spatial location of the catheter tip and catheter type are important parameters in particle distribution. The present in silico study assesses the performance of a novel catheter design that promotes particle dispersion near the injection point, with the goal of generating a particle distribution that mimics the flow split to facilitate tumour targeting. The design is based on two factors: the direction and the velocity at which particles are released from the catheter. A series of simulations was performed with the catheter inserted at an idealised hepatic artery tree with physiologically realistic boundary conditions. Two longitudinal microcatheter positions in the first generation of the tree were studied by analysing the performance of the catheter in terms of the outlet-to-outlet particle distribution and split flow matching. The results show that the catheter with the best performance is one with side holes on the catheter wall and a closed frontal tip. This catheter promotes a flow-split-matching particle distribution, which improves as the injection crossflow increases.
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Affiliation(s)
- Julio Ortega
- Escuela de Ingeniería MecánicaPontificia Universidad Católica de ValparaísoQuilpuéChile
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Raúl Antón
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
| | - Juan Carlos Ramos
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Alejandro Rivas
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Gorka S. Larraona
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Bruno Sangro
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
| | - José Ignacio Bilbao
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
| | - Jorge Aramburu
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
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5
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d'Abadie P, Walrand S, Goffette P, Amini N, Maanen AV, Lhommel R, Jamar F. Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:768-773. [PMID: 34792032 DOI: 10.5152/dir.2021.20785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using 90Y-resin microspheres. METHODS Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For 90Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). 90Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. 99mTc-MAA SPECT and 90Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL[MAA or 90Y]) and tumor dose (TD[MAA or 90Y]) for the planning and therapy. RESULTS Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL90Y and TD90Y were significantly higher than T/NLMAA and TDMAA. Median (IQR) T/NL90Y was 2.16 (2.15) versus 1.74 (1.43) for T/NLMAA (p < 0.001). Median (IQR) TD90Y was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TDMAA (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated. CONCLUSION The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
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Affiliation(s)
- Philippe d'Abadie
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Stephan Walrand
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Pierre Goffette
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Nadia Amini
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Aline van Maanen
- From the Department of Nuclear Medicine Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Renaud Lhommel
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
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6
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Aramburu J, Antón R, Rodríguez-Fraile M, Sangro B, Bilbao JI. Computational Fluid Dynamics Modeling of Liver Radioembolization: A Review. Cardiovasc Intervent Radiol 2021; 45:12-20. [PMID: 34518913 PMCID: PMC8716346 DOI: 10.1007/s00270-021-02956-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022]
Abstract
Yttrium-90 radioembolization (RE) is a widely used transcatheter intraarterial therapy for patients with unresectable liver cancer. In the last decade, computer simulations of hepatic artery hemodynamics during RE have been performed with the aim of better understanding and improving the therapy. In this review, we introduce the concept of computational fluid dynamics (CFD) modeling with a clinical perspective and we review the CFD models used to study RE from the fluid mechanics point of view. Finally, we show what CFD simulations have taught us about the hemodynamics during RE, the current capabilities of CFD simulations of RE, and we suggest some future perspectives.
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Affiliation(s)
- Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain.
| | - Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain.,IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.,Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.,Liver Unit, Clínica Universidad de Navarra and CIBEREHD, 31008, Pamplona, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.,Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
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7
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CFD Simulations of Radioembolization: A Proof-of-Concept Study on the Impact of the Hepatic Artery Tree Truncation. MATHEMATICS 2021. [DOI: 10.3390/math9080839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radioembolization (RE) is a treatment for patients with liver cancer, one of the leading cause of cancer-related deaths worldwide. RE consists of the transcatheter intraarterial infusion of radioactive microspheres, which are injected at the hepatic artery level and are transported in the bloodstream, aiming to target tumors and spare healthy liver parenchyma. In paving the way towards a computer platform that allows for a treatment planning based on computational fluid dynamics (CFD) simulations, the current simulation (model preprocess, model solving, model postprocess) times (of the order of days) make the CFD-based assessment non-viable. One of the approaches to reduce the simulation time includes the reduction in size of the simulated truncated hepatic artery. In this study, we analyze for three patient-specific hepatic arteries the impact of reducing the geometry of the hepatic artery on the simulation time. Results show that geometries can be efficiently shortened without impacting greatly on the microsphere distribution.
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8
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Antón R, Antoñana J, Aramburu J, Ezponda A, Prieto E, Andonegui A, Ortega J, Vivas I, Sancho L, Sangro B, Bilbao JI, Rodríguez-Fraile M. A proof-of-concept study of the in-vivo validation of a computational fluid dynamics model of personalized radioembolization. Sci Rep 2021; 11:3895. [PMID: 33594143 PMCID: PMC7886872 DOI: 10.1038/s41598-021-83414-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Radioembolization (RE) with yttrium-90 (90Y) microspheres, a transcatheter intraarterial therapy for patients with liver cancer, can be modeled computationally. The purpose of this work was to correlate the results obtained with this methodology using in vivo data, so that this computational tool could be used for the optimization of the RE procedure. The hepatic artery three-dimensional (3D) hemodynamics and microsphere distribution during RE were modeled for six 90Y-loaded microsphere infusions in three patients with hepatocellular carcinoma using a commercially available computational fluid dynamics (CFD) software package. The model was built based on in vivo data acquired during the pretreatment stage. The results of the simulations were compared with the in vivo distribution assessed by 90Y PET/CT. Specifically, the microsphere distribution predicted was compared with the actual 90Y activity per liver segment with a commercially available 3D-voxel dosimetry software (PLANET Dose, DOSIsoft). The average difference between the CFD-based and the PET/CT-based activity distribution was 2.36 percentage points for Patient 1, 3.51 percentage points for Patient 2 and 2.02 percentage points for Patient 3. These results suggest that CFD simulations may help to predict 90Y-microsphere distribution after RE and could be used to optimize the RE procedure on a patient-specific basis.
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Affiliation(s)
- Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
| | - Javier Antoñana
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Ana Ezponda
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Elena Prieto
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Asier Andonegui
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Julio Ortega
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Isabel Vivas
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Lidia Sancho
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Hepatology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- CIBEREHD, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas, 28029, Madrid, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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9
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Bomberna T, Koudehi GA, Claerebout C, Verslype C, Maleux G, Debbaut C. Transarterial drug delivery for liver cancer: numerical simulations and experimental validation of particle distribution in patient-specific livers. Expert Opin Drug Deliv 2020; 18:409-422. [PMID: 33210955 DOI: 10.1080/17425247.2021.1853702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Transarterial therapies are routinely used for the locoregional treatment of unresectable hepatocellular carcinoma (HCC). However, the impact of clinical parameters (i.e. injection location, particle size, particle density etc.) and patient-specific conditions (i.e. hepatic geometry, cancer burden) on the intrahepatic particle distribution (PD) after transarterial injection of embolizing microparticles is still unclear. Computational fluid dynamics (CFD) may help to better understand this impact.Methods: Using CFD, both the blood flow and microparticle mass transport were modeled throughout the 3D-reconstructed arterial vasculature of a patient-specific healthy and cirrhotic liver. An experimental feasibility study was performed to simulate the PD in a 3D-printed phantom of the cirrhotic arterial network.Results: Axial and in-plane injection locations were shown to be effective parameters to steer particles toward tumor tissue in both geometries. Increasing particle size or density made it more difficult for particles to exit the domain. As cancer burden increased, the catheter tip location mattered less. The in vitro study and numerical results confirmed that PD largely mimics flow distribution, but that significant differences are still possible.Conclusions: Our findings highlight that optimal parameter choice can lead to selective targeting of tumor tissue, but that targeting potential highly depends on patient-specific conditions.
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Affiliation(s)
- Tim Bomberna
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Gent, Belgium
| | - Ghazal Adeli Koudehi
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium
| | - Charlotte Claerebout
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium
| | - Chris Verslype
- Department of Clinical Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Leuven, Belgium
| | - Charlotte Debbaut
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Gent, Belgium
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10
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Ortega J, Antón R, Ramos JC, Rivas A, Larraona GS, Sangro B, Bilbao JI, Aramburu J. On the importance of spiral-flow inflow boundary conditions when using idealized artery geometries in the analysis of liver radioembolization: A parametric study. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3337. [PMID: 32212316 DOI: 10.1002/cnm.3337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Abstract
In the last decades, the numerical studies on hemodynamics have become a valuable explorative scientific tool. The very first studies were done over idealized geometries, but as numerical methods and the power of computers have become more affordable, the studies tend to be patient specific. We apply the study to the numerical analysis of tumor-targeting during liver radioembolization (RE). RE is a treatment for liver cancer, and is performed by injecting radiolabeled microspheres via a catheter placed in the hepatic artery. The objective of the procedure is to maximize the release of radiolabeled microspheres into the tumor and avoid a healthy tissue damage. Idealized virtual arteries can serve as a generalist approach that permits to separately analyze the effect of a variable in the microsphere distribution with respect to others. However, it is important to use proper physiological boundary conditions (BCs). It is not obvious, the need to account for the effect of tortuosity when using an idealized virtual artery. We study the use of idealized geometry of a hepatic artery as a valid research tool, exploring the importance of using realistic spiral-flow inflow BC. By using a literature-based cancer scenario, we vary two parameters to analyze the microsphere distribution through the outlets of the geometry. The parameters varied are the type of microspheres injected and the microsphere injection velocity. The results with realistic inlet velocity profile showed that the particle distribution in the liver segments is not affected by the analyzed injection velocity values neither by the particle density. NOVELTY STATEMENT: In this article, we assessed the use of idealized geometries as a valid research tool and applied the use of an idealized geometry to the case of an idealized hepatic artery to study the particle-hemodynamics during radioembolization (RE). We studied three different inflow boundary conditions (BCs) to assess the usefulness of the geometry, two types of particle injection velocities and two types of commercially available microspheres for RE treatment. In recent years, the advent in computational resources allowed for more detailed patient-specific geometry generation and discretization and hemodynamics simulations. However, general studies based on idealized geometries can be performed in order to provide medical doctors with some basic and general guidelines when using a given catheter for a given cancer scenario. Moreover, using an idealized geometry can be a reasonable approach which allows us to isolate a given parameter and control other parameters, so that parameters can be independently assessed. Even though an idealized geometry does not match any patient's geometry, the use of an idealized geometry can be valid when drawing general conclusions that may be useful in patient-specific cases. However, we believe that even if an idealized hepatic artery geometry is used for the study, it is necessary to account for the upstream and downstream tortuosity of vessels through the BCs. In this work, we highlighted the need of modeling the tortuosity of upstream and downstream vasculatures through the BCs.
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Affiliation(s)
- Julio Ortega
- Escuela de Ingeniería Mecánica, Pontificia Universidad Católica de Valparaíso, Quilpué, Chile
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Raul Antón
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Juan C Ramos
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Alejandro Rivas
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Gorka S Larraona
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
| | - Bruno Sangro
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose I Bilbao
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Jorge Aramburu
- Departamento de Ingeniería Mecánica y Materiales, niversidad de Navarra, TECNUN - Escuela de Ingenieros, San Sebastián, Spain
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11
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Aramburu J, Antón R, Rivas A, Ramos JC, Sangro B, Bilbao JI. Liver Radioembolization: An Analysis of Parameters that Influence the Catheter-Based Particle-Delivery via CFD. Curr Med Chem 2020; 27:1600-1615. [DOI: 10.2174/0929867325666180622145647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 12/13/2022]
Abstract
Radioembolization (RE) is a valuable treatment for liver cancer. It consists of administering
radioactive microspheres by an intra-arterially placed catheter with the aim of
lodging these microspheres, which are driven by the bloodstream, in the tumoral bed. Even
though it is a safe treatment, some radiation-induced complications may arise. In trying to
detect or solve the possible incidences that cause nontarget irradiation, simulating the particle-
hemodynamics in hepatic arteries during RE by computational fluid dynamics (CFD)
tools has become a valuable approach. This paper reviews the parameters that influence the
outcome of RE and that have been studied via numerical simulations. In this numerical approach,
the outcome of RE is regarded as successful if particles reach the artery branches that
feed tumor-bearing liver segments. Up to 10 parameters have been reviewed. The variation
of each parameter actually alters the hemodynamic pattern in the vicinities of the catheter tip
and locally alters the incorporation of the particles into the bloodstream. Therefore, in general,
the local influences of these parameters should result in global differences in terms of
particle distribution in the hepatic artery branches. However, it has been observed that under
some (qualitatively described) appropriate conditions where particles align with blood
streamlines, the local influence resulting from a variation of a given parameter vanishes and
no global differences are observed. Furthermore, the increasing number of CFD studies on
RE suggests that numerical simulations have become an invaluable research tool in the study
of RE.
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Affiliation(s)
- Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingenieros, 20018 Donostia-San Sebastian, Spain
| | - Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingenieros, 20018 Donostia-San Sebastian, Spain
| | - Alejandro Rivas
- Universidad de Navarra, TECNUN Escuela de Ingenieros, 20018 Donostia-San Sebastian, Spain
| | - Juan C. Ramos
- Universidad de Navarra, TECNUN Escuela de Ingenieros, 20018 Donostia-San Sebastian, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigacion Sanitaria de Navarra, 31008 Pamplona, Spain
| | - José I. Bilbao
- IdiSNA, Instituto de Investigacion Sanitaria de Navarra, 31008 Pamplona, Spain
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12
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In Vitro Study of Particle Transport in Successively Bifurcating Vessels. Ann Biomed Eng 2019; 47:2271-2283. [PMID: 31165293 DOI: 10.1007/s10439-019-02293-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/20/2019] [Indexed: 12/24/2022]
Abstract
To reach a predictive understanding of how particles travel through bifurcating vessels is of paramount importance in many biomedical settings, including embolization, thromboembolism, and drug delivery. Here we utilize an in vitro model in which solid particles are injected through a rigid vessel that symmetrically bifurcates in successive branching generations. The geometric proportion and fluid dynamics parameters are relevant to the liver embolization. The volumetric flow field is reconstructed via phase-contrast magnetic resonance imaging, from which the particle trajectories are calculated for a range of size and density using the particle equation of motion. The method is validated by directly tracking the injected particles via optical imaging. The results indicate that, opposite to the common assumption, the particles distribution is fundamentally different from the volumetric flow partition. In fact, the amount of delivered particles vary substantially between adjacent branches even when the flow is uniformly distributed. This is not due to the inertia of the particles, nor to gravity. The particle distribution is rather rooted in their different pathways, which in turn are linked to their release origin along the main vessel cross-section. Therefore, the tree geometry and the associated flow streamlines are the prime determinant of the particle fate, while local changes of volumetric flow rate to selected branches do not generally produce proportional changes of particle delivery.
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13
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Toskich BB, Liu DM. Y90 Radioembolization Dosimetry: Concepts for the Interventional Radiologist. Tech Vasc Interv Radiol 2019; 22:100-111. [PMID: 31079706 DOI: 10.1053/j.tvir.2019.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Transarterial radioembolization (TARE) with beta particle emitting microspheres via Yttrium-90 decay has become a fundamental component of the contemporary Interventional Oncology practice. TARE continues to advance as a result of increased utilization, clinical study, technological improvements, and evolving applications. To maximize TARE safety and efficacy, a core understanding of dosimetry is essential. The intent of this overview is to provide the reader with a general survey of radiation physics and biology, device differentiation, patient selection, anatomic assessment, activity administration models, and procedural techniques involved with TARE dosimetry.
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Affiliation(s)
| | - David M Liu
- University of British Columbia, Vancouver, BC, Canada
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14
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Xu Z, Kleinstreuer C. Direct nanodrug delivery for tumor targeting subject to shear-augmented diffusion in blood flow. Med Biol Eng Comput 2018; 56:1949-1958. [DOI: 10.1007/s11517-018-1818-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/15/2018] [Indexed: 12/15/2022]
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