MR arteriography using an implantable port system: a new method in assessing perfusion abnormalities during hepatic arterial infusion chemotherapy

Percutaneous catheter placement for hepatic arterial infusion chemotherapy

Hepatic arterial infusion chemotherapy employs a hepatic artery catheter as a conduit to achieve a high concentration of antineoplastic agents to liver tumors. Historically, this catheter placement has been performed via laparotomy. However, it may now be performed using less-invasive percutaneous image guided procedures. There are many anatomical hepatic arterial variations and complicated blood flow patterns. Various techniques are required to ensure high concentration of antineoplastic agents in liver tumors. These techniques are composed of arterial redistribution by embolization, percutaneous catheter placement applying "tip-fixation method," and evaluation and management of flow patterns that reflect drug distribution. The role of interventional radiologists in hepatic arterial infusion chemotherapy is to create and manage the access to achieve these objectives.

Using slow-infusion MR arteriography and an implantable port system to assess drug distribution at hepatic arterial infusion chemotherapy

OBJECTIVE

The purpose of this study was to assess perfusion patterns seen on slow-infusion MR arteriography using the hepatic arterial infusion system compared with those seen on CT arteriography.

SUBJECTS AND METHODS

In 37 patients with liver metastases who had implantable port systems for hepatic arterial infusion chemotherapy, slow-infusion MR arteriography using an infusion rate of 10 mL/hr through an implantable port and CT arteriography using an injection rate of 0.7 mL/sec were performed. In 15 of 37 patients, we evaluated enhancement patterns of tumors of the liver and visceral organs using slow-infusion MR arteriography. In all 37 patients, we compared slow-infusion MR arteriography with CT arteriography concerning intra- and extrahepatic perfusion patterns.

RESULTS

On slow-infusion MR arteriography performed 10-20 min after initiation of infusion, tumors of the liver revealed significant enhancement with only a slight effect of systemic enhancement. In seven (19%) of 37 patients, intrahepatic distributions on slow-infusion MR arteriography differed from those on CT arteriography. In eight patients, the patterns of extrahepatic perfusion into the duodenum and the pancreas head differed on slow-infusion MR arteriography from those seen on CT arteriography. In addition, strong artifact caused by platinum coils in the gastroduodenal artery interfered with the evaluation of perfusion in the area around the coils on CT arteriography, whereas no imaging artifact was seen on slow-infusion MR arteriography.

CONCLUSION

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.