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Frangakis C, Sohn JH, Bas A, Chapiro J, Schernthaner RE, Lin M, Hamilton JP, Pawlik TM, Hong K, Duran R. Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure. Front Oncol 2021; 11:639235. [PMID: 34804911 PMCID: PMC8602787 DOI: 10.3389/fonc.2021.639235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension. Methods Retrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient. Results No significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%). Conclusion Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.
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Affiliation(s)
- Constantine Frangakis
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jae Ho Sohn
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ahmet Bas
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Ruediger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - MingDe Lin
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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2
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Lin PT, Teng W, Jeng WJ, Hsieh YC, Hung CF, Huang CH, Lui KW, Chen YC, Lin CC, Lin SM, Sheen IS, Lin CY. The incidence and predictors of post transarterial chemoembolization variceal bleeding in hepatocellular carcinoma patients. J Formos Med Assoc 2019; 119:635-643. [PMID: 31495543 DOI: 10.1016/j.jfma.2019.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/19/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND & AIMS Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) patients. Variceal bleeding is a life-threatening complication and may alter the initial treatment plan. This study was aimed to elucidate the risk factors for variceal bleeding in HCC patients receiving TACE treatment. METHODS From 2005 to 2016, a total of 1233 treatment-naive HCC patients receiving first time TACE treatment in Chang Gung Memorial Hospital, Linkou medical center were recruited. Pre-TACE status including baseline characteristics, prior history of ascites, and parameters for liver function evaluation were analyzed. All the variables were compared between patients with and without variceal bleeding. RESULTS Among the 1233 patients, the median age was 63.7 (range 25.8-91.5) years old, and 73.5% were male. Variceal bleeding events were documented in 19 patients (1.5%) within 3 months post TACE treatment. Patients with younger age, cirrhosis, pre-treatment ascites and advanced fibrosis status (higher MELD score, CTP score, ALBI grade, FIB-4 and APRI score) were more likely to encounter post-treatment variceal bleeding. Multivariate Cox regression analysis revealed existence of ascites (adjusted HR: 4.859 (1.947-12.124), p = 0.001), and higher FIB-4 score (adjusted HR: 4.481 (1.796-11.179), p = 0.001) were the independent predictive factors for variceal bleeding. Patients with post-TACE variceal bleeding are more likely to encounter tumor progression (42.1% vs. 20.3%, p = 0.039) and mortality owing to GI bleeding (15.8% vs. 3%, p = 0.032). CONCLUSION The incidence of post-TACE variceal bleeding was 1.5%. Patients with post-TACE variceal bleeding have poorer TACE treatment response. The pre-treatment ascites and FIB-4 score are the independent predictors for post-TACE variceal bleeding.
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Affiliation(s)
- Po-Ting Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Chen-Fu Hung
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Kar-Wai Lui
- Department of Radiology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taiwan; College of Medicine, Chang Gung University, Taiwan.
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3
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Scheiner B, Ulbrich G, Mandorfer M, Reiberger T, Müller C, Waneck F, Trauner M, Kölblinger C, Ferlitsch A, Sieghart W, Peck-Radosavljevic M, Pinter M. Short- and long-term effects of transarterial chemoembolization on portal hypertension in patients with hepatocellular carcinoma. United European Gastroenterol J 2019; 7:850-858. [PMID: 31316789 PMCID: PMC6620878 DOI: 10.1177/2050640619840199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background Transarterial chemoembolization (TACE) affects hepatic perfusion, and might
have an impact on portal pressure in patients with hepatocellular carcinoma
(HCC). Objective The objective of this article is to report the secondary outcome “hepatic
hemodynamics” from the AVATACE trial, a prospective randomized,
placebo-controlled trial on the efficacy of conventional TACE in combination
with bevacizumab or placebo. Methods Hepatic venous pressure gradient (HVPG) was measured at baseline (prior to
first TACE), within nine days (“acute effects”), two months (“intermediate
effects”) and six months (“long-term effects”) after the first TACE. Results Of 28 patients with early-intermediate stage HCC, n = 20
(71%) had clinically significant portal hypertension (CSPH, HVPG ≥ 10 mmHg)
at baseline (median, 12 (interquartile range (IQR): 9–19) mmHg). TACE had
neither “acute effects” nor “intermediate effects” on HVPG. However, in 13
patients with available HVPG measurement at month 6, there was a significant
increase in HVPG (median, 16 (IQR: 11–19) mmHg) compared with baseline
(median, 10 (IQR: 5–12) mmHg; p = 0.007). Portal
hypertension-related complications occurred exclusively in patients with
CSPH (8 (40%) vs 0). Conclusions Repeated TACE was associated with a significant long-term increase in HVPG.
This should be considered when deciding whether to continue with TACE or
switch to systemic treatment, since CSPH drives the development of
complications.
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Affiliation(s)
- Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - Gregor Ulbrich
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria
| | - Christian Müller
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Fredrik Waneck
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claus Kölblinger
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Krankenhaus Barmherzige Schwestern Ried, Ried, Austria
| | - Arnulf Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine, Krankenhaus Barmherzige Brüder Wien, Vienna Austria
| | - Wolfgang Sieghart
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Markus Peck-Radosavljevic
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
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4
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Jo PC, Jang HJ, Burns PN, Burak KW, Kim TK, Wilson SR. Integration of Contrast-enhanced US into a Multimodality Approach to Imaging of Nodules in a Cirrhotic Liver: How I Do It. Radiology 2017; 282:317-331. [PMID: 28099108 DOI: 10.1148/radiol.2016151732] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accurate characterization of cirrhotic nodules and early diagnosis of hepatocellular carcinoma (HCC) are of vital importance. Currently, computed tomography (CT) and magnetic resonance (MR) imaging are standard modalities for the investigation of new nodules found at surveillance ultrasonography (US). This article describes the successful integration of contrast material-enhanced US into a multimodality approach for diagnosis of HCC and its benefits in this population. The application of contrast-enhanced US immediately following surveillance US allows for prompt dynamic contrast-enhanced evaluation, removing the need for further imaging of benign lesions. Contrast-enhanced US also provides dynamic real-time assessment of tumor vascularity so that contrast enhancement can be identified regardless of its timing or duration, allowing for detection of arterial hypervascularity and portal venous washout. The purely intravascular nature of US contrast agents is valuable as the rapid washout of nonhepatocyte malignancies is highly contributory to their differentiation from HCC. The authors believe contrast-enhanced US provides complementary information to CT and MR imaging in the characterization of nodules in high-risk patients. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Patricia C Jo
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
| | - Hyun-Jung Jang
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
| | - Peter N Burns
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
| | - Kelly W Burak
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
| | - Tae Kyoung Kim
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
| | - Stephanie R Wilson
- From the Department of Radiology (P.C.J., S.R.W.) and Department of Medicine, Division of Gastroenterology (K.W.B., S.R.W.), Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, AB, Canada T2N 2T9; Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ont, Canada (H.J.J., T.K.K.); and Department of Imaging Research, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont, Canada (P.N.B.)
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5
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Kaufmann S, Horger T, Oelker A, Beck S, Schulze M, Nikolaou K, Ketelsen D, Horger M. Volume perfusion computed tomography (VPCT)-based evaluation of response to TACE using two different sized drug eluting beads in patients with nonresectable hepatocellular carcinoma: Impact on tumor and liver parenchymal vascularisation. Eur J Radiol 2015; 84:2548-54. [PMID: 26428842 DOI: 10.1016/j.ejrad.2015.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Response monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose. MATERIALS AND METHODS Institutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU1; 24 h post-TACE) and at follow-up (FU2; median, 81 days) in 45 consecutive patients. 100-300 μm (n=17) and 300-500 μm (n=28) drug eluting beads (DEB) using an epirubicin dose of (<=25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64×0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR). RESULTS A significant reduction of viable tumor tissue was found in all patients between baseline and FU1 (p<0.001) being independent on particle size and epirubicin dose (p>0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU1) results for prediction of the mid-term tumor course (FU2) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU1 in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU1 and FU2. CONCLUSION VPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.
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Affiliation(s)
- S Kaufmann
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - T Horger
- Technische Universität München, M2-Lehrstuhl für Numerische Mathematik, Boltzmannstraße 3, 85748 Garching, Germany.
| | - A Oelker
- Technische Universität München, M6-Lehrstuhl für Mathematische Modellierung, Boltzmannstraße 3, 85748 Garching, Germany.
| | - S Beck
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - M Schulze
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - K Nikolaou
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - D Ketelsen
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
| | - M Horger
- University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
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Transcatheter arterial chemoembolization for hepatocellular carcinoma in cirrhosis: influence on portal hypertension. Eur J Gastroenterol Hepatol 2011; 23:573-7. [PMID: 21546840 DOI: 10.1097/meg.0b013e32834701f5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Transcatheter arterial chemoembolization (TACE) is a routine treatment for hepatocellular carcinoma in cirrhotic patients. Whether TACE influences the degree of portal hypertension remains uncertain. AIM AND PATIENTS: We retrospectively analyzed the clinical course of 283 TACE to investigate the incidence of variceal bleeding and ascites after the procedure. We also prospectively evaluated portal pressure by hepatic venous portal gradient (HVPG) before and within 3 days by TACE in a group of 15 patients. RESULTS Before TACE, esophageal varices were present in 125 patients. Variceal bleeding occurred in three (1.5%) and ascites in two (1%) patients during the follow-up post-TACE. Patients with variceal bleeding were significantly older (P=0.019). In 15 patients who underwent portal pressure measurement before and within 3 days by TACE, HVPG was unchanged (mean 13.1 vs. 12.8 mmHg, P>0.05). CONCLUSION In our series portal hypertension-related complications after TACE were rare and did not result in higher mortality. As TACE did not influence HVPG, the preventive ligation of esophageal varices before TACE does not seem justified.
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7
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Erinjeri JP, Deodhar A, Thornton RH, Allen PJ, Getrajdman GI, Brown KT, Sofocleous CT, Reidy DL. Resolution of hepatic encephalopathy following hepatic artery embolization in a patient with well-differentiated neuroendocrine tumor metastatic to the liver. Cardiovasc Intervent Radiol 2009; 33:610-4. [PMID: 19756861 DOI: 10.1007/s00270-009-9698-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 08/17/2009] [Accepted: 08/18/2009] [Indexed: 12/21/2022]
Abstract
Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.
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Affiliation(s)
- Joseph P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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8
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Nyland TG, Fisher PE. EVALUATION OF EXPERIMENTALLY INDUCED CANINE HEPATIC CIRRHOSIS USING DUPLEX DOPPLER ULTRASOUND. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1740-8261.1990.tb01809.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Tsushima Y, Unno Y, Koizumi J, Kusano S. Hepatic perfusion changes after transcatheter arterial embolization (TAE) of hepatocellular carcinoma: measurement by dynamic computed tomography (CT). Dig Dis Sci 1998; 43:317-22. [PMID: 9512124 DOI: 10.1023/a:1018850204743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We observed the hemodynamic changes at the level of the hepatic parenchyma induced by transcatheter arterial embolization (TAE) for hepatocellular carcinoma in 22 patients. TAE was performed by administration of a mixture of iodized oil, adriamycin, and mitomycin C, followed by injection of gelatin sponge particles (1-mm pieces). Perfusion measurements (arterial and portal) were done by dynamic computed tomography (CT). Arterial perfusion was increased two to six days after TAE (0.146 +/- 0.073 ml/min/ml, P < 0.0002) compared with that before TAE (0.064 +/- 0.039), but decreased again one month after TAE (0.086 +/- 0.038). Portal perfusion was decreased two to six days after TAE (0.541 +/- 0.180, P < 0.001) compared with that before TAE (0.733 +/- 0.263) and was grossly unchanged one month after TAE (0.651 +/- 0.214). We suspected that these perfusion changes were due to acute inflammatory responses. Quantification of tissue perfusion by dynamic CT was useful for studying hemodynamic changes after TAE.
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Affiliation(s)
- Y Tsushima
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
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Bianco S, Merkel C, Savastano S, Bellon S, Chiesura-Corona M, Bolognesi M, Miotto D, Enzo E, Feltrin G, Gatta A. Short-term effects of transcatheter arterial chemoembolisation on metabolic activity of the liver of cirrhotic patients with hepatocellular carcinoma. Gut 1996; 39:325-9. [PMID: 8977351 PMCID: PMC1383319 DOI: 10.1136/gut.39.2.325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transcatheter arterial chemoembolisation, a procedure for the treatment of hepatocellular carcinoma, provokes a pronounced but transient increase in hepatic cytolysis parameters. A definite evaluation of the impairment of liver function after this treatment, performed by adequate techniques, is still lacking. AIMS To assess and quantify the impairment of liver metabolic activity after arterial chemoembolisation in patients with cirrhosis. The variations of hepatic vein pressure gradient provoked by this procedure were evaluated. PATIENTS 15 patients with cirrhosis (Child's class A and B) and hepatocellular carcinoma. METHODS 17 transcatheter arterial chemoembolisations with epirubicin, iodised oil, and gelfoam were performed; liver function was assessed before, the following day, and after seven days measuring galactose elimination capacity; aminopyrine breath test was also performed in six patients before the procedure and seven days after. In 10 patients intrinsic hepatic clearance of indocyanine green and hepatic vein pressure gradient were measured by hepatic vein catheterisation before and 30 minutes after chemoembolisation. RESULTS Intrinsic hepatic clearance of indocyanine green decreased significantly from (mean (SEM)) 355 (140) ml/min to 277 (98) ml/min after the procedure (p = 0.0007). Galactose elimination capacity did not show significant changes, being 4.00 (0.90) mg/min/kg body weight at baseline, 4.20 (0.90) mg/min/kg body weight after one day, and 3.95 (0.87) mg/min/kg body weight seven days after chemoembolisation. Aminopyrine breath test was 2.31 (1.09)% and remained unchanged after treatment, being 2.39 (2.04)% at day 7. Baseline hepatic vein pressure gradient was 17.0 (5.5) mm Hg, and 14.4 (3.7) mm Hg 30 minutes after chemoembolisation (p = 0.09). CONCLUSIONS A single transcatheter chemoembolisation in cirrhotic patients was detected by galactose elimination capacity and aminopyrine breath test one and seven days after the procedure. Therefore it can be considered a safe therapeutic tool for hepatocellular carcinoma in Child's class A and B cirrhotic patients.
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Affiliation(s)
- S Bianco
- Department of Clinical Medicine, University of Padua, Italy
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11
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Schlund JF, Semelka RC, Kettritz U, Eisenberg LB, Lee JK. Transient increased segmental hepatic enhancement distal to portal vein obstruction on dynamic gadolinium-enhanced gradient echo MR images. J Magn Reson Imaging 1995; 5:375-7. [PMID: 7549197 DOI: 10.1002/jmri.1880050402] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The purpose of the present study was to demonstrate the frequency of occurrence of transient increased segmental hepatic enhancement distal to portal vein obstruction in patients with a lobar (main branch) portal vein obstruction. MR images of all patients with main and lobar branch portal vein obstruction examined by dynamic gadolinium enhanced gradient echo MR images between December 1990 and July 1994 were reviewed retrospectively. All studies included T2-weighted imaging, T1-weighted spoiled gradient echo 'fast low angle shot ([FLASH])', and postgadolinium enhanced FLASH imaging at 1, 45, and 90 sec and 10 min. Fourteen patients were identified with portal vein obstruction which included: six with main portal and right and left branch occlusion, six with right lobar, and two with left lobar. In the six patients with main portal vein obstruction, enhancement on 1-sec postgadolinium FLASH images was homogenous (three patients), diffusely heterogeneous (two patients), or peripherally hyperintense (one patient). In eight of eight patients with isolated obstruction of the right or left lobar portal vein, transient-increased segmental enhancement distal to portal vein occlusion was observed on immediate postcontrast images. Relatively high signal intensity of the involved segments was present on 1-sec images and liver parenchymal enhancement became more homogeneous by 45 to 90 sec in all cases. In conclusion, transient-increased segmental enhancement occurred in eight of eight patients with isolated right or left portal vein occlusion. We postulate that this effect occurs due to increased hepatic arterial blood flow in the presence of portal vein obstruction.
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Affiliation(s)
- J F Schlund
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill 27599-7510, USA
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12
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Abstract
Perhaps the most valuable application of duplex sonography in the abdomen is in the diagnosis of vascular disorders of the liver. Duplex sonography provides an accurate assessment of the portal and hepatic venous systems that is both noninvasive and convenient, because the examination can be conducted at the bedside. In this article, the normal features of portal and hepatic venous flow are considered as well as the sonographic manifestations of pathological conditions, including: (1) portal hypertension; (2) portosystemic collaterals; (3) portal vein thrombosis; and (4) hepatic vein thrombosis (Budd-Chiari syndrome).
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Affiliation(s)
- W J Zwiebel
- University of Utah School of Medicine, Salt Lake City, USA
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13
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Kajimura K, Moriyasu F, Someda H, Okuma M, Mori K, Ozawa K. Transcatheter hepatic arterial drug infusion therapy for hepatocellular carcinoma. Effect on the arterial ketone body ratio. Scand J Gastroenterol 1993; 28:522-6. [PMID: 8391717 DOI: 10.3109/00365529309098260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The arterial ketone body ratio (acetoacetate to beta-hydroxybutyrate) was measured in 15 patients with chronic liver disease before and after the infusion of anticancer drugs or embolic agents (gelatin sponge or iodized oil) into the hepatic artery. The arterial ketone body ratio decreased after hepatic angiography and decreased further at 15 min after infusion therapy. When the arterial ketone body ratio decreased to 1.0 or less on at least one occasion after infusion therapy, the ratio after hepatic angiography was always 1.35 or less. Such patients developed marked systemic symptoms like fever and severe liver dysfunction. Ascites also developed in three patients in whom the arterial ketone body ratio was reduced to 0.7 or less at 24 h after infusion therapy. The arterial ketone body ratios improved at 3-7 days after infusion therapy. In the seven patients treated with gelatin sponge embolization, the ratio at 3-7 days after therapy was actually higher than that before angiography.
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Affiliation(s)
- K Kajimura
- First Dept. of Internal Medicine, Faculty of Medicine, Kyoto University, Japan
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Brown HS, Halliwell M, Qamar M, Read AE, Evans JM, Wells PN. Measurement of normal portal venous blood flow by Doppler ultrasound. Gut 1989; 30:503-9. [PMID: 2653973 PMCID: PMC1434022 DOI: 10.1136/gut.30.4.503] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The volume flow rate of blood in the portal vein was measured using a duplex ultrasound system. The many errors inherent in the duplex method were assessed with particular reference to the portal vein and appropriate correction factors were obtained by in vitro calibration. The effect of posture on flow was investigated by examining 45 healthy volunteers in three different positions; standing, supine and tilted head down at 20 degrees from the horizontal. The mean volume blood flow in the supine position was 864 (188)ml/min (mean 1SD). When standing, the mean volume blood flow was significantly reduced by 26% to 662 (169)ml/min. There was, however, no significant difference between flow when supine and when tilted head down at 20 degrees from the horizontal.
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Affiliation(s)
- H S Brown
- Department of Medical Physics, Bristol and Weston Health Authority
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