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Ge Z, Wang K, Zhang Z, Zhang X, Sun P, Chen N, Tan Y, Shen T, Dai H, Li W. Successful treatment of refractory ascites in a patient with liver cirrhosis combined with hepatic artery-portal vein malformation: A case report. Medicine (Baltimore) 2024; 103:e36886. [PMID: 38277566 PMCID: PMC10817139 DOI: 10.1097/md.0000000000036886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024] Open
Abstract
INTRODUCTION Hepatic artery-portal vein malformation is rarely encountered in clinical practice. Here, we reported a case of liver cirrhosis combined with hepatic artery-portal vein malformation with refractory ascites as the main symptom. And it was successfully treated by us. The present case demonstrates the role of hepatic artery-portal vein malformation in cirrhotic ascites and the importance of early diagnosis and interventional treatment. This article may provides some experience for the treatment of such patients. PATIENT CONCERNS The patient was a 72-year-old woman with a 40-year history of Hepatitis B virus surface antigen positivity who sought medical advice with a chief complaint of abdominal distension for 1 week. DIAGNOSES Enhanced abdominal computed tomography imaging of this patient revealed liver cirrhosis, splenomegaly, esophageal and gastric varices, massive ascites, and a low-density area in the S4 segment of the liver with an ambiguous boundary. Widening of the left branch of the portal vein was evident, and the portal vein was highlighted in the arterial phase and the venous phase. Digital subtraction angiography revealed substantial thickening of the left hepatic artery, and the administered contrast agent drained through the malformed vascular mass to the thickened left portal vein. Liver cirrhosis combined with hepatic artery-portal vein malformation were diagnosed. And we considered that the artery-portal vein malformation in this patient might be caused by cirrhosis. INTERVENTIONS The patient was applied diuretics, entecavir and transcatheter embolization. OUTCOMES The patient ascites did not resolve significantly when treated with diuretics alone. After the transcatheter embolization, the patient ascites relieved remarkably. CONCLUSION The patient underwent transcatheter embolization for hepatic artery-portal vein malformation, after which her ascites resolved with good short-term curative efficacy. So, the patients who suffered from liver cirrhosis combined with hepatic artery-portal vein malformation and refractory ascites, should be active on transcatheter embolization.
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Affiliation(s)
- Zhenyu Ge
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Kai Wang
- Department Vascular intervention, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Zhaomei Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Xiaoqian Zhang
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Peng Sun
- Department Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Ning Chen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Yang Tan
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Tingting Shen
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Hongsheng Dai
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Wenwen Li
- Department Gastroenterology, Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
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Layton BM, Lapsia SK. The Portal Vein: A Comprehensive Review. Radiographics 2023; 43:e230058. [PMID: 37856316 DOI: 10.1148/rg.230058] [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: 10/21/2023]
Abstract
Radiologists are familiar with the appearances of a normal portal vein; variations in its anatomy are commonplace and require careful consideration due to the implications for surgery. These alterations in portal vein anatomy have characteristic appearances that are clearly depicted on CT, MR, and US images. Similarly, there are numerous congenital and acquired disorders of the portal vein that are deleterious to its function and can be diagnosed by using imaging alone. Some of these conditions have subtle imaging features, and some are conspicuous at imaging but poorly understood or underrecognized. The authors examine imaging appearances of the portal vein, first by outlining the classic and variant anatomy and then by describing each of the disorders that impact portal vein function. The imaging appearances of portal vein abnormalities discussed in this review include (a) occlusion from and differentiation between bland thrombus and tumor in vein and the changes associated with resultant hepatic artery buffer response changes, cavernous transformation of the portal vein, and portal biliopathy; (b) ascending thrombophlebitis of the portal vein (pylephlebitis); (c) portal hypertension and its causes and sequelae; (d) the newly described disease entity portosinusoidal vascular disorder; and (e) intra- and extrahepatic shunts of the portal system, both congenital and acquired (including Abernethy malformations), and the associated risks. Current understanding of the pathophysiologic processes of each of these disorders is considered to aid the approach to reporting. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Benjamin M Layton
- From the Department of Radiology, East Lancashire Hospitals Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn, BB2 3HH, England (B.M.L., S.K.L.)
| | - Snehal K Lapsia
- From the Department of Radiology, East Lancashire Hospitals Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn, BB2 3HH, England (B.M.L., S.K.L.)
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Panda A, Narayanan D, Netaji A, Varshney VK, Agarwal L, Garg PK. Spontaneous hepatic arterioportal fistula in extrahepatic portal vein obstruction: Combined endovascular and surgical management. Ann Hepatobiliary Pancreat Surg 2023; 27:307-312. [PMID: 36944615 PMCID: PMC10472122 DOI: 10.14701/ahbps.22-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 03/23/2023] Open
Abstract
Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepatic portal hypertension. A spontaneous superimposed hepatic arterioportal fistula can lead to pre-sinusoidal portal hypertension, further exacerbating its physiology. This report describes a young woman with long-standing EHPVO presenting with repeated upper gastrointestinal variceal bleeding and symptomatic hypersplenism. Computed tomography scan demonstrated a cavernous transformation of the portal vein and a macroscopic hepatic arterioportal fistula between the left hepatic artery and portal vein collateral in the central liver. The hepatic arterioportal fistula was associated with a flow-related left hepatic artery aneurysm and a portal venous collateral aneurysm proximal and distal to the fistula, respectively. Endovascular coiling was performed for the hepatic arterioportal fistula, followed by proximal splenorenal shunt procedure. This case illustrates an uncommon association of a spontaneous hepatic arterioportal fistula with EHPVO and the utility of a combined endovascular and surgical approach for managing multifactorial non-cirrhotic portal hypertension in such patients.
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Affiliation(s)
- Ananya Panda
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Durgadevi Narayanan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjunlokesh Netaji
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Lokesh Agarwal
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Kumar Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Can MRI features predict clinically relevant hepatocellular carcinoma genetic subtypes? Abdom Radiol (NY) 2023; 48:1955-1964. [PMID: 36933025 DOI: 10.1007/s00261-023-03876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Recent studies in cancer genomics have revealed core drivers for hepatocellular carcinoma (HCC) pathogenesis. We aim to study whether MRI features can serve as non-invasive markers for the prediction of common genetic subtypes of HCC. METHODS Sequencing of 447 cancer-implicated genes was performed on 43 pathology proven HCC from 42 patients, who underwent contrast-enhanced MRI followed by biopsy or resection. MRI features were retrospectively evaluated including tumor size, infiltrative tumor margin, diffusion restriction, arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, peritumoral enhancement, tumor in vein, fat in mass, blood products in mass, cirrhosis and tumor heterogeneity. Fisher's exact test was used to correlate genetic subtypes with imaging features. Prediction performance using correlated MRI features for genetic subtype and inter-reader agreement were assessed. RESULTS The two most prevalent genetic mutations were TP53 (13/43, 30%) and CTNNB1 (17/43, 40%). Tumors with TP53 mutation more often demonstrated an infiltrative tumor margin on MRI (p = 0.01); inter-reader agreement was almost perfect (kappa = 0.95). The CTNNB1 mutation was associated with peritumoral enhancement on MRI (p = 0.04), inter-reader agreement was substantial (kappa = 0.74). The MRI feature of an infiltrative tumor margin correlated with the TP53 mutation with accuracy, sensitivity, and specificity of 74.4%, 61.5% and 80.0%, respectively. Peritumoral enhancement correlated with the CTNNB1 mutation with accuracy, sensitivity, and specificity of 69.8%, 47.0% and 84.6%, respectively. CONCLUSION An infiltrative tumor margin on MRI correlated with TP53 mutation and peritumoral enhancement correlated with CTNNB1 mutation in HCC. Absence of these MRI features are potential negative predictors of the respective HCC genetic subtypes that have implications for prognosis and treatment response.
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Firat A, Abbasoglu TT, Karcaaltincaba M, Balaban YH. Clinical anatomy of hepatic vessels by computed tomography angiography: A minireview. World J Radiol 2023; 15:1-9. [PMID: 36721671 PMCID: PMC9884335 DOI: 10.4329/wjr.v15.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/02/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
The liver has a complex vascular anatomy with a unique dual blood supply. Clinical conditions of the liver vary widely and include disorders originating in the vascular and biliary systems as well as the parenchyma. In most vascular disorders, the effects on the liver are generally subclinical because of its abundant blood supply. However, early diagnosis of such vascular diseases can significantly reduce patient morbidity and mortality. Because imaging findings of vascular disease are not always readily apparent, diagnosis can be difficult. Computed tomography angiography is an excellent imaging modality for visualizing the vascular anatomy of patients for treatment planning. In this review article, we focus on the vascular anatomy of the liver and the imaging findings in some acute hepatic vascular diseases.
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Affiliation(s)
- Aysegul Firat
- Department of Anatomy, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | | | | | - Yasemin H Balaban
- Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
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Okumura K, Kobayashi S, Ogi T, Sugiura T, Zhang Y, Kanatani M, Yoneda N, Kitao A, Kozaka K, Gabata T, Koda W. Transcatheter arterial embolization of iatrogenic massive arterioportal fistula in the liver. Acta Radiol 2022; 63:867-876. [PMID: 34121466 DOI: 10.1177/02841851211023995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Massive arterioportal fistula (APF) is naturally irreversible and can induce portal hypertension and portal vein thrombosis (PVT), worsening survival outcomes. PURPOSE To evaluate the clinical course and details of transarterial embolization (TAE) procedures for massive APF. MATERIAL AND METHODS This retrospective single-center observational study evaluated the time until embolization after puncture, imaging, embolization methods, and laboratory data of 10 consecutive patients who were diagnosed with massive APF after puncture and underwent TAE at our hospital from 1 April 2012 to 30 September 2019. RESULTS Out of 10 cases, eight demonstrated a simple type and the other two cases a complex network type on the digital subtraction angiography pattern of massive APF. In two simple-type cases for which re-embolization was required, other subsegmental branches were embolized. The two cases showing a complex network type had been embolized via not only the subsegmental branch, but also the extrahepatic and multiple subsegmental branches. Child-Pugh scores were improved in eight of the ten cases. PVT was seen in six cases before embolization, but disappeared after embolization in all cases, despite the fact that three cases had not received anticoagulant therapy. Six cases had digestive varices before embolization, suggesting portal hypertension, and two of the six cases with esophageal varices and one with gastric varices decreased after embolization. CONCLUSION TAE for massive APF contributed to the improvement of hepatic reserve, the disappearance of PVT, and the improvement of portal hypertension; however, embolization of multiple branches may still be required in some cases.
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Affiliation(s)
- Kenichiro Okumura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
- Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takahiro Ogi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takumi Sugiura
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Yu Zhang
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Mao Kanatani
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Azusa Kitao
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
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Kobayashi S. Hepatic pseudolesions caused by alterations in intrahepatic hemodynamics. World J Gastroenterol 2021; 27:7894-7908. [PMID: 35046619 PMCID: PMC8678815 DOI: 10.3748/wjg.v27.i46.7894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatic pseudolesion may occur in contrast-enhanced computed tomography and magnetic resonance imaging due to the unique haemodynamic characteristics of the liver. The concept of hepatic arterial buffer response (HABR) has become mainstream for the understanding of the mechanism of the reciprocal effect between hepatic arterial and portal venous flow. And HABR is thought to be significantly related to the occurrence of the abnormal imaging findings on arterial phase of contrast enhanced images, such as hepatic arterial-portal vein shunt and transient hepatic attenuation difference, which mimic hypervascular tumor and may cause clinical problems. Third inflow to the liver also cause hepatic pseudolesion, and some of the cases may show histopathologic change such as focal hyperplasia, focal fatty liver, and focal sparing of fatty liver, and called pseudotumor. To understand these phenomena might be valuable for interpreting the liver imaging findings.
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Affiliation(s)
- Satoshi Kobayashi
- Department of Quantum Medical Technology, Kanazawa University Graduate School of Medical Sciences, Kanazawa 9200942, Ishikawa, Japan
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An Anomalous Cause of Portal Hypertension. ACG Case Rep J 2021; 8:e00552. [PMID: 34549053 PMCID: PMC8443832 DOI: 10.14309/crj.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/23/2020] [Indexed: 12/02/2022] Open
Abstract
Portal hypertension is a syndrome marked by an increase in the pressure of the portal vein. Portal hypertension can be diagnosed clinically or if the measurement of the hepatic venous pressure gradient is greater than 5 mm Hg. Cirrhosis is the most common etiology in Western countries, but there are other causes which lead to presinusoidal portal hypertension. We present a patient with a rare cause of portal hypertension.
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Arterioportal Fistulas (APFs) in Pediatric Patients: Single Center Experience with Interventional Radiological versus Conservative Management and Clinical Outcomes. J Clin Med 2021; 10:jcm10122612. [PMID: 34198478 PMCID: PMC8231897 DOI: 10.3390/jcm10122612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023] Open
Abstract
Arterioportal fistulas (APFs) are uncommon vascular abnormalities with a heterogeneous etiology. In pediatric orthotopic liver transplantation (OLT), APFs are frequently iatrogenic, following percutaneous liver interventions. The aim of this study was to report the 10-year experience of a tertiary referral center for pediatric OLT in the interventional radiological (IR) and conservative management of acquired APFs. A retrospective search was performed to retrieve pediatric patients (<18 years old) with a diagnosis of APF at color Doppler ultrasound (CDUS) or computed tomography angiography (CTA) from 2010 to 2020. Criteria for IR treatment were the presence of hemodynamic alterations at CDUS (resistive index <0.5; portal flow reversal) or clinical manifestations (bleeding; portal hypertension). Conservatively managed patients served as a control population. Clinical and imaging follow-up was analyzed. Twenty-three pediatric patients (median age, 4 years; interquartile range = 11 years; 15 males) with 24 APFs were retrieved. Twenty patients were OLT recipients with acquired APFs (16 iatrogenic). Twelve out of twenty-three patients were managed conservatively. The remaining 11 underwent angiography with confirmation of a shunt in 10, who underwent a total of 16 embolization procedures (14 endovascular; 2 transhepatic). Technical success was reached in 12/16 (75%) procedures. Clinical success was achieved in 8/11 (73%) patients; three clinical failures resulted in one death and two OLTs. After a median follow-up time of 42 months (range 1–107), successfully treated patients showed an improvement in hemodynamic parameters at CDUS. Conservatively managed patients showed a stable persistence of the shunts in six cases, spontaneous resolution in four, reduction in one and mild shunt increase in one. In pediatric patients undergoing liver interventions, APFs should be investigated. Although asymptomatic in most cases, IR treatment of APFs should be considered whenever hemodynamic changes are found at CDUS.
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Savic LJ, Chapiro J, Funai E, Bousabarah K, Schobert IT, Isufi E, Geschwind JFH, Stark S, He P, Rudek MA, Perez Lozada JC, Ayyagari R, Pollak J, Schlachter T. Prospective study of Lipiodol distribution as an imaging marker for doxorubicin pharmacokinetics during conventional transarterial chemoembolization of liver malignancies. Eur Radiol 2020; 31:3002-3014. [PMID: 33063185 DOI: 10.1007/s00330-020-07380-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the prognostic potential of Lipiodol distribution for the pharmacokinetic (PK) profiles of doxorubicin (DOX) and doxorubicinol (DOXOL) after conventional transarterial chemoembolization (cTACE). METHODS This prospective clinical trial ( ClinicalTrials.gov : NCT02753881) included 30 consecutive participants with liver malignancies treated with cTACE (5/2016-10/2018) using 50 mg DOX/10 mg mitomycin C emulsified 1:2 with ethiodized oil (Lipiodol). Peripheral blood was sampled at 10 timepoints for standard non-compartmental analysis of peak concentrations (Cmax) and area under the curve (AUC) with dose normalization (DN). Imaging markers included Lipiodol distribution on post-cTACE CT for patient stratification into 1 segment (n = 10), ≥ 2 segments (n = 10), and lobar cTACE (n = 10), and baseline enhancing tumor volume (ETV). Adverse events (AEs) and tumor response on MRI were recorded 3-4 weeks post-cTACE. Statistics included repeated measurement ANOVA (RM-ANOVA), Mann-Whitney, Kruskal-Wallis, Fisher's exact test, and Pearson correlation. RESULTS Hepatocellular (n = 26), cholangiocarcinoma (n = 1), and neuroendocrine metastases (n = 3) were included. Stratified according to Lipiodol distribution, DOX-Cmax increased from 1 segment (DOX-Cmax, 83.94 ± 75.09 ng/mL; DN-DOX-Cmax, 2.67 ± 2.02 ng/mL/mg) to ≥ 2 segments (DOX-Cmax, 139.66 ± 117.73 ng/mL; DN-DOX-Cmax, 3.68 ± 4.20 ng/mL/mg) to lobar distribution (DOX-Cmax, 334.35 ± 215.18 ng/mL; DN-DOX-Cmax, 7.11 ± 4.24 ng/mL/mg; p = 0.036). While differences in DN-DOX-AUC remained insignificant, RM-ANOVA revealed significant separation of time concentration curves for DOX (p = 0.023) and DOXOL (p = 0.041) comparing 1, ≥ 2 segments, and lobar cTACE. Additional indicators of higher DN-DOX-Cmax were high ETV (p = 0.047) and Child-Pugh B (p = 0.009). High ETV and tumoral Lipiodol coverage also correlated with tumor response. AE occurred less frequently after segmental cTACE. CONCLUSIONS This prospective clinical trial provides updated PK data revealing Lipiodol distribution as an imaging marker predictive of DOX-Cmax and tumor response after cTACE in liver cancer. KEY POINTS • Prospective pharmacokinetic analysis after conventional TACE revealed Lipiodol distribution (1 vs. ≥ 2 segments vs. lobar) as an imaging marker predictive of doxorubicin peak concentrations (Cmax). • Child-Pugh B class and tumor hypervascularization, measurable as enhancing tumor volume (ETV) at baseline, were identified as additional predictors for higher dose-normalized doxorubicin Cmax after conventional TACE. • ETV at baseline and tumoral Lipiodol coverage can serve as predictors of volumetric tumor response after conventional TACE according to quantitative European Association for the Study of the Liver (qEASL) criteria.
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Affiliation(s)
- Lynn J Savic
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Eliot Funai
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Isabel T Schobert
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Edvin Isufi
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | | | - Sophie Stark
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
- Institute of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
| | - Ping He
- Sidney Kimmel Comprehensive Cancer Center at Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle A Rudek
- Sidney Kimmel Comprehensive Cancer Center at Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Carlos Perez Lozada
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Rajasekhara Ayyagari
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Todd Schlachter
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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Koniaris LG. Gastrointestinal carcinoma and sarcoma surgery. Transl Gastroenterol Hepatol 2019; 4:43. [PMID: 31304420 DOI: 10.21037/tgh.2019.05.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Leonidas G Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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