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Sample records for hepatic arterial chemoembolization

  1. The Effect of Transcatheter Arterial Chemoembolization on Hepatitis C Viremia

    OpenAIRE

    Mahale, Parag; Kaseb, Ahmed; Davila, Marta; Torres, Harrys A.

    2012-01-01

    A retrospective study analyzing patient medical records examined the effect of transarterial chemoembolization on hepatitis C virus viremia in patients with hepatitis C virus–associated hepatocellular carcinoma. Transarterial chemoembolization did not lead to a substantial increase in hepatitis C virus viral load.

  2. Pharmacokinetics of Mitomycin C Following Hepatic Arterial Chemoembolization With Gelfoam

    OpenAIRE

    Jin Wen Ding; Zai de Wu; Roland Andersson; Stig Bengmark

    1992-01-01

    Twelve mongrel dogs were randomly allocated into two groups using matched paired-design. Catheters were inserted into the hepatic artery, hepatic vein and the femoral vein, respectively. In the first group, gelfoam supplemented with mitomycin C (MMC) was injected into the hepatic artery, whereas the second group received a hepatic arterial injection of MMC solution alone. Simultaneous blood sampling from the hepatic and femoral veins at regular intervals was performed. MMC concent...

  3. Pharmacokinetics of Mitomycin C Following Hepatic Arterial Chemoembolization With Gelfoam

    OpenAIRE

    Ding, J. W.; Wu, Z. D.; Andersson, R.; S. Bengmark

    1992-01-01

    Twelve mongrel dogs were randomly allocated into two groups using matched paired-design. Catheters were inserted into the hepatic artery, hepatic vein and the femoral vein, respectively. In the first group, gelfoam supplemented with mitomycin C (MMC) was injected into the hepatic artery, whereas the second group received a hepatic arterial injection of MMC solution alone. Simultaneous blood sampling from the hepatic and femoral vein at regular intervals was performed. MMC concentrations in pl...

  4. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

    OpenAIRE

    2015-01-01

    Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE) induced by transcatheter arterial chemoembolization (TACE) so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures ...

  5. Coadministration of telaprevir and transcatheter arterial chemoembolization in hepatitis C virus-associated hepatocellular carcinoma.

    Science.gov (United States)

    Torres, Harrys A; Mahale, Parag; Miller, Ethan D; Oo, Thein H; Frenette, Catherine; Kaseb, Ahmed O

    2013-06-27

    The use of direct-acting antiviral agents (e.g., telaprevir, boceprevir) has improved response rates in patients with hepatitis C virus (HCV) genotype 1 infections. Substantial number of drug-drug interactions are anticipated with the use of telaprevir, a cytochrome P450 3A and P-glycoprotein substrate and inhibitor. Herein we describe a patient with HCV-associated hepatocellular carcinoma treated simultaneously with a telaprevir-containing regimen and localized chemotherapy (transcatheter arterial chemoembolization) with doxorubicin. No clinically relevant interactions or adverse events developed while on antiviral therapy.

  6. Hepatocellular carcinoma with extensive hepatic artery injury: transcatheter arterial chemoembolization through collaterals after coil embolizatoin of gastric arteries

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    Kim, Gab Choul; Yoon, Hyun Ki; Hwang, Jae Cheol; Lee, Duck Hee; Song, Ho Young; Suh, Dong Jin; Lee, Yung Sang; Chung, Young Hwa; Sung, Gyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of); Ko, Ki Young [Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepatocellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same TNM stage and Clild-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evaluation of the patients' clinical symptoms. The results obtained after six months and one year were compared within and between each group. At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p = 0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50 %) and three patients(30 %), respectively. The six-month survival rate was 81 % (13/16) in group A and 67% (10/15) in group B (p 0.43), while the one-year survival figures for these two groups were 50 % (8/16) and 20 % (3/15), respectively(p = 0.135). In group A, the CT findings were steady in five out of eight patients(63 %), while in groupB, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six

  7. Acute lung injury following transcatheter hepatic arterial chemoembolization of doxorubicin-loaded LC beads in a patient with hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Ihsan Khan

    2012-01-01

    Full Text Available Transcatheter arterial chemoembolization (TACE currently is being used as an effective palliative therapy for unresectable cancers especially hepatocelluar carcinoma (HCC. Accidental lipiodol embolism to the lungs is a rare but potentially fatal complication of TACE. This procedure involves injection of drug-eluting microspheres (LC Bead loaded with doxorubicin, followed by embolization with embozene microspheres until stasis is evident, being used in advanced HCC. We report a patient with inoperable HCC with underlying Hepatitis C and liver cirrhosis, who developed acute lung injury following targeted chemoembolization of selective feeding hepatic artery with LC beads loaded with doxorubicin. Acute lung injury as a complication of unintended lung chemoembolization with doxorubicin has not been previously reported in the literature. Interventional radiologists screen patients for potential hepatic A-V shunt and take appropriate precautions to prevent unintended pulmonary embolization. These include appropriate selection of LC bead particle size especially in patients who are embolized with radiation pellets. This report highlights the need for a screening total body scintigraphy after injection of radionuclide Tc-99 MAA in the feeding hepatic artery to identify patients with hepatic A-V shunt. In such patients, appropriate size selection of LC bead particles is critical to prevent unintended pulmonary chemoembolization and acute lung injury. Other measures include careful patient selection, low dose of chemotherapy, and transient selective hepatic vein balloon occlusion.

  8. Imaging findings and transcatheter arterial chemoembolization of hepatic malignancy with right atrial embolus in 46 patients

    Institute of Scientific and Technical Information of China (English)

    Hong-Yan Cheng; Xiao-Yan Wang; Guo-Li Zhao; Dong Chen

    2008-01-01

    AIM: To analyze the imaging findings of hepatic malignancy with right atrial (RA) embolus.METHODS: Forty-six patients with an embolus in the RA were diagnosed, including 44 patients with hepatocellular carcinoma (HCC), 1 patient with cholangiocellular carcinoma and 1 patient with hepatic carcinoma metastasis. The diagnosis was confirmed by clinical examination, serum α-fetoprotein and imaging. Seventeen patients underwent transcatheter arterial chemoembolization (TACE).RESULTS: On enhancement computer tomography (CT) or magnetic resonance (MR) imaging, a nodular filling defect in the RA could be easily found, with a slight enhancement in the arterial phase. The coronal images of CT or MR showed the extent of lesion. Lipiodol entered the embolus after TACE, hence reducing the speed of embolus growth. There was a survival benefit for patients receiving anticancer treatment.CONCLUSION: Patients with HCC, showing a filling defect of the inferior vena cava (IVC), hepatic vein (HV) and RA on images, can be diagnosed with RA embolus. Encroachment of the RA is very rare in patients with hepatic malignancies. Furthermore, a prolongation of survival time is found in those patients who underwent TACE.

  9. Incidentally Detected Inoperable Malignant Pheochromocytoma with Hepatic Metastasis Treated by Transcatheter Arterial Chemoembolization

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    Joong Keun Kim

    2014-12-01

    Full Text Available Malignant pheochromocytoma (PCC is a rare condition. Although the liver is the second most frequent site of metastasis in malignant PCC, no definite treatments have been established. Herein, we report a case of liver metastasis of PCC that was successfully treated by transcatheter arterial chemoembolization (TACE. A 69-year-old man was admitted to the Department of Gastroenterology for evaluation of an incidental hepatic mass in August 2013. He had undergone right adrenalectomy in May 2005 and PCC had been confirmed on the basis of histopathological findings. Liver biopsy was performed, and metastatic PCC was diagnosed. The lesion appeared inoperable because of invasion of the portal vein and metastases in the lymph nodes along the hepatoduodenal ligament. Thus, TACE was performed instead. After TACE, symptoms including dizziness and cold sweating improved, and the patient's serum catecholamine levels decreased. On the basis of this case, we believe that TACE may be a useful treatment for liver metastasis in malignant PCC.

  10. Clinical Analysis of Pulmonary Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

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    Wen-jin JIANG

    2015-03-01

    Full Text Available Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE induced by transcatheter arterial chemoembolization (TACE so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up.Results: Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inflammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3-15 d. The re-examined chest X-ray showed normal after 20-60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein fistula and 7 with lipiodol dosage ≥20 mL.Conclusion: PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein fistula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

  11. Clinical Analysis of Pulmonar y Lipiodol Embolism in Patients with Hepatic Carcinoma after Transcatheter Arterial Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    JIANG Wen-jin; WANG Li-gang; SONG Xue-peng; ZHENG Yan-bo; LIU Xiao-gang; SUN Bo-lin

    2015-01-01

    Objective:To explore the clinical manifestations, therapeutic methods and preventive measures of pulmonary lipiodol embolism (PLE) induced by transcatheter arterial chemoembolization (TACE) so as to improve the cognition and management of PLE. Methods:A total of 2 613 patients with hepatic cancer without history of pulmonary disease who were treated with TACE in our hospital from Sept., 2004 to Mar., 2013 were selected. The clinical manifestations, therapeutic methods and preventing measures of the 9 patients who were accompanied with PLE were observed to analyze the pre-operative hepatic computed tomography (CT) and chest X-ray, intra-operative contrast examination, dosage of lipiodol and chemotherapeutic drugs, clinical manifestation and therapeutic progression as well as the postoperative follow-up. Results:Nine patients accompanied by PLE had different-severity cough, hemoptysis and progressive dyspnea, and chest X-ray and/or CT showed flaky high-density radiography. After treated with oxygen inhalation, bronchus expansion and inlfammation alleviation, 8 patients were improved but 1 died. Of the 8 patients, 2 were given ventilator to assist breath, and the clinical symptoms of 8 patients disappeared within 3~15 d. The re-examined chest X-ray showed normal after 20~60 d follow-up observation. Additionally, 6 patients were with nidus diameter ≥10 cm, 6 with hepatic artery-vein ifstula and 7 with lipiodol dosage≥20 mL. Conclusion:PLE often occurs in patients with giant hepatic carcinoma accompanied by hepatic artery-vein ifstula, whose lipiodol dosage is ≥20 mL. Accurate and correct management during operation can effectively reduce the development of PLE.

  12. Studies of Selective Arterial Perfusion plus Chemoembolization on Hepatic Metastasis from Rectal Cancer

    Institute of Scientific and Technical Information of China (English)

    Shiliang Tu; Jianhua Yuan; Gaoli Deng; Tingyang Hu; Quanjin Dong

    2007-01-01

    OBJECTIVE To develop an effectual method for treating hepatic metastasis from rectal cancer.METHODS A randomized control study of celiac artery perfusion plus transcatheter hepatic arterial chemoembolization (TACE) (observation group) and intravenous chemotherapy (control group) for 99 cases with hepatic metastasis from rectal cancer was performed. The perfusion was repeated once at 4 weeks after the first treatment of 52 cases in the observation group, and it was subsequently repeated at an interval of 2 or 3 months. Using intravenous administration, the perfusion was repeated once every 3 weeks with 47 cases in the control group.RESULTS Three months after treatment, the patients in the observation group who showed a relief or elimination of a former superior abdominal pain amounted to 70.6%, and those with a diminution of their intrahepatic mass reached 55.8%. In the control group, the patients with a relief or disappearance of hepatalgia reached 20%, and those with a diminution of their intrahepatic mass reached 10.6%. The 1, 2 and 3-year survival rates were 80.8%, 46.2% and 25.0% in the cases of the observation group and 61.7%, 19.1% and 4.3% in the control group, respectively.CONCLUSION For the patients who failed to receive a surgical operation on their hepatic metastasis from rectal cancer, celiac artery perfusion plus TACE is a more effective regimen for improvement of the clinical symptoms and extension of the survival time, compared to intravenous chemotherapy, and is a better choice for palliative therapy.

  13. Evaluating transcatheter arterial chemoembolization for primary hepatic cancer by magnetic resonance diffusion-weighted imaging

    Institute of Scientific and Technical Information of China (English)

    FAN Wei-jun; ZHANG Liang; OUYANG Yus-hu; WANG Li-gang; WU Pei-hong

    2008-01-01

    @@ Hepatic cancer is associated with very high mortality and morbidity,and the world's highest morbidity and mortality rates for this malignant tumor are found in China.Each year,the number of people who die of hepatic cancer in China amounts for 53% of the world total.1 Although resection is the first-choice treatment for hepatic cancer,only 20%-30% of patients have the opportunity to undergo resection.2 Transcatheter arterial chemoembolization (TACE) is a typical intervention therapy.Its advantages include minimal trauma,precise efficacy,and ease of administration.Consequently,it has become a widely used first-line treatment for patients who cannot undergo resection.Effective treatment planning and follow-up require an imaging method for evaluation of tumor response and detection of tumor recurrence.The objective of this study was to evaluate the efficacy of diffusion-weighted imaging (DWI)quantitative technique in identifying the composition of tissue after TACE,detecting remnant tumor after TACE,and detecting the sensitivity and specificity for recurrence by means of magnetic resonance imaging (MRI).

  14. Malignant hepatic epithelioid hemangioendothelioma with high-output heart failure: successful management of heart failure with transcatheter arterial chemoembolization.

    Science.gov (United States)

    Hsu, Chien-Yi; Liu, Yao-Chung; Li, Chung-Pin; Huang, Po-Hsun; Lin, Chin-Hsuan; Chao, Yee

    2014-06-01

    A 73-year-old woman was admitted to hospital because of progressive dyspnea on exertion. Computed tomography revealed a large hepatic tumor, which was proved to be a hepatic epithelioid hemangioendothelioma (EHE). Echocardiography demonstrated high cardiac output, for which the tumor was considered to be the leading cause. A transcatheter arterial chemoembolization (TACE) was performed sequentially at 1-month intervals to reduce the size of the hepatic tumor, and this temporarily improved the patient's cardiac condition and quality of life. In this case, we successfully used TACE in the treatment of hepatic EHE with high-output heart failure. TACE is a reasonable choice of treatment both for managing malignant hepatic tumors and resolving low systemic vascular resistance by embolization of the abnormal neoangiogenic vessels. Nevertheless, clinicians should be aware of the potential adverse effect of hepatic decompensation induced by TACE, especially when the tumor involvement is widespread and poorly preserved hepatic function is encountered.

  15. Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE)in treatment of hepatocellular carcinoma (HCC).METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes,platelets and red blood cells) and treatment-associated complications.RESULTS: Prior to treatment, there was no significant difference in sex, age, Child-Pugh grade, tumor diameter,mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome,including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05).CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.

  16. Transient hepatic attenuation difference (THAD) following transcatheter arterial chemoembolization for hepatic malignancy: changes on serial CT examinations

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    Hwang, Sung Ho; Yu, Jeong-Sik; Chung, Jin; Chung, Jae-Joon; Kim, Joo Hee; Kim, Ki Whang [Yonsei University College of Medicine, YongDong Severance Hospital, Department of Diagnostic Radiology and Research Institute of Radiological Science, Gangnam-Gu, Seoul (Korea)

    2008-08-15

    The purpose of this study was to investigate the natural history of transcatheter arterial chemoembolization (TACE)-induced, transient hepatic attenuation difference (THAD). Among the patients who underwent TACE for treatment of hepatocellular carcinomas during a 32-month period, 32 patients with 40 newly developed THADs defined as localized, transient, peripheral hepatic parenchymal enhancement during the hepatic arterial phase of dynamic CT (axial dimension, 1.9-8.8 cm; mean, 4.9 cm) in the vicinity of iodized-oil accumulation were subjected to a retrospective analysis of serial follow-up CT examinations. Among the 40 TACE-induced THADs, 18 (45%) and 9 (23%) were accompanied with arterial-portal venous fistula (APF) and portal venous stenosis (PVS), respectively, while 2 (5%) THADs showed both APF and PVS simultaneously. Thirty-eight (95%) THADs disappeared spontaneously during the follow-up period (range, 4-26 months; mean, 9 months), and 11 (29%) of them showed progressive atrophy of the corresponding hepatic parenchyma. Regardless of the presence of APF, 10 (91%) of 11 THADs of following parenchymal atrophy had shown PVSs (P<0.001). During the long-term follow-up period after TACE, almost all of the TACE-induced THADs spontaneously disappeared and either had or did not have corresponding parenchymal atrophy, which is strongly related to the presence of PVS. Understanding the nature of these CT features would be helpful for radiologists in determining the prognosis of the TACE-induced hepatic injuries as well as in distinguishing them from the recurrent tumour. (orig.)

  17. Psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy:A complementary approach to drug analgesia

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    AIM:To assess whether psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy.METHODS:Two hundred and sixty-two patients,who required hepatic arterial chemoembolization for hepatic malignancy and postembolization pain,were randomized into control group(n = 46,receiving medication)and intervention group(n = 216,receiving psychological intervention and medication in turn).The symptom checklist-90 (SCL-90) was used to scale the psychological symptoms of the patients before operation.Pain was scored with a 0 to 10 numeric rating scale(NRS-10)before and after analgesia as well as after psychological intervention(only in intervention group).RESULTS:All psychological symptomatic scores measured with SCL-90 in the intervention group were higher than the normal range in Chinese (P < 0.05).The somatization,phobia and anxiety symptomatic scores were associated with pain numerical rating score before analgesia(r = 0.141, 0.157 and 0.192,respectively,P < 0.05).Patients in both groups experienced pain relief after medication,psychotherapy or psychotherapy combined with medication during the procedure (P < 0.01).Only some patients in the intervention group reported partial or entire pain relief (29.17% and 2.31%) after psychological intervention.The pain score after analgesia in the intervention group was significantly lower than that in the control group (P < 0.01).CONCLUSION:Severe psychological distress occurs in patients with hepatic malignancy.Psychological intervention reduces pain scores significantly during hepatic arterial chemoembolization therapy and is thus,highly recommended as a complementary approach to drug analgesia.

  18. Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC). The authors present a case of CLE that occurred after the second hepatic arterial chemoembolization for HCC, and attempt to introduce several plausible mechanisms of CLE, after reporting the clinical and radiological findings and reviewing the medical literature.

  19. Fatal Bile Duct Necrosis: A Rare Complication of Transcatheter Arterial Chemoembolization in a Patient with Endocrine Hepatic Metastasis

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    Anne-Laure Pelletier

    2008-11-01

    Full Text Available We report the first case of fatal bile duct necrosis following transcatheter arterial chemoembolization (TACE in a 58-year-old woman. The patient underwent two TACEs to treat hepatic metastases from an ileal endocrine tumor. Persistent cholestasis occurred after the second procedure, leading to the diagnosis of bile duct necrosis confirmed by liver biopsy. The patient died of liver failure with encephalopathy six months after the second TACE. Even though this complication is very rare, physicians should consider this diagnosis in patients who develop chronic, marked cholestasis following a TACE procedure.

  20. Is hepatic arterial infusion chemotherapy effective treatment for advanced hepatocellular carcinoma resistant to transarterial chemoembolization?

    Institute of Scientific and Technical Information of China (English)

    Hiroyuki Kirikoshi; Shin Maeda; Atsushi Nakajima; Satoru Saito; Masato Yoneda; Hironori Mawatari; Koji Fujita; Kento Imajo; Shingo Kato; Kaori Suzuki; Noritoshi Kobayashi; Kensuke Kubota

    2012-01-01

    AIM:To evaluate the effectiveness of hepatic arterial infusion chemotherapy (HAIC) for advanced hepatocellular carcinoma (HCC) resistant to transarterial chemoembolization (TACE).METHODS:This study was conducted on 42 patients who received HAIC for advanced HCC between 2001 and 2010 at our hospital.5-fluorouracil (5-FU) was administered continuously for 24 h from day 1 to day 5 every 2-4 wk via an injection reservoir.Intra-arterial cisplatin or subcutaneous interferon was administered in combination with the 5-FU.The patients enrolled in this retrospective study were divided into two groups according to whether or not they fulfilled the criteria for resistance to TACE proposed by the Japan Society of Hepatology in 2010 (written in Japanese); one group of patients who did not fulfill the criteria for TACE resistance (group A,n =23),and another group who fulfilled the criteria for TACE resistance (group B,n =19).We compared the outcomes in terms of the response and survival rates between the two groups.RESULTS:Both the response rate and tumor suppression rate following HAIC were significantly superior in group A than in group B (response rate:48% vs 16%,P =0.028,tumor suppression rate:87% vs 53%,P =0.014).Furthermore,both the progression-free survival rate and survival time were significantly superior in group A than in group B (3-,6-,12-,and 24-mo =83%,70%,29% and 20% vs 63%,42%,16% and 0%,respectively,P =0.040,and 9.8 mo vs 6.2 mo,P =0.040).A multivariate analysis (Cox proportional hazards regression model) showed that resistance to TACE was an independent predictor of poor survival (P =0.007).CONCLUSION:HAIC administrating 5-FU was not effective against advanced HCC resistant to TACE.Other tools for treatment,i.e.,molecular-targeting agents may be considered for these cases.

  1. Image Fusion of Preprocedural CTA with Real-time Fluoroscopy to Guide Proper Hepatic Artery Catheterization During Transarterial Chemoembolization of Hepatocellular Carcinoma: A Feasibility Study

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    Bargellini, Irene, E-mail: irenebargellini@hotmail.com; Turini, Francesca; Bozzi, Elena; Lauretti, Dario; Cicorelli, Antonio; Lunardi, Alessandro; Cioni, Roberto; Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology (Italy)

    2013-04-15

    To assess feasibility of proper hepatic artery catheterization using a 3D model obtained from preprocedural computed tomographic angiography (CTA), fused with real-time fluoroscopy, during transarterial chemoembolization of hepatocellular carcinoma. Twenty consecutive cirrhotic patients with hepatocellular carcinoma undergoing transarterial chemoembolization were prospectively enrolled onto the study. The early arterial phase axial images of the preprocedural CTA were postprocessed on an independent workstation connected to the angiographic system (Innova 4100; GE Healthcare, Milwaukee, WI), obtaining a 3D volume rendering image (VR) that included abdominal aorta, splanchnic arteries, and first and second lumbar vertebrae. The VR image was manually registered to the real-time X-ray fluoroscopy, with the lumbar spine used as the reference. The VR image was then used as guidance to selectively catheterize the proper hepatic artery. The procedure was considered successful when performed with no need for intraarterial contrast injections or angiographic acquisitions. The procedure was successful in 19 (95 %) of 20 patients. In one patient, celiac trunk angiography was required for the presence of a significant ostial stenosis that was underestimated at computed tomography. Time for image reconstruction and registration was <10 min in all cases. The use of preprocedural CTA model with fluoroscopy enables confident and direct catheterization of the proper hepatic artery with no need for preliminary celiac trunk angiography, thus reducing radiation exposure and contrast media administration.

  2. Hepatic Artery Chemoembolization for Hepatocellular Carcinoma Recurrence Confined to the Transplanted Liver

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    Brian I. Carr

    2012-09-01

    Full Text Available Background: Careful hepatocellular carcinoma (HCC case selection permits orthotopic liver transplantation with the expectation of around 70% plus 5-year survival. However, many patients have tumor recurrences and there is little literature guidance in the management of these patients. Aims: A retrospective examination of patients transplanted with HCC who subsequently developed liver recurrence. Methods: A case cohort series of patients was prospectively followed who had liver-only multifocal tumor recurrence of HCC after liver transplant and were then treated with chemoembolization. Results: All 6 patients had recurrent HCC. 2 had no response, 1 had stable disease, 2 had partial response (PR and 1 had complete disappearance (CR of disease. Their survival (in months was: 13 (no response, 18 (no response, 12 (stable disease, 19 (PR, 30 (PR and 50 (CR. There were no liver toxicities. Conclusions: Chemoembolization for tumor recurrence in the transplanted liver is as safe as or safer than in the pre-transplant liver, due to the absence of cirrhosis. In this series, there were 3 of 6 responses with some long survivors.

  3. Detecting hepatic nodules and identifying feeding arteries of hepatocellular carcinoma:efifcacy of cone-beam computed tomography in transcatheter arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Yasuhiro Ushijima; Tsuyoshi Tajima; Akihiro Nishie; Yoshiki Asayama; Kousei Ishigami; Masakazu Hirakawa; Daisuke Kakihara; Daisuke Okamoto; Hiroshi Honda

    2016-01-01

    Aim: To evaluate the effectiveness of using cone-beam computed tomography (CBCT) in transcatheter arterial chemoembolization (TACE) to detect hapatocelular carcinoma (HCC) nodules and their feeding arteries.Methods: Twenty-four patients with HCCs who underwent TACE using CBCT in addition to conventional digital subtraction angiography (DSA) were enroled. After both conventional DSA and CBCT through the hepatic artery were acquired, TACE were performed. The nodules were deifned as an HCC when dense accumulation of iodized oil was found within the nodule on CT obtained 2 weeks after the TACE. The number of detected nodules and identiifed feeding arteries, and their correlations with anatomical locations were assessed.Results: A total of 39 HCC nodules (tumor diameter, 7-40 mm; mean, 17.4 ± 7.9 mm) were detected. Thirty-one nodules were detected by DSA alone but 8 nodules were additionaly detected by adding CBCT to DSA. There were 53 feeding arteries associated with the 39 HCC nodules. Among these arteries, 21 were identiifed by DSA alone; however, 47 were identiifed by combining CBCT with DSA. Additional feeding arteries, especialy for the nodules located at the right and caudate lobes, were identiifed by CBCT. On the other hand, there was no difference in detection of nodules between the anatomical locations by CBCT.Conclusion: The use of CBCT in addition to DSA offers potential for increasing the number of detected nodules, and the number of their feeding arteries at the right and caudate lobes. CBCT might improve the quality of TACE procedure for HCC than DSA alone.

  4. Chemoembolization through intercostal arteries in hepatocellular carcinoma: Report of a case of transient spinal cord injury

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    Moon, Tae Yong; Hwang, In Tae; Kim, Byung Soo; Ko, Hyun Yoon; Yang, Ung Suk; Kim, Hak Jin [Pusan National University College of Medicine, Pusan (Korea, Republic of)

    1994-07-15

    Liver has a dual blood supply from portal vein and hepatic artery. Hepatocellular carcinoma receive their blood supply almost exclusively from hepatic artery. Thus, the concept of treating hepatocellular carcinoma by chemoembolization through these arteries is very effective . However, there may be several collateral or parasitic vessels feeding them in case of huge tumor or previous chemoembolization. We experienced a case of huge tumor involving right upper posterior portion of liver fed by 9th, 10th, 11th right posterior intercostal arteries and an anomalous hepatic artery. We tried chemoembolization with Adriamycin-Lipiodol suspension and Gelfoam material through the right posterior intercostal arteries to treat the lesion. After the procedure, the patient(55 years old female) became paraplegic with voiding and defecation difficulty which could be due to spinal cord infarction by anterior spinal arterial occlusion caused by embolic material through the artery of Adamkiewicz from a posterior intercostal artery. She recovered completely after 20 days of treatment.

  5. Safety of Chemotherapeutic Infusion or Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Cystic Artery

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    Kang, Beomsik, E-mail: kangbs98@gmail.com; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Chung, Jin Wook, E-mail: chungjw@snu.ac.kr; Hur, Saebeom, E-mail: hurz21@gmail.com; Joo, Seung-Moon, E-mail: huchi79@gmail.com; Jae, Hwan Jun, E-mail: jhj@radiol.snu.ac.kr; Park, Jae Hyung, E-mail: parkjh4803@gmail.com [Seoul National University College of Medicine, Department of Radiology (Korea, Republic of)

    2013-10-15

    Purpose: This study was designed to evaluate the safety of chemotherapeutic infusion or chemoembolization by way of the cystic artery in patients with hepatocellular carcinoma (HCC) supplied exclusively by the cystic artery. Methods: Between Jan 2002 and Dec 2011, we performed chemotherapeutic infusion or chemoembolization using iodized oil for the treatment of 27 patients with HCC supplied exclusively by the cystic artery. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. Results: The cystic artery originated from the main right hepatic artery in 24 (89 %) patients, from the right anterior hepatic artery in 2 (7 %) patients, and from the left hepatic artery in 1 (4 %) patient. Selective catheterization of the cystic artery was achieved in all patients. Superselection of tumor-feeding vessels from the cystic artery was achieved in 7 patients (26 %). Chemotherapeutic infusion was performed in 18 patients (67 %), and chemoembolization was performed in 9 patients (33 %). There were no major complications and only 2 minor complications, including vasovagal syncope and nausea with vomiting. Individual tumor response supplied exclusively by the cystic artery at the follow-up enhanced CT scan were complete response (n = 16), partial response (n = 3), and stable disease (n = 8). Conclusion: HCC supplied exclusively by the cystic artery can be safely treated without severe complications by chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.

  6. Left bisegmentectomy for liver cirrhosis associated primary hepatic carcinoma with preoperative chemoembolization

    Directory of Open Access Journals (Sweden)

    Molnar C.

    2014-12-01

    Full Text Available Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.

  7. Rupture of hepatocellular carcinoma following transcatheter arterial chemoembolization: A case report

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    Kang, Hyo Jin; Lee, Byung Hoon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young [Ilsan Paik Hospital/Inje Univ. School of Medicine, Goyang (Korea, Republic of); Han, Yoon Hee [Seonam Hospital/Ewha Womans Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    Transcatheter arterial chemoembolization (TACE) is known to be an effective palliative treatment for unresectable hepatocellular carcinoma (HCC). Serious complications, such as neutropenic sepsis and hepatic decompensation, are well known. A HCC rupture following TACE is a rare complication; however, it can be life threatening if it occurs. In a 75 year old male patient who subsequently developed capsular rupture of the lipiodol laden mass and several free intraperitoneal chemoembolization agents with hemoperitoneum, we report a case of a ruptured HCC that superficially located arterial enhancing and early wash out mass in the right hepatic dome following TACE.

  8. Hepatic artery injection of {sup 131}I-labelled metuximab combined with chemoembolization for intermediate hepatocellular carcinoma: a prospective nonrandomized study

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    Wu, Lu; Yang, Ye-Fa; Ge, Nai-Jian; Shen, Shu-Qun; Liang, Jun [Second Military Medical University, The First Department of Interventional Radiology, Eastern Hepatobiliary Surgery Hospital, Shanghai (China); Wang, Yi [Second Military Medical University, The Second Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai (China); Zhou, Wei-Ping [Second Military Medical University, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai (China); Shen, Feng; Wu, Meng-Chao [Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai (China)

    2012-08-15

    Hepatocellular carcinoma (HCC) is the fifth and seventh most common cause of cancer in men and women, respectively. Transcatheter arterial chemoembolization (TACE) is the standardized therapy for the intermediate stage of HCC. However, the 3-year overall survival remains low (<30 %) in these patients. Thus, there is a critical need for the development of treatment modalities to improve the survival rate. This study aimed to evaluate whether the combination of {sup 131}I-metuximab with chemoembolization could improve treatment efficiency. Between January 2009 and January 2010, a prospective two-arm nonrandomized study was performed in patients with intermediate HCC. Of 138 patients, 68 (combination therapy group) received 132 courses of intraarterial {sup 131}I-metuximab injections combined with chemoembolization (mean 1.94 per patient, median 2, range 1-2), followed by 152 sessions of TACE (mean 2.24 per patient, median 2, range 0-4). The remaining 70 patients (monotherapy group) received 296 sessions of TACE (mean 4.23 per patient, median 4, range 1-7). The overall median survival times for the combination therapy group and the group treated only with TACE were 26.7 months (95 % CI 20.7-31.3 months) and 20.6 months (95 % CI 15.3-24.7 months), respectively. The combination therapy group had a significantly higher survival rate than the TACE-only group (P = 0.038). Age {>=}65 years, serum albumin {<=}35 g/l, and treatment category (combination therapy or TACE only) were independent prognostic factors for survival according to multivariate analysis. The combination of {sup 131}I-metuximab and chemoembolization extended survival in patients with intermediate HCC compared with TACE only, and was well tolerated by patients with Child-Pugh class A or B disease. This combination seems to be a promising treatment modality for patients with intermediate HCC. (orig.)

  9. Hepatogastric Fistula following Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma

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    Inderpreet Grover

    2014-10-01

    Full Text Available Hepatogastric fistula (HGF formation following transcatheter arterial chemoembolization (TACE leads to increased morbidity and mortality. A 51-year-old Caucasian male with chronic hepatitis B virus-associated cirrhosis and unresectable hepatocellular carcinoma (HCC presented to the Interventional Radiology Unit for TACE to achieve tumor necrosis. Following the procedure, the patient was admitted with symptoms of fever, epigastric and right upper quadrant pain secondary to the development of an abscess. The abscess was drained; however, an exceedingly rare HGF resulted that was favored to represent a direct invasion of HCC. HGF, the rare complication following TACE, leads to grave consequences and vigilant monitoring, for the development of this entity is recommended to reduce patient mortality. We present a case and literature review of HGF development following TACE for HCC.

  10. Local radiative treatment of hepatocellular cancer with phosphorus-32 glassmicrospheres to enhance the efficacy of hepatic artery chemoembolism andpossibly related with MDR expressed P-glycoprotein

    Institute of Scientific and Technical Information of China (English)

    Zao Jiang; Lu Liu; Wen Fang; Wei Zhang Shou; Dong Sheng Zhang; Mei Mei Dai

    2000-01-01

    AIM To investigate the local effect of phosphorus-32 glass microspheres (32 P-GMS) on hepatocellularcancer and its relation with chemoembolism.MVIETHODS (① Thirty-two BALB/c nu/nu nude mice were divided randomly into four groups, control groupand 3 treatment groups. Every mouse was implanted with human liver cancer cell line subset (H-CS). 32p-GMS amalgamated in iodine oil was injected directly into the tumor mass. After 2 wk, all animals but thosein the control group, were injected with 32p-GMS in the dosage of 880cGY, 1760cGY and 3520cGY formouce groups Ⅰ, Ⅱ and Ⅲ respectively. The histological reactions of tumor mass were observed; multidrugresistance (MDR) expressed p-glycoprotein was detected by flow cytometry. ②Forty-three patients withhepatocellular carcinoma based on the evidence from B sonography or CT and serum AFP >400 ng/mL orcytological and histological evidences in some cases with the negative AFP were divided randomly into twogroups, group Ⅰ treated with 32p-GMS (absorbed dose of 50Gy- 100Gy) alone, group Ⅱ treated with 32p-GMS and chemotherapeutics (half-dosage, doxorubicin 20mg/m2, cisplatin 30mg/m2). 32 P-GMS wasinjected through intra hepatic artery in these cases with single massive type and multi-nodular type. Everypatient was repeatedly treated with this method for 2 - 3 times. For evaluating the therapeutic results. Themodified WHO criteria for tumor therapy standard is the.RESULTS (①) Animal bearing tumors showed that the mass decreased markedly and the inhibitive ratesattained 66.53%, 83.06% and 91.53% in the absorbed doses ranged form 880GY, 1760Gy and 3520Gyrespectively (P<0.05, ANOVA). Flow cytometry detected MDR expressed p-glycoprotein decreased from68.2 ± 4.6 in control to 43.6 ± 3.4, 35.3 ± 4.3 and 33.2 ± 3.8 (P<0.05, compared with control, t-test) inthe cells from the tumors. (②) The foci in group Ⅰ revealed decreased in size dramatically with effective rate of71.43%, compared with 86.36% in the group Ⅱ (P<0

  11. A Meta-Analysis of Arsenic Trioxide Combined with Transcatheter Arterial Chemoembolization for Treatment of Primary Hepatic Carcinoma

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    Ling He

    2016-01-01

    Full Text Available Primary hepatic carcinoma (PHC is one of the most common malignant tumours in the world. More and more research has shown that As2O3 combined with TACE has a good curative effect in treating PHC. The objectives of this study were to evaluate the therapeutic efficacy and safety of As2O3 combined with TACE in treating PHC. The CNKI, VIP, Wanfang, PubMed, and Cochrane databases were searched from their inception until December 2015. Randomized controlled trials (RCTs comparing As2O3 combined with TACE versus TACE alone in treating PHC were identified. Stata SE 12.0 was used for data analysis. 17 RCTs with 1055 patients were included. Meta-analysis showed that, compared with TACE alone, As2O3 combined with TACE showed significant effects in improving the clinical efficacy rate (P<0.01, decreasing the value of alpha-fetoprotein (P<0.01, increasing the one-year survival rate (P<0.01, and improving the quality of life of PHC patients (P<0.01. Fifteen studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, As2O3 combined with TACE therapy appears to be potentially effective in treating PHC and is generally safe. However, further studies with rigorous designs trials and multiregional cooperation trials are needed.

  12. Delayed cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    WU Jian-jun; CHAO Ming; ZHANG Guang-qiang; LI Bin

    2009-01-01

    @@ Transcatheter arterial chemoembolization (TACE) has been an effective mean in treating hepatocellular carcinoma for nearly 30 years.The reported complications associated with TACE mainly include acute hepatic failure (accounting for 0.26%),liver abscess (0.22%),multiple intrahepatic aneurysms (0.17%),hepatic artery occlusion (1.52%),spontaneous rupture of tumor (0.15%),gallbladder infarction (0.3%),perforation of duodenum (0.05%),acute renal failure (0.05%),pulmonary embolism (0.17%),femoral nerve injury (0.15%),etc.1,2

  13. Gangrenous Cholecystitis Related to Transcatheter Arterial Chemoembolization (TACE) Treatment for Hepatocellular Carcinoma.

    Science.gov (United States)

    Karavias, Dimitrios; Kourea, Helen; Sotiriadi, Athanasia; Karnabatidis, Dimitrios; Karavias, Dionissios

    2015-11-01

    A 69-year-old male with a history of hepatitis B-induced cirrhosis underwent segmental liver resection for hepatocellular carcinoma. At his 12-month follow-up, local recurrence in segment VII was diagnosed, measuring 7.8 by 6.2 cm, with irregular margins and the presence of a tumor thrombus in the portal vein. After evaluation by the multidisciplinary liver team, the patient underwent transcatheter arterial chemoembolization with drug-eluting beads. Forty-eight hours after his discharge, the patient presented with gangrenous cholecystitis and he underwent an uneventful cholecystectomy. Cholecystitis is a well-documented complication of transcatheter arterial chemoembolization due to inadvertent reflux of the embolic material into the cystic artery. However, super selective embolization significantly reduces the risk of cholecystitis. In most cases, management is conservative and only severe cases require further intervention.

  14. Chemoembolization for Hepatocellular Carcinoma Supplied by a Lumbar Artery

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    Kim, Han Myun, E-mail: seoul49@naver.com [Hallym University College of Medicine, Department of Radiology, Kangnam Sacred Heart Hospital (Korea, Republic of); Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Woo, Sungmin, E-mail: j-crew7@hotmail.com [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of); Son, Kyu Ri, E-mail: kyurad@gmail.com [Korea University College of Medicine, Department of Radiology, Korea University Medical Center (Korea, Republic of); Cho, Seong Whi, E-mail: chosw@kangwon.ac.kr [Kangwon National University College of Medicine, Department of Radiology, Kangwon National University Hospital (Korea, Republic of); Chung, Jin Wook, E-mail: chungjw@snu.ac.kr [Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Department of Radiology (Korea, Republic of)

    2015-02-15

    PurposeTo describe the radiologic findings and imaging response of hepatocellular carcinoma (HCC) supplied by the lumbar artery.MethodsBetween April 2004 and December 2012, we encountered HCC supplied by a lumbar artery in 21 patients. Two investigators retrospectively reviewed clinical and radiological findings of HCC supplied by the lumbar artery using computed tomography (CT) scans and digital subtraction angiograms.ResultsPatients had received 1–27 sessions of previous chemoembolization procedures (mean 7.7 sessions, median 4 sessions). Mean tumor size was 5.3 cm. The locations of HCC supplied by lumbar artery were the bare area (n = 14, 67 %) and segment VI (n = 7, 33 %). Tumor-feeding arteries arose from the main lumbar artery (n = 7), proximal anterior division (n = 4), and distal anterior division (n = 14). In 20 patients, selective chemoembolization through the tumor-feeding arteries of the lumbar artery was achieved. In 1 patient, nonselective embolization at the main lumbar artery was performed. There was no complication such as skin necrosis or paralysis. On the first follow-up enhanced CT scan, target tumors fed by the lumbar artery showed complete response (n = 6), partial response (n = 4), stable disease (n = 3), and progressive disease (n = 8), but overall tumor response was partial response (n = 1) and progressive disease (n = 20).ConclusionWhen HCC is located in the inferior tip or bare area of the liver, a lumbar artery may supply the tumor. Although selective chemoembolization via the tumor-feeding vessel of the lumbar artery can be achieved in most cases, overall tumor response is commonly unfavorable.

  15. Transcatheter arterial chemoembolization of liver metastasis of gastrointestinal leiomyosarcoma

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    Won, Hyung Jin; Chung, Jin Wook; Kim, Tae Kyoung; Han Dae Hee; Kim, Sun Ho; Cheon, Jung Eun; Han, Joon Koo; Park, Jae Hyung [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the usefulness of transcatheter arterial chemoembolization (TACE) in the management of gastrointestinal leiomyosarcoma metastatic to the liver. Ten patients with gastrointestinal leiomyosarcoma and hepatic metastasis underwent TACE after surgical resection of the primary tumor. All of the leiomyosarcomas originated from the stomach(n=3D5), duodenum (n=3D1) or jejunum(n=3D4), and the interval between primary tumor resection and hepatic metastasis was 1-120(mean 26) months. Using an emulsion of 3-20mL of Lipiodol and 15-60mg of doxorubicin. TACE was performed, and in five patients, gelfoam embolization was added. Therapeutic response was evaluated by follow-up CT, and nine patients underwent repeated TACE (range:2-9 times;interval:1-9 months). On celiac arteriography, all cases showed hypervascular tumor staining. As an initial therapeutic response based on CT assessment, more than 50% regression of the tumor (partial remission) was achieved in seven patients, and in the remaining three, regression was 20-30%(stable disease); neither complete remission nor progression was seen. With regard to long-term survival, five patients died at 5, 8, 14, 20 and 49 (median, 19) months after initial TACE. The remaining five, in whom follow-up has extended for 13-54 months, are still alive. Overall, survival time ranged from 5-54(median, 19) months, and except for postembolization syndrome, there was no specific complication. The period of durable tumor regression before progression ranged from 6 to 54 (median, 17) months. TACE can be a safe and effective method for the palliation of gastrointestinal leiomyosarcoma metastatic to the liver.=20.

  16. 肝癌TACE术后胆管狭窄致梗阻性黄疸的外科治疗%Surgical Treatment of Obstructive Jaundice Caused by Bile Duct Strictures after Hepatic Transcatheter Arterial Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    蒋振宇; 朱锦辉; 曹利平

    2014-01-01

    Objective To examine the surgical treatments for obstructive jaundice caused by bile duct strictures after hepat-ic transcatheter arterial chemoembolization(TACE).Methods Clinical data were retrospectively analyzed of 9 patients who de-veloped bile duct strictures among 229 patients after TACE between June 1994 and March 2011 in People’s Hospital of Zhe-jiang Provincial and the Second Affiliated Hospital of Zhejiang University.There were 6 cases of primary liver cancer,and 3 ca-ses of metastatic liver cancer.Obstructive jaundice occurred 5 to 16 months after TACE treatment.The median time was 8 months.Results All the nine patients with bile duct strictures suffered different degrees of obstructive j aundice,which was cured after surgical operations or PTC + stenting in 7 patients and significantly relieved by percutaneous transhepatic cholangic drainage(PTCD)in 2 ones.Two patients with obstructive j aundice after TACE for primary liver cancer were followed up for 3 years,and no recurrence of hepatic carcinoma and bile duct obstruction was found.The other 7 patients were followed up for 3 to 13 months,and they all died of deterioration of primary disease.Conclusion Patients with obstructive jaundice caused by bile duct strictures after TACE benefit from surgical operations or intervention treatment.Different surgical strategies are selected based on the characteristics of primary disease,the site and extent of bile duct stricture.%目的:分析肝癌经导管动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)术后胆管狭窄致梗阻性黄疸的外科治疗方法。方法回顾性分析1994年6月至2011年3月在浙江省人民医院及浙江大学医学院附属第二医院229例因肝癌行肝脏TACE治疗后出现胆管狭窄的9例患者的临床资料。6例为原发性肝癌,3例为转移性肝癌。肝癌经TACE治疗后出现梗阻性黄疸的时间为5~16个月,中位时间为8个月。结果9例胆管狭窄病例均出

  17. Sclerosing Cholangitis after Transcatheter Arterial Chemoembolization:a Case Report

    Institute of Scientific and Technical Information of China (English)

    Kai Qu; Chang Liu; Qi-fei Wu; Bo Wang; Aasef Mohamed Ali Mansoor; Hao Qin; Qiang Ma; Ya-min Liu

    2011-01-01

    @@ SCLEROSING cholangitis represents progressing jaundice or/and paroxysmal symptom of cholangitis, finally developing to end-stage of liver disease.When compared with primary sclerosing cholangitis (PSC), there are no apparent differences in pathology and clinical manifestation in secondary sclerosing cholangitis (SSC).But unlike PSC, SSC always has underlying causes, the most common being biliary obstruction, surgical trauma and ischemic injury of bile duct during liver transplantation .1,2 Repeated transcatheter arterial chemoembolization (TACE) leading to progressive SSC was rarely reported.Because of its rapid and irreversible progression, once SSC begins, it is difficult to deal with.Therefore, clinicians need to pay more attention to it.

  18. The observation of the effect of intravenous chemotherapy combined with hepatic artery chemoembolization for treatment of gastric cancer with hepatic metastasis%静脉化疗联合肝动脉化疗栓塞治疗胃癌伴肝转移的效果观察

    Institute of Scientific and Technical Information of China (English)

    蒋文慧

    2015-01-01

    目的:观察静脉化疗联合肝动脉化疗栓塞治疗胃癌伴肝转移的效果。方法:收治胃癌伴肝转移患者80例,随机分成观察组和对照组,各40例。对照组予静脉化疗,观察组在此基础上加肝动脉化疗栓塞治疗,比较两组疗效、中位生存期和不良反应。结果:观察组临床总有效率55.00%高于对照组的37.50%,中位生存期(13.48±2.51)个月多于对照组的(9.73±2.46)个月,差异有统计学意义(P<0.05)。结论:静脉化疗联合肝动脉化疗栓塞治疗胃癌伴肝转移的效果显著,可延长患者生命且不明显增加不良反应。%Objective:To explore the effect of intravenous chemotherapy combined with hepatic artery chemoembolization for treatment of gastric cancer with hepatic metastasis.Methods:80 patients with gastric cancer with liver metastasis were selected. They were randomly divided into the observation group and the control group with 40 cases in each group.The control group was given intravenous chemotherapy,and the observation group was given hepatic artery chemoembolization on the basis of the control group.We compared the efficacy,median survival time and adverse reactions of the two groups.Results:In the observation group, the clinical total effective rate of 55% was higher than 37.50% of the control group;the median survival time of (13.48±2.51) month was more than (9.73±2.46)month of the control group;the difference was statistically significant(P<0.05).Conclusion:The effect of intravenous chemotherapy combined with hepatic artery chemotherapy for embolization treatment of gastric cancer with hepatic metastasis is significant.It can prolong the life of patients and there is no significant increase in adverse reactions.

  19. Cone-Beam Computed Tomography (CBCT) Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Performance Depicting Tumors and Tumor Feeders

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Joon [National Cancer Center, Department of Radiology (Korea, Republic of); Chung, Jin Wook, E-mail: chungjw@snu.ac.kr; Yin, Yong Hu; Kim, Hyo-Cheol; Kim, Young Il; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology (Korea, Republic of)

    2015-10-15

    PurposeThis study was designed to analyze retrospectively the performance of cone-beam computed tomography (CBCT) hepatic arteriography in depicting tumors and their feeders and to investigate the related determining factors in chemoembolization for hepatocellular carcinoma (HCC).MethodsEighty-six patients with 142 tumors satisfying the imaging diagnosis criteria of HCC were included in this study. The performance of CBCT hepatic arteriography for chemoembolization per tumor and per patient was evaluated using maximum intensity projection images alone (MIP analysis) or MIP combined with multiplanar reformation images (MIP + MPR analysis) regarding the following three aspects: tumor depiction, confidence of tumor feeder detection, and trackability of tumor feeders. Tumor size, tumor enhancement, tumor location, number of feeders, diaphragmatic motion, portal vein enhancement, and hepatic artery to parenchyma enhancement ratio were regarded as potential determining factors.ResultsTumors were depicted in 125 (88.0 %) and 142 tumors (100 %) on MIP and MIP + MPR analysis, respectively. Imaging performances on MIP and MIP + MPR analysis were good enough to perform subsegmental chemoembolization without additional angiographic investigation in 88 (62.0 %) and 128 tumors (90.1 %) on per-tumor basis and in 43 (50 %) and 73 (84.9 %) on per-patient basis, respectively. Significant determining factors for performance in MIP + MPR analysis on per tumor basis were tumor size (p = 0.030), tumor enhancement (0.005), tumor location (p = 0.001), and diaphragmatic motion (p < 0.001).ConclusionsCBCT hepatic arteriography provided sufficient information for subsegmental chemoembolization by depicting tumors and their feeders in the vast majority of patients. Combined analysis of MIP and MPR images was essential to enhance the performance of CBCT hepatic arteriography.

  20. Hepatocellular Carcinoma Supplied From the Short Gastric Artery: Treatment With Chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Ung Bae, E-mail: junwb73@pnuyh.co.kr; Lee, Jun Woo, E-mail: jwlee@pusan.ac.kr; Baik, Seung Kug, E-mail: skbaik9@gmail.com; Kim, Tae Un, E-mail: kimtaeun78@hanmail.net; Choo, Ki Seok, E-mail: kschoo0618@naver.com; Kim, Kun Il, E-mail: kikim@pusan.ac.kr; Kim, Yong-Woo, E-mail: kyw47914@yahoo.co.kr; Moon, Tae-Yong, E-mail: tymn@pusan.ac.kr [Pusan National University Yangsan Hospital, Department of Radiology (Korea, Republic of)

    2012-12-15

    We report a case of transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) that was supplied by the short gastric artery. A 67-year-old woman with two nodular HCCs underwent repeated TACE. One of the nodules was supplied by the short gastric artery.

  1. Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Zhao Q

    2016-12-01

    Full Text Available Qianqian Zhao,1,2 Kunli Zhu,2 Jinbo Yue,2 Zhonghua Qi,1,2 Shumei Jiang,2 Xiaoqing Xu,2 Rui Feng,2 Renben Wang2 1School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 2Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People’s Republic of China Purpose: Numerous studies have tried to combine transarterial chemoembolization (TACE or hepatic arterial infusion chemotherapy (HAIC with radiotherapy (RT for the treatment of hepatocellular carcinoma (HCC patients with portal vein tumor thrombus (PVTT. However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT.Methods: PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR, overall survival (OS, and adverse events.Results: Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07–5.80; P<0.001 and OS (HR, 0.69; 95% CI, 0.57–0.83; P=0.001, but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67–2.79; P=0.390. The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478–13.56; P<0.001 and thrombocytopenia (OR, 3.77; 95% CI, 1.06–13.43; P=0.041 was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group.Conclusion: Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could

  2. Pulmonary complications of transcatheter arterial chemoembolization for hepatocellular carcinoma

    Science.gov (United States)

    Nhu, Quan M; Knowles, Harry; Pockros, Paul J; Frenette, Catherine T

    2016-01-01

    Transarterial chemoembolization (TACE) is an effective palliative intervention that is widely accepted for the management of hepatocellular carcinoma (HCC). Post-TACE pulmonary complications resulting in acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are rare events. Pulmonary complications after TACE are thought to be related to chemical injury subsequent to the migration of the infused ethiodized oil or chemotherapeutic agent to the lung vasculature, facilitated by arteriovenous (AV) shunts within the hyper-vascular HCC. We review herein the literature on pulmonary complications related to TACE for HCC. Post-TACE pulmonary complications have included pulmonary oil embolism, interstitial pneumonitis, chemical pneumonitis, ALI, ARDS, lipoid pneumonia, acute eosinophilic and neutrophilic pneumonia, bilious pleuritis, pulmonary abscess, pulmonary tumor embolism, and possibly pulmonary metastasis with HCC. The risk factors associated with post-TACE pulmonary complications identified in the literature include large hyper-vascular HCC with AV shunts, large-volume Lipiodol infusion, and embolization via the right inferior phrenic artery. However, the absence of known risk factors is not a guarantee against serious complications. An astute awareness of the potential post-TACE pulmonary complications should expedite appropriate therapeutic interventions and increase potential for early recovery. PMID:27904836

  3. Combined transarterial chemoembolization and arterial administration of Bletilla striata in treatment of liver tumor in rats

    Institute of Scientific and Technical Information of China (English)

    Jun Qian; Daryusch Vossoughi; Dirk Woitaschek; Elsie Oppermann; Wolf O.Bechstein; Wei-Yong Li; Gan-Sheng Feng; Thomas Vogl

    2003-01-01

    AIM: To evaluate and compare the effect of combined transarterial chemoembolization (TACE) and arterial administration of Bletilla striata (a Chinese traditionalmedicine against liver tumor) versusTACE alone for the treatment of hepatocellular carcinoma (HCC) in ACI rats.METHODS: Subcapsular implantation of a solid Morris hepatoma 3 924A (2 mm3) in the liver was carried out in 30 male ACI rats. Tumor volume (V1) was measured by magnetic resonance imaging (MRI) on day 13 after implantation. The following different agents of interventional treatment were injected after retrograde catheterization via gastroduodenal artery (on day 14), namely, (A) TACE (0.1 mg mitomycin +0.1 mi Lipiodol) + Bletilla striata (1.0 mg) (n= 10); (B) TACE + Blebilla stnata(1.0 mg) + ligation of hepatic artery (n=10),(C) TACE alone (control group, n=10). Tumor volume (V2)was assessed by MRI (on day 13 after treatment) and the tumor growth ratio (V2/V1) was calculated.RESULTS: The mean tumor volume before (V1) and after (V2) treatment was 0.0355 cm3 and 0.2248 cm3 in group A,0.0374 cm3 and 0.0573 cm3 in group B, 0.0380 cm3 and 0.3674 cm3 in group C, respectively. The mean ratio (V2/V1)was 6.2791 in group A, 1.5324 in group B and 9.1382 in group C. Compared with the control group (group C), group B showed significant inhibition of tumor growth (P<0.01),while group A did not (P>0.05). None of the animals died during implantation or in the postoperative period.CONCLUSION: Combination of TACE and arterial administration of Bletilla striata plus ligation of hepatic artery is more effective than TACE alone in the treatment of HCC in rats.

  4. A Meta-analysis of transcatheter arterial chemoembolization comparing stereotactic body radiation the-rapy in patients for primary hepatic carcinoma%TACE联合SBRT治疗原发性肝癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陈亚平; 姜晓晓; 蒋冠; 冯守信

    2015-01-01

    目的:系统评价经导管肝动脉化疗栓塞术( TACE )单用与联合应用体部立体定向放疗( SBRT)治疗原发性肝癌的疗效和不良反应,为临床实践提供参考。方法检索PubMed、Cochrane Library、EMBase、Ovid、MEDLINE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库、医学期刊全文数据库,查找关于TACE和SBRT治疗原发性肝癌的临床对照试验研究。按照Cochrane协作网的RevMan 5.2软件进行Meta分析。分析TACE单用与联合应用SBRT两组间的近期疗效,肿瘤局部控制率,1、2、3、5年生存率的差异。结果共有10篇文献,1143例患者满足纳入标准。Meta分析结果显示, TACE联合SBRT组比单纯TACE组近期疗效,肿瘤局部控制率,1、2、3、5生存率均高(RR=1.43,95%CI为1.32~1.56,P﹤0.00001;RR=2.09,95%CI为1.63~2.69,P﹤0.00001;RR=1.31,95%CI 为1.21~1.42,P﹤0.00001;RR=1.46,95%CI为1.23~1.72,P﹤0.00001;RR=1.76,95%CI为1.14~2.71,P=0.01;RR=2.29,95%CI为1.22~4.32,P=0.01)。白细胞减少( RR=0.97,P=0.61)、血小板减少( RR=0.99,P=0.85)、血红蛋白减少(RR=0.95,P=0.63)、恶心呕吐(RR=1.00,P=0.98)、肝功能损害(RR=0.98,P=0.87)的发生率两组之间差异无统计学意义。结论与TACE相比,TACE联合SBRT能明显提高患者近期疗效,提高肿瘤局部控制率和1、2、3、5生存率,同时不增加不良反应发生率,但其长期疗效和安全性尚需开展更多大样本、高质量的临床对照试验加以验证。%Objective To compare the clinical efficacy and the adverse reaction of transcatheter arteri-al chemoembolization( TACE)alone and combined with stereotactic body radiation therapy( SBRT)in patients with primary hepatic carcinoma by a Meta-analysis. Methods PubMed,Cochrane Library,EMBase,Ovid, MEDLIN,CNKI,CBMdisc,VIP and Wanfang were

  5. Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a meta-analysis

    Science.gov (United States)

    Zhao, Qianqian; Zhu, Kunli; Yue, Jinbo; Qi, Zhonghua; Jiang, Shumei; Xu, Xiaoqing; Feng, Rui; Wang, Renben

    2017-01-01

    Purpose Numerous studies have tried to combine transarterial chemoembolization (TACE) or hepatic arterial infusion chemotherapy (HAIC) with radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). However, the efficacy of TACE or HAIC combined with RT versus TACE or HAIC alone remains controversial. Thus, we performed a meta-analysis to compare the efficacy and safety of intra-arterial chemoembolization combined with RT versus intra-arterial chemoembolization alone for the treatment of HCC patients with PVTT. Methods PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies. Two authors independently reviewed the abstracts, extracted relevant data and rated the quality of studies. The major end points were objective response rate (ORR), overall survival (OS), and adverse events. Results Eight studies with a total of 1,760 patients were included in this meta-analysis. The pooled results showed that intra-arterial chemoembolization combined with RT significantly improved ORR of PVTT (OR, 4.22; 95% CI, 3.07–5.80; P<0.001) and OS (HR, 0.69; 95% CI, 0.57–0.83; P=0.001), but did not affect ORR of primary liver tumor (OR, 1.37; 95% CI, 0.67–2.79; P=0.390). The incidence of grade 3 or 4 leukopenia (OR, 5.80; 95% CI, 2.478–13.56; P<0.001) and thrombocytopenia (OR, 3.77; 95% CI, 1.06–13.43; P=0.041) was higher in the intra-arterial chemoembolization plus RT group than in the intra-arterial chemoembolization group. Conclusion Combination therapy of intra-arterial chemoembolization and RT for HCC patients with PVTT could bring higher ORR of PVTT and better survival benefits. This combination therapy was also associated with a significantly increased risk of adverse events. However, they were mostly mild to moderate and successfully treated with conservative treatment. PMID:28053537

  6. Hepatocellular Carcinoma with Blood Supply from Parasitized Omental Artery: Angiographic Appearance And Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Song Gao; Ren-jie Yang; Jia-hong Dong

    2012-01-01

    Objective:To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA),and evaluate the technical feasibility,safety and therapeutic efficacy of chemoembolization via the POAs.Methods:A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively.The evaluated indexes included the incidence rate of POAs,success rate of superselective catheterization,post-reaction after chemoembolization,and the cumulative survival rates.Results:Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures,and 32 patients with POAs were enrolled,with 97 POAs found in 76 angiography procedures,giving an incidence rate of 2.09%.POA was observed mostly at the right lobe and left medial lobe except the segment Ⅱ,and 62 POAs underwent superselective catheterization with microcatheter,giving a success rate of 63.9%.The angiographic appearance was:(1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11),displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7).In 19 patients,chemoembolization via POAs was performed successfully (A group),while the remaining 13 patients failed (B group).Except 1 acute edema pancreatitis case,no serious complication was recorded.The cumulative survival rates of 6-,12-,18-and 24-month were 78.9%,47.4%,31.6% and 21.1% respectively for A group; correspondingly,61.5%,30.g%,15.4% and 7.7%% for B group,in which 2 patients died of ruptured HCC.Conclusion:Chemoembolization with microcatheter via POAs is a relatively safe,feasible and valuable method.

  7. 多烯磷脂酰胆碱治疗原发性肝癌经导管肝动脉化疗栓塞相关性肝损伤的临床研究%Therapeutic efficacy of polyene phosphatidylcholine on hepatic injury in patients with primary liver cancer receiving transcatheter arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    贺冬林; 吴孝雄; 罗明

    2014-01-01

    Objective To investigate the therapeutic efficacy of polyene phosphatidylcholine on hepatic injury in patients with primary liver cancer (PLC) receiving transcatheter arterial chemoembolization (TACE). Methods A total of 66 PLC patients were randomized into a treatment group and a control group, with 33 patients in each group. Both the groups received TACE. Since two days before TACE, the control group began to receive routine liver-protecting therapy with drugs such as glutathione, while the treatment group received intravenous administration of polyene phosphatidylcholine, 930 mg daily, in addition to the routine liver-protecting therapy. The levels of TBIL, PA, ALT and AST were detected before drug therapy and on the 3rd day after giving TACE. Results As compared with the control group, TBIL, ALT and AST in the patients of the treatment group, who had received polyene phosphatidylcholine, significantly improved (P<0.05). Conclusion Treatment with polyene phosphatidylcholine has good effect on hepatic injury in PLC patients receiving TACE.%目的:观察多烯磷脂酰胆碱治疗原发性肝癌(primary liver cancer, PLC)患者行经导管肝动脉化疗栓塞(trans-catheter arterial chemoembolization, TACE)后肝损伤的效果。方法66例PLC患者被随机分为治疗组和对照组,每组各33例,均行TACE治疗。TACE治疗前2天,对照组开始接受谷胱甘肽等药物常规保肝治疗,治疗组在对照组基础上加用多烯磷脂酰胆碱静脉滴注,930 mg/d。在药物治疗前和TACE治疗后第3天检测2组患者的TBIL、前白蛋白、ALT和AST水平。结果治疗组经多烯磷脂酰胆碱治疗后,TBIL、ALT和AST与对照组相比均显著改善(P均<0.05)。结论多烯磷脂酰胆碱治疗PLC患者TACE相关性肝损伤效果较好。

  8. The value of multi-slice spiral CT perfusion imaging in evaluating the changes of blood supply of hepatocellular carcinoma before and after transcatheter hepatic arterial chemoembolization%多层螺旋CT灌注成像对肝癌经导管肝动脉栓塞化疗前后血供变化的应用价值

    Institute of Scientific and Technical Information of China (English)

    周霖; 邹文远; 陈玉峰

    2010-01-01

    目的 研究多层螺旋CT灌注成像在评价肝癌经导管肝动脉栓塞化疗(TACE)前后血流动力学改变中的价值.方法 17例肝癌患者TACE术前及术后行CT灌注扫描.计算肝血流量(HBF)、肝血容量(HBV)、平均通过时间(MTT)、毛细血管表面通透性(PS)、肝动脉灌注分数(HAF),并计算肝动脉灌注量(HAP)、门静脉灌注量(PVP).根据各灌注参数值评价肝癌TACE前后血流动力学改变.结果 TACE术后,HBF、HBV和HAP[(167.89±96.06)ml/(100 g·min),(14.95±15.13)ml/100 g,(97.71±68.18)ml/(100g·min)]较TACE术前[(250.59±129.56)ml/(100 g·min),(24.44±20.03)ml/100 g,(184.61±178.83)ml/(100 g·min)]减少(P0.05).结论 肝脏灌注参数可有效评价TACE前后肝癌组织的血流灌注改变,具有重要的临床应用价值.%Objective To study the multi-slice spiral CT (MSCT) perfusion imaging in evaluating the changes of blood supply of hepatocellular carcinoma( HCC ) before and after transcatheter hepatic arterial chemoembolization (TACE). Methods Before and after TACE, MSCT perfusion was performed in 17 patients with HCC. The perfusion indexes such as hepatic blood flow (HBF), hepatic blood volume(HBV),mean transit time (MTT),hepatic arterial fracture (HAF),permeability surface (PS), hepatic artery perfusion (HAP), portal venous perfusion (PVP) were calculated. The hemodynamic changes of HCC after TACE were evaluated according to perfusion parameters. Results After TACE, HBF,HBV and HAP found in MTT and PS before and after TACE (P > 0.05). Conclusion The parameters of MSCT perfusion imaging( HBF, HBV and HAP) can effectively evaluate the hemodynamic changes of HCC after TACE, and has important value in chnical application.

  9. Effect of resection following downstaging of unresectable hepatocelluar carcinoma by transcatheter arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    SHI Xian-jie; JIN Xin; WANG Mao-qiang; WEI Li-xin; YE Hui-yi; LIANG Yu-rong; LUO Ying; DONG Jia-hong

    2012-01-01

    Background This retrospective study was undertaken to analyze the outcome of hepatic resection in fifty-two patients with unresectable hepatocellular carcinoma (HCC) between January 2004 and December 2008.Methods Among these fifty-two patients,the mean diameter of the tumor was 7.9 cm (4.4-15.5 cm,median 8.5 cm) prior to the first transcatheter arterial chemoembolization (TACE).After 1-6 times of TACE (median 2),the median tumor diameter was reduced to 4.2 cm (0-8.4 cm) prior to resection.The duration between the last TACE treatment and sequential resection varied from one to six months (median 2.7 months).Serum α-fetoprotein (AFP) levels were abnormal in thirty-eight out of the fifty-two patients.In AFP producing HCCs,AFP levels returned to normal (≤400 μg/L) in twenty-five out of thirty-eight patients.Hepatic segmentectomy,multiple hepatic segmentectomy or partial hepatic resection were performed in forty-five patients,two underwent extended left hemihepatectomy,and one underwent right posterior branch portal vein thrombectomy.One patient received a right hemihepatectomy and three had left hemihepatectomies.Results Complete tumor radiological response (CR) occurred in five patients (9.6%).There were three cases of perioperative mortality in the fifty-two patients (5.8%).One patient underwent salvaged orthotopic liver transplantation,and twenty-one patients observed tumor recurrence within two years.The 1-,3- and 5-year survival rates of the fifty-two patients were 77.0% (n=40),55.0% (n=29),and 52.0% (n=28),respectively.The median survival time after surgery was 49 months (95% confidence interval 7.5-52.7 months).Conclusions TACE treatment provides a better chance for HCC resection in patients initially diagnosed with unresectable HCC.Furthermore,liver resection should be performed once the tumor is downstaged to be compatible for successful resection

  10. Safety of superselective transcatheter arterial chemoembolization through cystic artery for treatment of hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Jae Ho; Yoon, Hyun Ki; Song, Ho Young; Lee, Duck Hee; Hwang, Jae Chul; Kim, Bong Soo; Kim, Jae Won; Sung, Kyu Bo [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-01-01

    To report on the safety and efficacy of superselective transcatheter arterial chemoembolization(TACE) of tumor feeding branches originating from the cystic artery for the treatment of hepatocellular carcinoma(HCC). From, May 1955 to, September 1999, eleven HCC patients aged between 38 and 82 (mean, 57.4) years with tumor-feeding branches originating from the cystic artery underwent TACE. In eight, for whom superselection of these branches was possible, TACE was done with the use of Gelform and a mixture of Lipiodol and cisplatin, while for three, for whom superselection was impossible, a mixture of Lipiodol and cisplatin only was used. Immediately after TACE, remnant tumor staining was angiographically evaluated, and tumor response was determined by follow-up CT at one month. After procedure, the development of cholecystitis was clinically. Post-FACE angiography showed remnant tumor staining in one patients who underwent embolization with Gelform and the mixture fo Lipiodol and cisplatin, and in one for whom the mix ture of Lipodol and cisplationly was used. Among the eight for whom Gelfoam and the mixture of Lipiodol and cisplatin was used, one-month follow up CT showed compact Lipiodol uptake in five, partial Lipiodol uptake in three, no change in tumor size in six, increased tumor size in one, and decreased tumor size in one. Among the three for whom the mixture of Lipiodol and cisplatin only was used,one-month follow-up CT showed neither Lipiodol uptake nor change in tumor size in one patient, partial Lipiodol uptake and increased tumor size in one, and compact Lipiodol uptake and decreased tumor size in one. Cholecystitis developed in only one patient who underwent embolization with Gelfoam and the mixture of Lipiodol and cisplatin, but was cured by conservative treatment. Superselective TACE of tumor feeding branches originating from the cystic artery seems to be a safe and effective method for the treatment of hepatocellular carcinoma.

  11. Branched-chain amino acid treatment before transcatheter arterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Hiroki Nishikawa; Yukio Osaki; Tadashi Inuzuka; Haruhiko Takeda; Jun Nakajima; Fumihiro Matsuda; Shin-ichiro Henmi

    2012-01-01

    AIM:To examine the significance of branched-chain amino acid (BCAA) treatment before transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).METHODS:This study included 99 patients who underwent TACE therapy for HCC at our hospital and were followed up without treatment for at least 6 mo between January 2004 and January 2010.They were divided into 2 groups:those receiving BCAA granules (n =40) or regular diet (n =59,control).Data obtained were retrospectively analyzed (prior to TACE,and 1 wk,1,3,and 6 mo after TACE) in terms of nutritional condition and clinical laboratory parameters (serum albumin level and Child-Pugh score),both of which are determinants of hepatic functional reserve.RESULTS:The BCAA group comprised 27 males and 13 females with a mean age of 69.9 ± 8.8 years.The patients of the BCAA group were classified as follows:Child-Pugh A/B/C in 22/15/3 patients,and Stage Ⅱ/Ⅲ/IVA HCC in 12/23/5 patients,respectively.The control group comprised 32 males and 27 females with a mean age of 73.2 ± 10.1 years.In the control group,9 patients had chronic hepatitis,Child-Pugh A/B/C in 39/10/1 patients,and Stage I/Ⅱ /Ⅲ/IVA HCC in 1/11/35/12 patients,respectively.Overall,both serum albumin level and Child-Pugh score improved significantly in the BCAA group as compared with the control 3 and 6 mo after TACE (P < 0.05).Further analysis was performed by the following categorization:(1) child-Pugh classification; (2) liver cirrhosis subgroup with a serum albumin level > 3.5 g/dL; and (3) epirubicin dose.A similar trend indicating a significant improvement of all variables in the BCAA group was noted (P < 0.05).CONCLUSION:Treatment with BCAA granules in patients who have undergone TACE for HCC is considered useful to maintain their hepatic functional reserve.

  12. Deep lingual arterial chemoembolization of tongue carcinoma with microcapsuled anticancer drug

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: Microcapsule chemoembolism is a promising treatment of tumors. We describe a deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum. Methods: Lingual artery cast specimens from cadavers were microscopically examined, and 78 patients with tongue cancer were recruited and treated with the deep lingual arterial embolization therapy. Results: Microcapsule embolism occurred approximately at the fifth or sixth level of the deep lingual artery branches. The five-year survival rate was 88.5% (69 out of 78), and the ten-year survival rate 52.6% (41 out of 78). Conclusion:The deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum is an effective therapy to treat carcinoma in mid-margin or mid-body of the tongue.

  13. Arcuate ligament syndrome inducing hepatic artery thrombosis after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Zhi-Jun Jiang; Ting-Bo Liang; Xiao-Ning Feng; Wei-Lin Wang; Yan Shen; Min Zhang; Jian Wu; Xiao Xu; Shu-Sen Zheng

    2008-01-01

    BACKGROUND: Hepatic artery thrombosis (HAT) is a frequent complication following liver transplantation, but it is rarely caused by arcuate ligament compression of the celiac artery. This article mainly describes our experience in managing a patient with celiac artery stenosis and HAT after liver transplantation. METHODS: A 44-year-old man with a 15-year history of hepatitis B was admitted to our hospital for hepatocellular carcinoma. Before the operation, he received trans-arterial chemoembolization once, and pretransplant MR angiography indicated a suspected stenosis at the initiation of the celiac artery, while color Doppler showed normal blood lfow in the arterial system. In this case, orthotopic liver transplantation was performed for radical cure of hepatocellular carcinoma. However, B-ultrasonography detected poor blood lfow in the intra- and extra-hepatic artery on the ifrst posttransplant day, and during exploratory laparotomy a thrombus was found in the hepatic artery. Thus, re-transplantation was conducted with a bypass between the graft hepatic artery and the recipient abdominal aorta with the donor's splenic artery. RESULTS: The patient made an uneventful recovery and color Doppler showed good blood lfow in the artery and portal system. Histology conifrmed extensive thrombosis in the left and right hepatic artery of the explanted graft, indicating HAT. CONCLUSIONS: Although HAT caused by celiac trunk compression is rarely reported in liver transplantation, the diagnosis should be considered in patients with pretransplant hepatic artery stenosis on angiography and abnormal blood lfow on B-ultrasonography. Once HAT is formed, treatment such as thrombectomy or re-transplantation should be performed as early as possible.

  14. Clinical research of the cause of pulmonary infection in patient with primary hepatic carcinoma after the treatment of transcatheter arterial chemoembolization%原发性肝癌患者TACE术后并发肺部炎症原因及临床特征的研究

    Institute of Scientific and Technical Information of China (English)

    张鸿文; 陶超超; 雷娟; 张芨; 林军

    2013-01-01

    目的 分析原发性肝癌TACE术后肺部炎症的发生原因及临床特征.方法 对我院1136例原发性肝癌TACE治疗患者进行分析.结果 术后发生肺炎25例(2.20%);肺癌中出现咳嗽、咳痰22例,占88%;发热占84%.白细胞计数升高7例,占28%;CRP升高17例,占68%.CD+4T 细胞下降19例,占76%.CD+4/CD+8比例下降15例,占60%.15例白蛋白下降,占60%;影像学表现以右肺下叶肺段不张为主,多伴有胸腔积液;3例死亡.结论 TACE术后部分患者会发生的肺部炎症,多见于右肝癌及巨块型肝癌患者;临床表现不典型.%Objective To analyze the cause and clinical features of pulmonary infection in patient with primary hepatic carcinoma after the treatment of transcatheter arterial chemoembolization ( TACE ). Methods 1136 patients with HCC were treated with TACE and then the clinical data were retrospectively analyzed. Results Pneumonia occurred in 25 patients ( 2. 20% ) after TACE. 19 patients had right hepatic carcinoma,and 10 of them had gigantic hepatic carcinoma. Cough and expectoration were present in 22 patients ( 88% ),fever in 21 patients ( 84% ),leucocyte count elevated in7 patients( 28% ),CRP elevated in 17 patients( 68% ),CD4 + T cell count decreased in 19 patients( 76% ) ,the ratio of CD4 + /CD8 + decreased in 15 patients ( 60% ), and the albumin level decreased in 15 patients( 60% ). The main imaging presentation was atelectasis of right lung with pleural effusion. 3 patients reported dead. Conclusion Pulmonary inflammation usually occurs in patients with right or gigantic hepatic carcinoma after TACE, and its clinical manifestation is atypical.

  15. Efficacy of nutritional intervention in patients with primary hepatocellular carcinoma treated by transcatheter arterial chemoembolization

    Directory of Open Access Journals (Sweden)

    HU Caixia

    2015-04-01

    Full Text Available ObjectiveTo investigate the efficacy of short-term nutritional intervention in patients with primary hepatocellular carcinoma treated by transcatheter arterial chemoembolization. MethodsSixty patients with primary hepatocellular carcinoma who were admitted to Beijing Youan Hospital to receive transcatheter arterial chemoembolization from January 2012 to October 2012 were equally and non-randomly divided into two groups: nutrition group and control group. The two groups were all given nutrition guidance after transcatheter arterial chemoembolization. The nutrition group was given 15 g liver essentials twice a day (one in the morning and the other in the evening by oral administration for 4 weeks, while the control group was given routine diet for 4 weeks. Comparison of data between the two groups was made by independent-samples t test. ResultsAfter 4 weeks of continuous treatment, the two groups had significantly increased body weight (P<0.05, arm muscle circumference (P<0.05, and triceps skinfold thickness (P<0.05. The two groups had significantly increased total protein (67±13 g/L vs 72±9 g/L, P=0.04; 66±10 g/L vs 74±8 g/L, P=0.02 after treatment, and there was a significant difference in changes in total protein after treatment between the two groups (P=0.04. The nutrition group had significantly increased albumin (34.7±2.9 g/L vs 39.9±3.5 g/L, P=0.03 and cholinesterase (3342±415 U/L vs 4600±459 U/L, P=0.01 after treatment, and there was a significant difference in changes in albumin (P=0.03 and cholinesterase (P=0.03 after treatment between the two groups. ConclusionFor patients with primary hepatocellular carcinoma treated by transcatheter arterial chemoembolization, oral administration of liver essentials improves their nutritional status and liver function, so as to increase their tolerance to subsequent treatments.

  16. Transcatheter arterial chemoembolization with a fine-powder formulation of cisplatin for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Kazuhiro; Kasai; Akira; Ushio; Kei; Sawara; Yasuhiro; Miyamoto; Yukiho; Kasai; Kanta; Oikawa; Hidekatsu; Kuroda; Yasuhiro; Takikawa; Kazuyuki; Suzuki

    2010-01-01

    AIM:To evaluate the efficacy of transcatheter arterial chemoembolization(TACE) using a suspension of a fine-powder formulation of cisplatin(DDPH) for hepatocellular carcinoma(HCC).METHODS:The study population was comprised of 164 patients who were treated by TACE alone.Of these patients,76 underwent TACE using a suspension of DDPH in lipiodol(LPD)(DDPH group),and the remaining 88 underwent TACE with an emulsion of doxorubicin(ADM) with LPD(ADM group).We compared the DDPH group with the ADM group in terms of...

  17. The right hepatic artery syndrome

    Institute of Scientific and Technical Information of China (English)

    Kazumi Miyashita; Katsuya Shiraki; Takeshi Ito; Hiroki Taoka; Takeshi Nakano

    2005-01-01

    Various benign and malignant conditions could cause biliary obstruction. Compression of extrahepatic bile duct (EBD) by right hepatic artery was reported as a right hepatic artery syndrome but all cases were compressed EBD from stomach side. Our case compressed from dorsum was not yet reported, so it was thought to be a very rare case. We present here the first case of bile duct obstruction due to the compression of EBD from dorsum by right hepatic artery.

  18. 音乐放松疗法对肝癌动脉化疗栓塞术病人生命体征与焦虑状态的影响%Influence of music relaxation therapy on vital signs and anxiety of liver cancer patients accepting transcatheter hepatic arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    金凤娟; 赵岳

    2011-01-01

    Objective: To probe into the influence of music therapy on physiological indexes (heart rate, respiration and blood pressure) and the anxiety of liver cancer patients accepting transcatheter hepatic arterial chemoembolization. Methods: A total of 102 patients accepting transcatheter hepatic aterial chemoembolization were randomly divided into intervention group and control group. Patients of control group received routine care. Patients of intervention group received music therapy based on the routine care. Then changes of heart rate,respiration and blood pressure of all cases were observed before, during,and after the operation respectively. And anxiety degrees of all patients were evaluated by adopting the state anxiety inventory (S -AI) before and after the operation. Results: There was no statistical significant difference between the two groups in terms of anxiety scores before the operation (P>0. 05). However,the anxiety score of intervention group was significantly lower than that of control group after the operation (P<0. 001). In terms of the anxiety level of control group cases, there was no statistical significant difference between before and after the operation (P>0. 05). However, in terms of the anxiety score of intervention group cases after the operation was significantly lower than that of before the operation (P<0. 001). In terms of heart rate, respiration and blood pressure, there were no statistical significant differences between the two groups before the operation (P>0. 05). During the operation, the heart rate and blood pressure of control group cases obviously changed. They mani fested as fast heart rate and higher tendency of blood pressure. However, both the heart rate and blood pressure of patients in intervention group were stable.In terms of the changes of heart rate and blood pressure, there were statistical significant differences between the two group cases (P<0. 05 or P<0. 001).Conclusion:Music therapy can improve

  19. Chemoembolization of Extrahepatic Collateral Arteries for Treatment of Hepatocellular Carcinoma in the Caudate Lobe of the Liver

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Sungmin; Kim, Hyo-Cheol, E-mail: angiointervention@gmail.com; Chung, Jin Wook; Jung, Hyun-Seok; Hur, Saebeom; Lee, Myungsu; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center, and Clinical Research Institute (Korea, Republic of)

    2015-04-15

    PurposeThis study was designed to evaluate the efficacy and safety in performing chemoembolization of extrahepatic collateral arteries (EHC) for hepatocellular carcinoma (HCC) located in the caudate lobe.MethodsBetween January 2006 and November 2013, chemoembolization via EHC was performed in 35 patients with 35 caudate HCCs. Preprocedural and follow-up CT or MR scans, angiographic images, and medical records were reviewed retrospectively in consensus. Chi-square analysis was used to evaluate the relationship between tumor characteristics and type of EHC and that between tumor response and the characteristics of the tumor and chemoembolization.ResultsIn 31 (88.6 %) patients, EHCs supplying the caudate HCC originated from the right inferior phrenic artery (RIPA). The remaining four HCCs were supplied by the gastroduodenal artery, dorsal pancreatic artery, and right and left gastric arteries. Superselective catheterization of tumor-feeding vessels from the EHC was achieved in 27 patients (77.1 %). There were no major complications. Individual tumor response supplied by the EHC at follow-up contrast-enhanced CT were as follows: complete response (n = 18), partial response (n = 9), stable disease (n = 3), and progressive disease (n = 3). Non-RIPA EHCs were significantly more common in patients who had previously received chemoembolization via the RIPA (50 %) than those who had not (6.5 %; P = 0.01). There was no significant predictive factor associated with tumor response.ConclusionsHCC in the caudate lobe can be supplied by several EHCs. Chemoembolization via these arteries can be performed safely and effectively.

  20. CT Findings of Completely Regressed Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis after Transcatheter Arterial Chemoembolization

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    Yoon, Jeong Hee; Kim, Hyo Cheol; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Yoon, Jung Hwan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The objective of this study was to determine the sequential CT findings of controlled hepatocellular carcinoma (HCC) with main portal vein (MPV) thrombosis with the use of transcatheter arterial chemoembolization and additional intra-arterial cisplatin infusion. From January 2004 to September 2006, 138 patients with HCC invading MPV were referred to the angiography unit of our institution for chemoembolization and additional intra-arterial cisplatin infusion. Until August 2008, seven (5%) of 138 patients were followed-up and found not to have tumor recurrence. CT scans were retrospectively reviewed by two radiologists, focusing on the following parameters: the extent of portal vein thrombosis, the diameter of the affected portal vein, and enhancement of portal vein thrombosis. The extent of portal vein thrombosis at the initial presentation was variable: left portal vein (LPV) and MPV (n = 1), right portal vein (RPV) and MPV (n = 3), as well as RPV, LPV and MPV (n = 3). The extent and diameter of the affected portal vein decreased during follow-up examinations. In addition, the degree of enhancement for tumor thrombi and serum alpha-feto-protein levels decreased after the transcatheter arterial chemoembolization. Portal vein thrombosis was found to be completely resolved in one patient, whereas residual thrombus without viability was persistent in six patients. If chemoembolization is effective in patients with HCC that invades the portal vein, the extent and enhancement of portal vein thrombosis is reduced, but residual thrombosis frequently persists for months or years, without evidence of a viable tumor.

  1. Analysis of factors related to severe hepatic dysfunction after transcatheter arterial chemoembolization in patients with liver cancer%肝癌患者化疗栓塞后肝功能严重失代偿的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    张正宇; 邓燕贤; 徐军红; 周志鹏; 廖国宇

    2015-01-01

    目的:探讨肝癌患者动脉灌注化疗栓塞(TACE)后肝功能严重失代偿的相关因素。方法回顾性分析接受 TACE治疗的109例患者,单因素分析性别、年龄、外科切除史、肝硬化史、肿瘤大体分型、TACE 次数、动门静脉瘘、门脉癌栓、Child-Pugh 分级、血清总胆红素、白蛋白、天门冬氨酸氨基转移酶、吲哚菁绿15 min 滞留率和术中碘油用量与术后发生严重肝功能失代偿的相关性,并将有统计学意义(P <0.05)的结果引入 Logistic 回归模型分析。结果肝硬化、Child-Pugh 分级、门脉癌栓、白蛋白和吲哚菁绿15 min 滞留率与术后发生严重的肝功能失代偿相关,多项 Logistic 回归分析显示:肝硬化、门脉癌栓和吲哚菁绿15 min 滞留率是导致术后发生严重肝功能失代偿的危险因素。结论导致 TACE 后发生肝功能严重失代偿的危险因素有肝硬化、门脉癌栓和吲哚菁绿15 min 滞留率,需要在术前评估中引起警惕。%Objective To investigate the relative risk factors of severe hepatic dysfunction after transcatheter arterial chemoembo-lization (TACE)in patients with liver cancer.Methods 109 cases with liver cancer after TACE treatment were retrospectively re-viewed.,The factors related to severe hepatic dysfunction after TACE including sex,age,surgical resection history,cirrhosis of the liver,tumor type,number of TACE,arterioportal shunting,portal vein thrombosis,Child-pugh grade,TBIL,level of ALB,AST, ICGR1 5 and the volume of lipiodol injected were ananlyzed by univariate analysis.Then the significant factors were taken into the multivariate logistic regression analysis.Results There was a postive relationship between cirrhosis of the liver,portal vein throm-bosis,level of ALB and ICGR1 5 and severe hepatic dysfunction after TACE (P <0.05 ).Furthermore,cirrhosis of the liver,portal vein thrombosis and ICGR1 5 were the risk factors for severe hepatic dysfunction after

  2. IN VIVO 1H MAGNETIC RESONANCE SPECTROSCOPY IN EVALUATION OF HEPATOCELLULAR CARCINOMA AND ITS EARLY RESPONSE TO TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION

    Institute of Scientific and Technical Information of China (English)

    Bin Wu; Wei-jun Peng; Pei-jun Wang; Ya-jia Gu; Wen-tao Li; Liang-pin Zhou; Feng Tang; Guo-ming Zhong

    2006-01-01

    Objective To investigate the value of in vivo proton magnetic resonance spectroscopy (MRS) in the assessment of hepatocellular carcinoma (HCC) and monitor its metabolic change shortly after transcatheter arterial chemoembolization (TACE).Methods In this prospective study,28 consecutive patients with large HCC (≥3 cm in diameter) confirmed by fine needle aspiration biopsy were recruited.The 1H MRS of all hepatic lesions and some uninvolved liver parenchyma were performed with 1.5T whole body MR scanner.Among them,15 cases were evaluated again about one week after TACE.The main metabolites such as choline and lipid before and after interventional therapy were measured to assess the early response of the tumor.Results The technical success rate of 1H MRS in liver was high (33/41,80%),closely related to breath motion,location of lesion,and size of voxel.In spectra,the choline compound peak of HCC elevated compared with uninvolved liver parenchyma.After TACE,both the amplitude and the area of choline resonance peak significantly descended (choline-to-lipid ratios from 0.352±0.080 to 0.167±0.030,P=0.026;from 0.205±0.060 to 0.070±0.020,P=0.042,respectively);yet lipid resonance peak ascended.Conclusions In vivo 1H MRS is technically feasible for the evaluation of large focal hepatic lesions,however,the reproducibility and stability are not as good as routine MR scan.1H MRS can monitor the early stage metabolic changes of HCC after TACE but limitation like quantification still exists.

  3. Preemptive antiviral therapy with entecavir can reduce acute deterioration of hepatic function following transarterial chemoembolization.

    Science.gov (United States)

    Yoo, Sun Hong; Jang, Jeong Won; Kwon, Jung Hyun; Jung, Seung Min; Jang, Bohyun; Choi, Jong Young

    2016-12-01

    Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P=0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P=0.013), hypoalbuminemia (HR=3.990, P=0.015), and absence of antiviral therapy (HR=7.597, P=0.006) were significantly associated with treatment-related hepatic decompensation. Our findings suggest that preemptive antiviral therapy significantly reduces the risk of

  4. Intrahepatic chemoembolization in unresectable pediatric liver malignancies

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    Arcement, C.M.; Towbin, R.B.; Meza, M.P.; Kaye, R.D.; Carr, B.I. [Department of Radiology, Children' s Hospital of Pittsburgh, PA (United States); Gerber, D.A.; Mazariegos, G.V.; Reyes, J. [Department of Transplant Surgery, Children' s Hospital of Pittsburgh, PA (United States)

    2000-11-01

    Objective. To determine the effectiveness of a new miltidisciplinary approach using neoadjuvant intrahepatic chemoembolization (IHCE) and liver transplant (OLTx) in patients with unresectable hepatic tumors who have failed systemic chemotherapy. Materials and methods. From November 1989 to April 1998, 14 children (2-15 years old) were treated with 50 courses of intra-arterial chemotherapy. Baseline and post-treatment contrast-enhanced CT and alpha-fetoprotein levels were performed. Seven had hepatoblastoma, and 7 had hepatocellular carcinoma (1 fibrolamellar variant). All patients had subselective hepatic angiography and infusion of cisplatin and/or adriamycin (36 courses were followed by gelfoam embolization). The procedure was repeated every 3-4 weeks based on hepatic function and patency of the hepatic artery. Results. Six of 14 children received orthotopic liver transplants (31 courses of IHC). Pretransplant, 3 of 6 showed a significant decrease in alpha-fetoprotein, while only 1 demonstrated a significant further reduction in tumor size. Three of 6 patients are disease free at this time. Three of 6 patients died of metastatic tumor 6, 38, and 58 months, respectively post-transplant. One of 14 is currently undergoing treatment, has demonstrated a positive response, and is awaiting OLTx. Three of 14 withdrew from the program and died. Four of 14 patients developed an increase in tumor size, developed metastatic disease, and were not transplant candidates. Two hepatic arteries thrombosed, and one child had a small sealed-off gastric ulcer as complications of intrahepatic chemoembolization. Conclusion. The results of intrahepatic chemoembolization are promising and suggest that some children who do not respond to systemic therapy can be eventually cured by a combination of intrahepatic chemoembolization orthotopic liver transplant. Alpha-fetoprotein and cross-sectional imaging appear to be complementary in evaluating tumor response. IHCE does not appear to convert

  5. Arsenic trioxide treatment of rabbit liver VX-2 carcinoma via hepatic arterial cannulationinduced apoptosis and decreased levels of survivin in the tumor tissue

    OpenAIRE

    LI, HONG; Gong, Jian; Jiang, Xuyuan; Shao, Haibo

    2013-01-01

    Aim To investigate the role of tumor apoptosis-inhibitory protein survivin in arsenic trioxide-induced apoptosis in VX-2 carcinoma in the rabbit liver by means of transcatheter arterial chemoembolization. Methods Sixteen rabbits with 32 implanted hepatic VX-2 tumors were randomly divided into two groups. The experimental group received 2 mg of arsenic trioxide and 1 mL of ultra-fluid lipiodol co-injected via hepatic arterial cannulation and the control group received o...

  6. Cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma: a report of two cases and literature review

    Institute of Scientific and Technical Information of China (English)

    LI Zhi; NI Rui-fang; BUSIREDDY Kiran Kumar Reddy; JIN Yong-hai; ZHAO Xin; LI Ming-ming; YANG Chao

    2011-01-01

    Cerebral lipiodol embolism (CLE) is an extremely rare complication of transcatheter arterial chemoembolization for hepatocellular carcinoma.To our knowledge,only 11 cases have been previously reported.We recently encountered two cases of CLE in our clinical work.Reviewing the 11 cases in the literature and the two cases in our report indicates that large dose lipiodol infusion and absence of particulate embolization should be avoided.The presence of a right-to-left shunt and inferior phrenic artery injection seems to increase the risk of CLE.More caution should be taken in these situations.

  7. Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma.

    Science.gov (United States)

    Zhu, Shao-Liang; Zhong, Jian-Hong; Ke, Yang; Ma, Liang; You, Xue-Mei; Li, Le-Qun

    2015-08-28

    To compare the efficacy of hepatic resection (HR) and transarterial chemoembolization (TACE) for patients with solitary huge (≥ 10 cm) hepatocellular carcinoma (HCC). Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival (OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups. OS at 5 years was significantly higher in the HR group than the TACE group, across all patients (P = 0.002) and across propensity score-matched pairs (36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/mL, presence of vascular invasion and TACE treatment as independent predictors of poor OS. Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.

  8. Serum YKL-40 independently predicts outcome after transcatheter arterial chemoembolization of hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Cheng-Bao Zhu

    Full Text Available BACKGROUND: Transcatheter arterial chemoembolization (TACE is the most widely used treatment option for unresectable hepatocellular carcinoma (HCC. Elevated serum YKL-40 level has been shown to predict poor prognosis in HCC patients undergoing resection. This study was designed to validate the prognostic significance of serum YKL-40 in patients with HCC undergoing TACE treatment. METHODS: Serum YKL-40 level was determined by enzyme-linked immunosorbent assay. Overall survival (OS was evaluated with the Kaplan-Meier method and compared by the log-rank test. Multivariate study with Cox proportional hazard model was used to evaluate independent prognostic variables of OS. RESULTS: The median pretreatment serum YKL-40 in HCC patients with was significantly higher than that in healthy controls (P<0.001. The YKL-40 could predict survival precisely either in a dichotomized or continuous fashion (P<0.001 and P = 0.001, respectively. Multivariate Cox regression analysis indicated that serum YKL-40 was an independent prognostic factor for OS in HCC patients (P = 0.001. In further stratified analyses, YKL-40 could discriminate the outcomes of patients with low and high alpha-fetoprotein (AFP level (P = 0.006 and 0.016, respectively. Furthermore, the combination of serum YKL-40 and AFP had more capacity to predict patients' outcomes. CONCLUSIONS: Serum YKL-40 was demonstrated to be an independent prognostic biomarker in HCC patients treated with TACE. Our results need confirmation in an independent study.

  9. Expression of Angiogenic Factors in Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    廖晓锋; 易继林; 李兴睿; 杨志芳; 邓巍; 田耕

    2003-01-01

    In order to investigate the changes of vascular endothelial growth factor (VEGF) andbasic fibroblast growth factor (bFGF) expression in residual hepatocellular carcinoma (HCC) aftertranscatheter arterial chemoembolization (TACE), the expression levels of VEGF and bFGF ex-pression in specimens surgically removed from 48 HCC patients were detected by immunohisto-chemical methods, and staining intensity of VEGF and bFGF was assessed by a computer-assistedimage-analyzer. Among the 48 patients, 25 underwent partial hepatectomy alone (single operatinggroup), and 23 were subjected to second stage surgical resection after TACE (TACE group) Theresults showed that the average absorbancevalue (A) of VEGF was higher in TACE group thanthat in single operating group (0. 152±0. 021 vs 0. 131±0. 012, P<0.01). The Average A of bF-GF in TACE group was 0. 127±0. 023, higher than in single operating group (0. 111±0. 016, P<0. 05). These results suggested that TACE of HCC can up-regulate the expression of VEGF andbFGF in HCC tissues possibly due to anoxia and ischemia.

  10. Hepatocellular Carcinoma Fed by the Hepatic Artery Arising from the Superior Mesenteric Artery: Angiographic Analysis and Interventional Treatment

    Institute of Scientific and Technical Information of China (English)

    MUWei; LIQiang; YOUJian; CHENJie

    2003-01-01

    Objective: To investigate the angiographic characteristics and the interventional catheterization techniques of hepatocellular carcinoma (HCC) fed by aberrant hepatic arteries arising from the superior mesenteric artery (SMA), namely SMA type. Methods: Digital subtraction angiography (DSA) manifes-tations and the data from interventional treatment in 41 cases of SMA type HCCs were retrospectively reviewed. The frequency of the aberrant arteries was summed up statistically and their anatomic charac-teristics (such as origin, course, branches and distribution) and the relationship with catheterization were described and analyzed. Results: Of 350 HCC cases, SMA type HCCs were found in 41 cases (11.9%),including accessory right hepatic artery (15 cases, 36.5%), replaced right hepatic artery (16 cases, 39.0%),common hepatic artery (8 cases, 19.5%) and celiac artery arising from SMA (2 cases, 5.0%). Of the 31 cases with accessory or replaced right hepatic arteries, right hepatic arteries were small or absent on celiac angiograph in 29 cases (94.0%), and there was an avascular zone on the right liver. Superselective catheter-ization was successfully performed in 25 cases (61%) by using RH catheter, but the rest acquired successful superselective catheterization by using Cobra, Simmon catheters and microcatheters. Conclusion: SMA type is a commonly seen variation of hepatic arterial blood supply. A knowledge of this is very important in transcatheter arterial chemoembolization for HCC.

  11. Livergraftvascularvariantwith 3 extra-hepatic arteries

    Institute of Scientific and Technical Information of China (English)

    Paulo N Martins

    2010-01-01

     Vascular anatomy of the liver is varied, and the"standard"anatomy is seen in 55%-80%of cases. It is very important that extrahepatic arteries are identiifed precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type Ⅶ, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5%of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

  12. Transcatheter arterial chemoembolization and radiation therapy for treatment-naive patients with locally advanced hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won [Dept. of Radiation Oncology, Yeungnam University Medical Center, Daegu (Korea, Republic of); Oh, Dong Ryul; Park, Hee Chul; Lim, Do Hoon; Shin, Sung Wook; Cho, Sung Ki; Gwak, Geum Youn; Choi, Moon Seok; Paik, Yong Han; Paik, Seung Woon [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) followed by radiotherapy (RT) in treatment-naive patients with locally advanced hepatocellular carcinoma (HCC). Eligibility criteria were as follows: newly diagnosed with HCC, the Barcelona Clinic Liver Cancer stage C, Child-Pugh class A or B, and no prior treatment for HCC. Patients with extrahepatic spread were excluded. A total of 59 patients were retrospectively enrolled. All patients were treated with TACE followed by RT. The time interval between TACE and RT was 2 weeks as per protocol. A median RT dose was 47.25 Gy10 as the biologically effective dose using the α/β = 10 (range, 39 to 65.25 Gy10). At 1 month, complete response was obtained in 3 patients (5%), partial response in 27 patients (46%), stable disease in 13 patients (22%), and progressive disease in 16 patients (27%). The actuarial one- and two-year OS rates were 60.1% and 47.2%, respectively. The median OS was 17 months (95% confidence interval, 5.6 to 28.4 months). The median time to progression was 4 months (range, 1 to 35 months). Grade 3 or greater liver enzyme elevation occurred in only two patients (3%) after RT. Grade 3 gastroduodenal toxicity developed in two patients (3%). The combination treatment of TACE followed by RT with two-week interval was safe and it showed favorable outcomes in treatment-naive patients with locally advanced HCC. A prospective randomized trial is needed to validate these results.

  13. Predisposing Factors of Liver Necrosis after Transcatheter Arterial Chemoembolization in Liver Metastases from Neuroendocrine Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Joskin, Julien, E-mail: j.joskin@gmail.com; Baere, Thierry de, E-mail: Thierry.DEBAERE@igr.fr [Institut Gustave Roussy, Department of Interventional Radiology (France); Auperin, Anne, E-mail: Anne.AUPERIN@igr.fr [Institut Gustave Roussy, Department of Epidemiology (France); Tselikas, Lambros, E-mail: lambros.tselikas@gmail.com; Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Farouil, Geoffroy, E-mail: g.farouil@gmail.com [Institut Gustave Roussy, Department of Interventional Radiology (France); Boige, Valérie, E-mail: boige@igr.fr; Malka, David, E-mail: david.malka@igr.fr [Institut Gustave Roussy, Department of Digestive Oncology (France); Leboulleux, Sophie, E-mail: sophie.leboulleux@igr.fr [Institut Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology (France); Ducreux, Michel, E-mail: ducreux@igr.fr [Institut Gustave Roussy, Department of Digestive Oncology (France); Baudin, Eric, E-mail: baudin@igr.fr [Institut Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology (France); Deschamps, Frédéric, E-mail: frederic.deschamps@igr.fr [Institut Gustave Roussy, Department of Interventional Radiology (France)

    2015-04-15

    PurposeTo investigate predictive factors for liver necrosis after transcatheter arterial chemoembolization (TACE) of neuroendocrine liver metastases.MethodsA total of 164 patients receiving 374 TACE were reviewed retrospectively to analyze predictive factors of liver necrosis. We analyzed patient age and sex; metastasis number and location; percentage of liver involvement; baseline liver function test; and pretreatment imaging abnormalities such as bile duct dilatation (BDD), portal vein narrowing (PVN), and portal vein thrombosis (PVT). We analyzed TACE technique such as Lipiodol or drug-eluting beads (DEB) as the drug’s vector; dose of chemotherapy; diameter of DEB; and number, frequency, and selectivity of TACE.ResultsLiver necrosis developed after 23 (6.1 %) of 374 TACE. In multivariate analysis, DEB > 300 μm in size induced more liver necrosis compared to Lipiodol (odds ratio [OR] 35.20; p < 0.0001) or with DEB < 300 μm in size (OR 19.95; p < 0.010). Pretreatment BDD (OR 119.64; p < 0.0001) and PVT (OR 9.83; p = 0.030) were predictive of liver necrosis. BDD or PVT responsible for liver necrosis were present before TACE in 59 % (13 of 22) and were induced by a previous TACE in 41 % (9 of 22) of cases.ConclusionDEB > 300 μm in size, BDD, and PVT are responsible for increased rate of liver necrosis after TACE. Careful analysis of BDD or PVT on pretreatment images as well as images taken between two courses can help avoid TACE complications.

  14. Transarterial chemoembolization combined with sorafenib for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus

    Directory of Open Access Journals (Sweden)

    Zhang YF

    2016-07-01

    Full Text Available Yong-Fa Zhang,1–3,* Wei Wei,1–3,* Jia-Hong Wang,1–3,* Li Xu,1–3 Pei-En Jian,1–3 Cheng-Zuo Xiao,4 Xiao-Ping Zhong,1–3 Ming Shi,1–3 Rong-Ping Guo1–3 1Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, 2State Key Laboratory of Oncology in South China, 3Collaborative Innovation Center for Cancer Medicine, Guangzhou, 4Department of General Surgery, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen, People’s Republic of China *These authors contributed equally to this work Objective: To compare the treatment outcomes of sorafenib plus transarterial chemoembolization (TACE vs TACE alone in patients with hepatocellular carcinoma (HCC and hepatic vein tumor thrombus (HVTT.Methods: Twenty patients who were initially diagnosed with HCC and HVTT and received TACE combined with sorafenib during February 2009 to October 2013 were included in the study. To minimize selection bias, these patients were compared with 60 case-matched controls selected from a pool of 81 patients (in a 1:3 ratio who received TACE alone during the same period. The primary end point was overall survival (OS. The secondary end points were time to progression, disease control rate, and adverse events.Results: After a median follow-up period of 12.5 months (range, 1.03–44.23 months, the OS of the combined group was found to be significantly higher compared with the monotherapy group (14.9 vs 6.1 months, P=0.010. The time to progression was found to be significantly longer in the combined group (4.9 vs 2.4 months, P=0.016. Univariate and multivariate analyses revealed that the treatment allocation was an independent predictor of OS.Conclusion: Sorafenib plus TACE was well tolerated and was more effective in treating patients with advanced HCC and HVTT. Future trials with prospective larger samples are required to validate these results. Keywords: hepatocellular carcinoma, hepatic vein tumor thrombus, prognosis

  15. p53 gene therapy in combination with transcatheter arterial chemoembolization for HCC: One-year follow-up

    Institute of Scientific and Technical Information of China (English)

    Yong-Song Guan; Yuan Liu; Qing He; Xiao Li; Lin Yang; Ying Hu; Zi La

    2011-01-01

    AIM: To evaluate the efficacy and safety of combination therapy with recombinant adenovirus p53 injection (rAdp53) and transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (HCC). METHODS: A total of 82 patients with advanced HCC treated only with TACE served as control group. Another 68 patients with HCC treated with TACE in combination with recombinant adenovirus-p53 injection served as p53 treatment group. Patients were followed up for 12 mo. Safety and therapeutic effects were evaluated according to the improvement in clinical symptoms, leukocyte count, Karnofsky and RECIST criteria. Survival rate was calculated with Kaplan-Meier method. RESULTS: The total effective rate was 58.3% for p53 treatment group, and 26.5% for control group (P < 0.05). The incidence of gastrointestinal symptoms was lower in p53 treatment group than in control group (P < 0.05). The 3-, 6- and 12-mo survival rates were significantly higher for p53 treatment group than for control group (P < 0.01). The combination treatment was well tolerated with such adverse events as fever (51.5%, P = 0.006) and pain of muscles and joints (13.2%, P = 0.003), which were significantly higher than the chemotherapy. Except for these minor adverse effects, no severe vector-related complications were identified. With respect to the efficacy, patients in p53 treatment group had less gastrointerestinal symptoms (P = 0.062), better improvement in tumor-related pain (P = 0.003), less downgrade of leukocyte counts (P = 0.003) and more upgrade of Karnofsky performance score (P = 0.029) than those in control group. The total effective rate (CR + PR) for p53 treatment group and control group was 58.3% and 26.5%, respectively, with distributions of different effect in two groups (P = 0.042). The survival rates were 89.71%, 76.13%, and 43.30% for p53 treatment group, and 68.15%, 36.98%, and 24.02% for control group, respectively, 3, 6 and 12 mo after treatment, suggesting that

  16. Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Zhong-Guo Zhou; Xiang-Ming Lao; and Sheng-Ping Li; Xing-Rong Zheng; Qian Zhou; Ming Shi; Yao-Jun Zhang; Rong-Ping Guo; Yun-Fei Yuan; Min-Shan Chen; Xiao-Jun Lin

    2015-01-01

    Introduction:Most hepatocellular carcinomas (HCC) develop in a background of underlying liver disease including chronic hepatitis B. However, the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus (HBV)-related HCC treated with chemoembolization is unclear. This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC. Methods:A total of 224 HCC patients who successfully underwent chemoembolization were identified, and their survival and other relevant clinical data were reviewed. Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival (OS). Results:The median survival time (MST) was 15.9 (95% confidence interval [CI], 9.5–27.7) months in the antiviral group and 9.6 (95% CI, 7.8–13.7) months in the non-antiviral group (log-rank test, P=0.044). Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS (P=0.008). Additionally, a further analysis was based on the stratification of the TNM tumor stages. In the subgroup of early stages, MST was significantly longer in the antiviral-treatment group than in the non-antiviral group (61.8 months [95% CI, 34.8 months to beyond the follow-up period] versus 26.2 [95% CI, 14.5–37.7] months, P=0.012). Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup (P=0.006). However, in the subgroup of advanced stages, MST of the antiviral-treated group was comparable to that of the non-antiviral group (8.4 [95%CI, 5.2–13.5] months versus 7.4 [95%CI, 5.9–9.3] months, P=0.219). Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup. Conclusion:Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC, especially in patients with early-stage tumors.

  17. Cisplatin Pharmacokinetics in Nontumoral Pig Liver Treated With Intravenous or Transarterial Hepatic Chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Chabrot, Pascal, E-mail: pchabrot@chu-clermontferrand.fr [CHU Clermont-Ferrand, Pole de Radiologie (France); Cardot, Jean-Michel [Universite d' Auvergne Clermont 1, Faculte de Pharmacie, Service de Biopharmacie (France); Guibert, Pierre; Bouculat, Francois [CHU Clermont-Ferrand, Pole Digestif et Hepato-Biliaire (France); Cassagnes, Lucie [CHU Clermont-Ferrand, Pole de Radiologie (France); Leger-Enreille, Anne [Centre Jean Perrin, Service de Biologie (France); Buc, Emmanuel [CHU Clermont-Ferrand, Pole Digestif et Hepato-Biliaire (France); Dechelotte, Pierre [CHU Clermont-Ferrand, Service d' Anatomie-Pathologique (France); Bommelaer, Gilles [CHU Clermont-Ferrand, Pole Digestif et Hepato-Biliaire (France); Boyer, Louis [CHU Clermont-Ferrand, Pole de Radiologie (France); Abergel, Armand [Universite d' Auvergne Clermont 1, Faculte de Medecine, ISIT, UMR CNRS 6284 (France)

    2012-12-15

    Purpose: To evaluate cisplatin (CDDP) pharmacokinetics after its intravenous (IV) or intrahepatic arterial administration (IHA) in healthy pigs with or without embolization by absorbable gelatine. Material and Methods: We analysed plasmatic and hepatic drug concentration in four groups of six mini-pigs each according to the modality of administration of CDDP (1 mg/kg): IV, IHA, IHA with partial embolization using absorbable gelatine (IHA-Pe), and IHA with complete embolization (IHA-Te). Unbounded plasmatic and hepatic platinum concentrations were measured. Concentration and pharmacokinetics parameters were compared using analysis of variance. Results: For all groups, there was a rapid and biexponential decrease in free platinum concentration. Plasmatic terminal half-life (T{sub 1/2}) was significantly decreased after embolization at 191, 178, 42, and 41 min after IV, IHA, IHA-Pe, and IHA-Te administration, respectively. Maximal plasmatic concentration and systemic exposure to CDDP (AUC{sub 24}) values were significantly decreased after embolization (C{sub max}p = 0.0075; AUC{sub 24}p = 0.0053). Hepatic CDDP concentration rapidly peaked and then decreased progressively. After 24 h, the residual concentration represented 45, 47, 60, and 63 % of C{sub max}, respectively, after IV, IHA, IHA-Pe, and IHA-Te. Hepatic T{sub 1/2} and AUC{sub {infinity}} values were increased after embolization, but the differences were not statistically significant. Conclusion: This preliminary study confirms the feasibility of a pig model to study systemic and hepatic CDDP pharmacokinetics. Systemic exposure is lower after embolization, which could minimize systemic toxicity. Hepatic T{sub 1/2} elimination and hepatic exposition values are increased with IHA compared with IV administration.

  18. Effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Ru-Juan Xu

    2016-01-01

    Objective:To study the effect of preoperative S-1 combined with regional transcatheter arterial chemoembolization on malignant degree of locally advanced gastric cancer. Methods:A total of 134 patients who were diagnosed with advanced gastric cancer in our hospital from May 2012 to December 2014 were selected for study, received surgical resection after chemotherapy, and were divided into intravenous chemotherapy group and combined treatment group according to different chemotherapy regimens. After chemotherapy and before operation, serum tumor marker levels were detected;after operation, recurrence and metastasis-related molecule levels in tumor tissue were detected. Results:After chemotherapy and before operation, serum CEA, CA199, CA72-4, TSGF, ESM-1 and DKK-1 levels of combined treatment group were significantly lower than those of intravenous chemotherapy group;TET1, TET2, LATS1 and RUNX3 levels in tumor tissue of combined treatment group were higher than those of intravenous chemotherapy group while Sipa1, GOLPH3, AEP, MT2-MMP, OPN, Galectin-1, Galectin-3 and Galectin-9 levels were lower than those of intravenous chemotherapy group. Conclusions:Compared with systemic intravenous chemotherapy, preoperative S-1 combined with regional transcatheter arterial chemoembolization can more effectively kill gastric cancer cells and prevent tumor recurrence and metastasis at molecular level.

  19. A ssessment of the malignant biology and bone metabolism after transcatheter vertebral arterial chemoembolization combined with zoledronic acid treatment of vertebral metastasis from lung cancer

    Institute of Scientific and Technical Information of China (English)

    Wei Lu; Zhe Zhang; Chao Yang; Jia-Cheng Zhang; Jun-Peng Ma; Peng Du; Jian Yang; Fu-Qiang Jiang; Xin-Li Jin; Peng Xie

    2016-01-01

    Objective:To study the malignant biology and bone metabolism after transcatheter vertebral arterial chemoembolization combined with zoledronic acid treatment of vertebral metastasis from lung cancer.Methods: A total of 46 cases of patients with vertebral metastasis from lung cancer treated in our hospital between May 2012 and December 2015 were selected and divided into two groups, observation group (n=23) received transcatheter vertebral arterial chemoembolization combined with zoledronic acid treatment and control group only received transcatheter vertebral arterial chemoembolization therapy. Eight weeks after treatment, serum was collected to determine the levels of tumor markers, invasive molecules and bone transformation indicators.Results:8 weeks after treatment, serum CEA, NSE, Cyfra21-1, TK1, RCAS1, CatB, CatD, CatX, MMP7, MMP9, MMP13, N-MID, BALP, OC, PINP,β-CTX, NTX, ICTP and TRACP5b levels of observation group were significantly lower than those of control group.Conclusions:Transcatheter vertebral arterial chemoembolization combined with zoledronic acid treatment can more effectively kill the cancer cells in vertebral metastases, inhibit the secretion of protease and regulate bone metabolism balance.

  20. Effect of preoperative transcatheter arterial chemoembolization on proliferation of hepatocellular carcinoma cells

    Institute of Scientific and Technical Information of China (English)

    En-Hua Xiao; Jing-Qing Li; Jie-Fu Huang

    2007-01-01

    AIM: To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on proliferation of hepatocellular carcinoma (HCC) cells.METHODS: A total of 136 patients with HCC underwent liver resection. Of 136 patients, 79 patients received 1 to 5 courses of TACE prior to liver resection (TACE group),who were further subdivided into four groups: Group A (n = 11) who received 1 to 4 courses of chemotherapy alone; Group B (n = 33) who received 1 to 5 courses of chemotherapy combined with iodized oil; Group C (n = 23) who received 1 to 3 courses of chemotherapy combined with iodized oil and gelatin sponge; and Group D (n = 12) who received 1 to 3 courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge.The other 57 patients only received liver resection (nonTACE group). The expressions of Ki-67 and proliferating cell nuclear antigen (PCNA) protein were detected in the liver cancer tissues by immunohistochemical method.RESULTS: The Ki-67 protein expression was significantly lower in Groups C and D as compared with non-TACE group (31.35% ± 10.85% vs 44.43% ± 20.70%,30.93% ± 18.10% vs 44.43% ± 20.70%, respectively, P < 0.05). The PCNA protein expression was significantly lower in Groups C and D as compared with non-TACE group (49.61% ± 15.11% vs 62.92% ± 17.21%, 41.16% ± 11.83% vs 62.92% ± 17.21%, respectively, P < 0.05).The Ki-67 protein expression was significantly higher in Group A as compared with non-TACE group (55.44% ± 13.72% vs 44.43% ± 20.70%, P < 0.05). The PCNA protein expression was significantly higher in Groups A and B as compared with non-TACE group (72.22% ± 8.71% vs 62.92% ± 17.21%, 69.91% ± 13.38% vs 62.92% ± 17.21%, respectively, P <0.05).CONCLUSION: Preoperative multi-material TACE suppresses the proliferation of HCC cells, while a single material embolization and chemotherapy alone enhance the proliferation of HCC cells.

  1. Analysis of the Curative Effect of Preoperative Intra-Arterial Infusion Chemoembolization on Stage,IB2-IIB Uterine Cervix Cancer

    Institute of Scientific and Technical Information of China (English)

    Huashu Li; Fuxiang Liu; Guohe Zhou; Zhaoxia Mo

    2008-01-01

    OBJECTIVE To investigate the short-term and long-term therapeutic efficacy of preoperative intra-arterial infusion chemo-embolization on stage IB2-IIB Uterine cervix cancer (UCC). METHODS A total of 143 patients with Stage IB2-lIB UCC were divided into a clinical trial group and a control group. The patients in the clinical trial group (n/=86) were treated with a combined therapy, i.e. preoperative intra-arterial infusion chemo-embolization, surgical therapy and postoperative radiotherapy, and those in the control group(n=57)were given surgical therapy and post-operative radiotherapy. The adverse effects, changes in local lesion and pathological examinations of the cancer, and the state during the surgery were observed after the intra-arterial infusion chemo-embolization. The survival rate and recurrence rate between the two groups were compared. RESUITS The total effective rate of the intra- arterial infusion chemo-embolization on Stage IB2-IIB UCC was 93.02%. The treatment could reduce tumor size, bring about retro-conversions of the clinical stage of the tumors and pathological grade of the cancer cells, and decrease the quantity, of intra-operative blood loss as well as the operating time. It could significantly improve the 5-year survival rate (P<0.05), and reduce the 2 and 5-yeartumor recurrence rates(P<0.05). Moreover, its side effects were little. CONCLUSIOAN Preoperative intra-arterial infusion chemo-embolization can create conditions for radical operation, lower the postoperative recurrence rate, and improve the prognosis in the patients with UCC. It is an effctive therapy in treating UCC.

  2. Hepatic arterial embolization in patients with neuroendocrine tumors

    Science.gov (United States)

    2014-01-01

    Liver metastases occur in 46-93% of patients with neuroendocrine neoplasms (NENs). Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patient’s quality of life, because of either tumor bulk or hormonal hypersecretion. Therapies for NEN liver metastases include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy, but in most of NEN patients with liver metastases, when surgery can not be applied, minimally invasive therapeutic approaches are adopted. They include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), radiofrequency thermal ablation and new emerging techniques. TAE is based on selective infusion of particles in the branch of the hepatic artery supplying the tumor lesions. The goal of TAE is to occlude tumor blood vessels resulting in ischemia and necrosis. Many reports have shown that TAE can reduce tumor size and hormone output, resulting in palliation of symptoms without the use of cytotoxic drugs, resulting in better tolerability. This review will focus on TAE performance and safety in NEN patients with liver metastases. PMID:24887262

  3. Transcatheter Arterial Chemoembolization With Gelatin Sponge Microparticles Treated for BCLC Stage B Hepatocellular Carcinoma: A Single Center Retrospective Study.

    Science.gov (United States)

    Kamran, Asad Ullah; Liu, Ying; Li, Feng E; Liu, Song; Wu, Jian Lin; Zhang, Yue Wei

    2015-12-01

    Gelatin sponge particles are commonly used in the conventional transarterial chemoembolization (c-TACE) as an adjuvant embolizing agent for hepatocellular carcinoma (HCC). However, there are few reports regarding the clinical applications of gelatin sponge microparticles (GSMs) as a main embolizing agent in the treatment of HCC. This retrospective study aim to evaluate the efficacy and safety of patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC treated with intra-arterial injection of 350 to 560 μm GSMs mixed with anticancer agents.Twenty-four patients with unresectable BCLC stage B HCC without any prior treatment underwent transarterial chemoembolization with gelatin sponge microparticles (GSMs-TACE) of diameter 350 to 560 μm mixed with lobaplatin. The mixture was injected into tumor-feeding arteries until the sluggish flow in selective artery. Safety was measured by assessing complication rate, and efficacy was reflected by assessing response to mRECIST therapy and overall survival. The survival rate was calculated using the Kaplan-Meier method.All 24 BCLC stage B HCC patients showed good tolerance to the procedure. The mean follow-up period was 27 months and mean number of TACE treatments per patient was 3.7 sessions (range 1-10) during the follow-up period. Postprocedure complications were mild and treated by symptomatic treatment. Six months and 1 year overall survival rates were 100% and 87.5%, respectively. Overall median survival time was 25 months (95%CI: 21.06-28.95 months).GSMs-TACE is a safe and effective method for BCLC stage B HCC patients.

  4. Multidetector CT of hepatic artery pathologies.

    Science.gov (United States)

    Karaosmanoglu, D; Erol, B; Karcaaltincaba, M

    2012-01-01

    The hepatic artery can be involved by a variety of pathology and diseases.Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT.

  5. Doxorubicin-eluting bead vs conventional transcatheter arterial chemoembolization for hepatocellular carcinoma before liver transplantation

    Science.gov (United States)

    Nicolini, Daniele; Svegliati-Baroni, Gianluca; Candelari, Roberto; Mincarelli, Cinzia; Mandolesi, Alessandra; Bearzi, Italo; Mocchegiani, Federico; Vecchi, Andrea; Montalti, Roberto; Benedetti, Antonio; Risaliti, Andrea; Vivarelli, Marco

    2013-01-01

    AIM: To assess the possible effect of two different types of preoperative transcatheter arterial chemoembolization (TACE) on recurrence-free survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) and to analyze the effects of TACE on tumor histology. METHODS: We retrospectively analyzed the histological features of 130 HCC nodules in 63 native livers removed at transplantation. Patients who received any other type of treatment such as radiofrequency tumor ablation, percutaneous ethanol ablation or who were not treated at all were excluded. All patients in the present study were within the Milan Criteria at the last imaging findings before transplantation. Doxorubicin-eluting bead TACE (DEB-TACE) was performed in 22 patients (38 nodules), and conventional TACE (c-TACE) in 16 (25 nodules). Patients’ and tumors’ characteristics were retrospectively reviewed. We performed a per-nodule analysis of the explanted livers to establish the mean percentage of necrosis of any nodule treated by TACE (conventional or DEB) and a per-patient analysis to establish the percentage of necrosis in the cumulative tumor area, including 21 nodules not reached by TACE. Inflammatory and fibrotic changes in the tissue surrounding the tumor nodule were analyzed and categorized as poor/absent, moderate and enhanced reaction. Uni- and multivariate analysis of risk factors for HCC-recurrence were performed. RESULTS: The number and diameter of the nodules, the time spent on the waiting list and the number of treatments were similar in the two groups. A trend towards higher appropriate response rates (necrosis ≥ 90%) was observed in the DEB-TACE group (44.7% vs 32.0%, P = 0.2834). The mean percentage of necrosis in the cumulative tumor area was 58.8% ± 36.6% in the DEB-TACE group and 50.2% ± 38.1% in the c-TACE group (P = 0.4856). Fibrotic and inflammatory reactions surrounding the tumor nodule were markedly more common in the DEB-TACE group (P < 0

  6. Primary hepatic carcinoid tumor

    Directory of Open Access Journals (Sweden)

    Gao Jinbo

    2011-11-01

    Full Text Available Abstract Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

  7. An Aberrant Artery Arising From Common Hepatic Artery

    Directory of Open Access Journals (Sweden)

    Surekha D. Jadhav

    2015-01-01

    Full Text Available Common hepatic artery is the branch of celiac trunk which is chief artery of the foregut. Branches of celiac trunk supply the gastrointestinal tract and its associated glands which are derived from foregut. Anatomy and variations of hepatic arterial system have become increasingly important due to increasing number of laparoscopic procedures, oncologic surgical interventions, and organ transplant cases. This case report describes a rare anatomical variation of an aberrant artery arising from common hepatic artery before the origin of gastroduodenal artery and proper hepatic artery.The aberrant artery traversed inferiorly and behind the body of the pancreas which divided into a right and left branches. The right branch ran behind the neck of the pancreas and it ended after giving few branches to head and body of pancreas. However, the left branch gave off branches to the proximal part of the jejunum. The presence of a branch arising directly from the common hepatic artery supplying the pancreas and jejunum is uncommon. Knowledge of such a rare variation is important not only for surgeons but also interventional radiologists and those studying anatomy

  8. The safety and efficacy of hemostasis with Clo-Sur P.A.D. after transcatheter arterial chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Chai; Jae, Hwan Jun; Kim, Sang Youn; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to evaluate the safety and efficacy of a new hemostatic device, Clo-Sur P.A.D., at an arterial access site after performing femoral arterial catheterization to achieve transcatheter arterial chemoembolization (TACE). From August 2002 to March 2005, 113 patients who underwent TACE and agreed on using the Clo-Sur P.A.D. were enrolled in this study. We evaluated the mean time interval from compression to the first movement and also to the first walk. We also evaluated such complications as rebleeding, pseudoaneurysm, vascular occlusion, hematoma, infection and pain. For 92 patients who had previous experiences with manual compression, we evaluated their preference of hemostatic method by asking them. Successful hemostasis was achieved with the Clo-Sur P.A.D. in 105 subjects (92%). The mean time interval from compression to the first movement was 201 minutes, and that to the first walk was 267 minutes. There was no statistical difference between the complicated and the uncomplicated groups for the mean time, prothrombin time, Child-Pugh class and platelet count ({rho} > 0.05). Rebleeding occurred in 3 patients (2.7%) and mild hematoma around puncture site was noted in 5 patients (5.4%). Eighty-seven patients (95%) preferred Clo-Sur P.A.D. to the manual compression method. The Clo-Sur P.A.D. is a safe and effective hemostatic device and it provides early ambulation after TACE.

  9. Prospective Evaluation of Transcatheter Arterial Chemoembolization (TACE) with Multiple Anti-Cancer Drugs (Epirubicin, Cisplatin, Mitomycin C, 5-Fluorouracil) Compared with TACE with Epirubicin for Treatment of Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sahara, Shinya; Kawai, Nobuyuki; Sato, Morio, E-mail: morisato@mail.wakayama-med.ac.jp; Tanaka, Takami; Ikoma, Akira; Nakata, Kouhei; Sanda, Hiroki; Minamiguchi, Hiroki; Nakai, Motoki; Shirai, Shintaro; Sonomura, Tetsuo [Wakayama Medical University, Department of Radiology (Japan)

    2012-12-15

    Purpose: To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC). Materials and Methods: The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group. Results: No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p = 0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p = 0.019). Conclusion: TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.

  10. Effects of preventive transcatheter arterial chemoembolization on the recurrence of hepatitis B-related small hepatocellular carcinoma after radical resection%乙型病毒性肝炎相关小肝癌术后预防性肝动脉栓塞化疗对术后复发的影响

    Institute of Scientific and Technical Information of China (English)

    王宗琰; 林孔英; 陶其飞; 黄罡; 王若愚; 杨远; 潘泽亚; 林川; 周伟平

    2016-01-01

    =0.008,P>0.05).(2)影响肿瘤复发的单因素和多因素分析:对配比后的674例患者进行术后肿瘤复发单因素分析结果显示:性别、术前HBV-DNA水平、术前ALT、HBeAg、术前AFP、肿瘤数目、镜下子灶、镜下微血管癌栓、肝纤维化或肝硬化、抗病毒治疗是影响乙型病毒性肝炎相关小肝癌患者术后肿瘤复发的相关因素(HR=0.593,1.454,0.660,1.400,1.311,1.789,1.303,1.358,1.307,0.743,95%可信区间:0.423 ~0.830,1.159 ~1.823,0.534 ~0.816,1.132 ~1.733,1.005~1.709,1.027~3.115,1.040~1.631,1.048 ~ 1.759,1.102~ 1.549,0.595~0.926,P<0.05).多因素分析结果显示:男性、术前HBV-DNA水平≥200 U/mL、术前ALT≥40 U/L、HBeAg阳性、镜下血管癌栓、肝纤维化或肝硬化、术后未接受抗病毒治疗为影响肿瘤复发的独立危险因素(HR =0.645,1.285,0.758,1.419,1.497,1.291,0.629,95%可信区间:0.455 ~0.916,1.001 ~ 1.649,0.604 ~0.951,1.128 ~ 1.784,1.134~1.976,1.084~1.538,0.500 ~0.792,P<0.05).结论 预防性TACE治疗不能降低乙型病毒性肝炎相关小肝癌术后复发率,因此不建议采用预防性TACE治疗.患者性别为男性,术前HBV-DNA水平≥200 U/mL、术前ALT≥40 U/L、HBeAg阳性、镜下血管癌栓、肝纤维化或肝硬化、术后未接受抗病毒治疗为影响乙型病毒性肝炎相关小肝癌术后复发的独立危险因素.%Objective To investigate the effects of preventive transcatheter arterial chemoembolization (TACE) on the recurrence of hepatitis B-related small hepatocellular carcinoma (HCC) after radical resection.Methods The retrospective case-control study was adopted by using propensity score matching (PSM) analysis.The clinicopathological data of 795 patients with small HCC who were admitted to the Eastern Hepatobiliary Surgery Hospital between January 2008 and December 2010 were collected,including 337 receiving preventive TACE treatment and 458 not receiving preventive TACE treatment.All the

  11. Right hepatic artery crossing the common hepatic artery: an unusual blood supply to the liver.

    Science.gov (United States)

    Felli, Emanuele; Vennarecci, Giovanni; Santoro, Roberto; Guglielmo, Nicola; Ettorre, Giuseppe Maria

    2016-04-01

    To perform hepatic surgery a precise preoperative and intraoperative study of liver vascular supply is mandatory. Detecting vascular variations may have great importance on surgical strategy and outcome, and details of anatomy do not concern only academical knowledge but become deeply involved in practice. We present a case of unusual blood supply to the liver, the common hepatic artery was directed to the right liver and a right hepatic artery originating from the superior mesenteric artery was directed to the left liver. The right hepatic artery crossed the common hepatic artery in the proximal part of the hepatic pedicle, anterior to the portal vein. To our knowledge this type of anatomical variation has not been described before and it represents a rare finding that has to be kept in mind, especially in case of major hepatectomies and more demanding splitting liver procedures such as A.L.P.P.S., in situ split, ex situ split and living donor liver transplantation.

  12. Arsenic trioxide treatment of rabbit liver VX-2 carcinoma via hepatic arterial cannulation-induced apoptosis and decreased levels of survivin in the tumor tissue.

    Science.gov (United States)

    Li, Hong; Gong, Jian; Jiang, Xuyuan; Shao, Haibo

    2013-02-01

    To investigate the role of tumor apoptosis-inhibitory protein survivin in arsenic trioxide-induced apoptosis in VX-2 carcinoma in the rabbit liver by means of transcatheter arterial chemoembolization. Sixteen rabbits with 32 implanted hepatic VX-2 tumors were randomly divided into two groups. The experimental group received 2 mg of arsenic trioxide and 1 mL of ultra-fluid lipiodol co-injected via hepatic arterial cannulation and the control group received only 1 mL of lipiodol. Animals were sacrificed 3 weeks after trans-catheterial arterial chemoembolization. Tumor tissue and tumor-peripheral tissue were collected for analysis. Terminal deoxynucleotidyl transferase-mediated dUTP nick-end-labeling staining was used to assess tumor cells apoptosis. Immunohistochemistry was used to assess the presence of survivin protein. Reverse transcription polymerase chain reaction was used to determine the expression of survivin gene. The number of apoptotic cells significantly increased in the tumor tissue (5.20 ± 0.60%) compared to tumor-peripheral tissue (1.29 ± 0.42%) of the arsenic trioxide-treated group. Survivin expression levels in the tumor tissue were significantly reduced in arsenic trioxide-treated group (7.68 ± 0.65) compared to the control group (35.30 ± 4.63). Transcatheter arterial chemoembolization with arsenic trioxide induced apoptosis of VX-2 carcinoma, in which tumor apoptosis-inhibitory protein survivin may have played a role.

  13. Abdominal Skin Rash After TACE Due to Non-Target Embolization of Hepatic Falciform Artery.

    Science.gov (United States)

    Nagpal, Prashant; Bhalala, Mitesh; Vidholia, Aditi; Sao, Rahul; Sharma, Nisha; Mehta, Dhruv; McCabe, Sam; Bodin, Roxana

    2016-04-01

    Transcatheter arterial chemoembolization (TACE) is a well-recognized procedure for management of hepatocellular carcinoma. We present a 54-year-old man who presented with a periumbilical maculopapular skin rash that developed after an otherwise uneventful TACE procedure. A retrospective review of imaging was consistent with non-target embolization of the hepatic falciform artery (HFA). He was treated with oral non-steroidal antiinflammatory medication for 3 weeks with improvement, but had slight skin induration and an excoriated papule at 6-month follow-up. Non-target embolization of HFA is very rare, but clinicians and interventionalists should be aware of this complication, especially in patients predisposed to enlargement of HFA.

  14. Symptomatic pulmonary lipiodol embolism after transarterial chemoembolization for hepatic malignant tumor: clinical presentation and chest imaging findings

    Institute of Scientific and Technical Information of China (English)

    Xu Haifeng; Yang Renjie; Wang Xiaodong; Zhu Xu; Chen Hui

    2014-01-01

    Background Pulmonary lipiodol embolism after transarterial chemoembolization (TACE) was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven (2.3%) of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was (13.6±2.0) cm.All were hyper-vascular.The mean volume of lipiodol was (21.8±8.2) ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature.

  15. Changes of tumor microcirculation after transcatheter arterial chemoembolization:First pass perfusion MR imaging and Chinese ink casting in a rabbit model

    Institute of Scientific and Technical Information of China (English)

    Jun-Gong Zhao; Gan-Sheng Feng; Xiang-Quan Kong; Xin Li; Ming-Hua Li; Ying-Sheng Cheng

    2004-01-01

    AIM: To observe the change of tumor microcirculation after transcatheter arterial chemoembolization (TACE) with bletilla microspheres by using first pass perfusion MR imaging (FP) and Chinese ink casting.METHODS: VX2 carcinoma cells were surgically implanted into the left and right lobes of liver of 30 New Zealand white rabbits, which were divided into 3 groups at random. Emulsion of lipiodol mixed with mitomycin C, and 5-FU bletilla microspheres were injected into the hepatic artery respectively, and saline was used as control agent. MR imaging was performed with turbo-flash sequence 14 d after tumor implantation and 7 d after interventional therapy. The steepest slopes (SS) of the signal intensity versus time curves were created for quantitative analysis, 7.5% Chinese ink gelatin solution was injected through ascending artery (17 cases) or portal vein (2 cases) for lesion microvessel area (MVA) measurement after the last MRI examination.The correlation between perfusion imaging and MVA was studied blindly.RESULTS: The SS values at the rim of tumor in lipiodol group (mean, 49% per second) and bletilla group (mean,35% per second) were significantly decreased (P<0.05) as compared with control group (mean, 124% per second), no difference was found between lipiodol and bletilla groups (P>0.05). In lipiodol group, the MVAs (24 974±11 836 μm2) in the center of the tumor were significantly smaller than those of the control group (35 510±15 675 μm2) (P<0.05),while the MVAs (80 031±22 745 μm2) around the tumor were significantly increased because small and dense plexuses appeared around the tumor which correlated to intense reaction of granulation tissue. None of the vessels was seen in the tumor in bletilla group, the peripheral MVAs of the tumor were significantly smaller than those of the control group (P<0.05) and lipiodol group (P<0.05). There was a good correlation between SS and MVAs in control group (rs, 0.985, P<0.0001) and bletilla group (rs, 0

  16. Assessment of hepatocellular carcinoma vascularity before and after transcatheter arterial chemoembolization by using first pass perfusion weighted MR imaging

    Institute of Scientific and Technical Information of China (English)

    Jun-Gong Zhao; Gan-Sheng Feng; Xiang-Quan Kong; Xin Li; Ming-Hua Li; Ying-Sheng Cheng

    2004-01-01

    AIM: To assess the vascularity of hepatocellular carcinoma (HCC)before and after transcatheter arterial chemoembolization (TACE) with the quantitative parameters obtained by first pass perfusion weighted MR imaging (FP-MRI).METHODS: Seventeen consecutive patients with one to three lesions in liver underwent FP-MRI before treatment.FP-MRI was also performed one, three, six, nine months,and one year after TACE. The baseline signal intensity (SO)of pre-TACE and one month after TACE was analyzed, the vascularity of HCC assessed by steepest slope of the signal intensity versus time curves (SS) was blindly correlated with their DSA feature and clinical outcome.RESULT: No significant difference was found on baseline signal intensity (SO) between pre-TACE and one month after TACE (F=0.309, P=0.583), The SS (mean, 32% per second) of lesion one month after TACE was lower than that of pre-TACE (mean, 69% per second), but with no statistical significance (F=3.067, P=0.092). When local recurrence occurred, the time intensity curves became steeper. The vascularity of HCC before and after TACE graded by SS closely correlated with that by DSA (K=0.453, P<0.05).CONCLUSION: FP-MRI is a useful criterion for selecting effective interventional treatment for patients with HCC in their initial treatment and during follow up.

  17. Parametric response mapping of dynamic CT for predicting intrahepatic recurrence of hepatocellular carcinoma after conventional transcatheter arterial chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Joon; Kim, Hyung Sik [Gachon University Gil Hospital, Department of Radiology, Incheon (Korea, Republic of); Kim, Jonghoon [Sungkyunkwan University, Department of Electronic Electrical and Computer Engineering, Suwon (Korea, Republic of); Seo, Jongbum [Yonsei University, Department of Biomedical Engineering, Wonju (Korea, Republic of); Lee, Jong-min [Hanyang University, Department of Biomedical Engineering, Seoul (Korea, Republic of); Park, Hyunjin [Sungkyunwkan University, School of Electronic and Electrical Engineering, Suwon (Korea, Republic of)

    2016-01-15

    The aim of our study was to determine the diagnostic value of a novel image analysis method called parametric response mapping (PRM) for prediction of intrahepatic recurrence of hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (TACE). This retrospective study was approved by the IRB. We recruited 55 HCC patients who achieved complete remission (CR) after TACE and received longitudinal multiphasic liver computed tomography (CT). The patients fell into two groups: the recurrent tumour group (n = 29) and the non-recurrent tumour group (n = 26). We applied the PRM analysis to see if this technique could distinguish between the two groups. The results of the PRM analysis were incorporated into a prediction algorithm. We retrospectively removed data from the last time point and attempted to predict the response to therapy of the removed data. The PRM analysis was able to distinguish between the non-recurrent and recurrent groups successfully. The prediction algorithm detected response to therapy with an area under the curve (AUC) of 0.76, while the manual approach had AUC 0.64. Adopting PRM analysis can potentially distinguish between recurrent and non-recurrent HCCs and allow for prediction of response to therapy after TACE. (orig.)

  18. Neoadjuvant transcatheter arterial chemoembolization does not provide survival benefit compared to curative therapy alone in single hepatocellular carcinoma.

    Science.gov (United States)

    Yeh, Ming-Lun; Huang, Ching-I; Huang, Chung-Feng; Hsieh, Ming-Yen; Huang, Jee-Fu; Dai, Chia-Yen; Lin, Zu-Yau; Chen, Shinn-Cherng; Yu, Ming-Lung; Chuang, Wan-Long

    2015-02-01

    The role of transcatheter arterial chemoembolization (TACE) prior to curative therapy is still unclear. The aim of our study was to elucidate the survival of single hepatocellular carcinoma (HCC) and also to clarify whether TACE plus sequential curative therapy provides benefits in single HCC. A total of 470 patients with a diagnosis of single HCC between 2005 and 2010 were studied. The factors associated with clinical outcomes were analyzed. The outcomes between patients who underwent neoadjuvant TACE and those who did not were also compared. The 1-, 3-, and 5-year overall survival (OS) rates of all patients were 92.6%, 73.3%, and 59.6%, respectively. Child-Pugh class A [HR: 2.04, 95% confidence interval (CI): 1.277-3.254, p = 0.003], very early stage Barcelona Clinic Liver Cancer (BCLC) (HR: 2.03, 95% CI: 1.021-4.025, p = 0.043), tumor size class A (HR: 1.57, 95% CI: 1.068-2.294, p = 0.022) and curative-based therapy (HR: 1.51, 95% CI: 1.128-2.028, p = 0.006) were significantly associated with better DFS. Neoadjuvant TACE did not provide benefit compared with curative therapy alone in subgroup analysis. In conclusion, neoadjuvant TACE is not recommended in single HCC patients who may indicate for curative therapy. Copyright © 2014. Published by Elsevier Taiwan.

  19. Initial Experience with Balloon-Occluded Trans-catheter Arterial Chemoembolization (B-TACE) for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Mitsunari, E-mail: mitunari@med-shimane.u.ac.jp; Yoshizako, Takeshi, E-mail: yosizako@med.shimane-u.ac.jp; Nakamura, Tomonori, E-mail: t-naka@med.shimane-u.ac.jp; Nakamura, Megumi, E-mail: megumi@med.shimane-u.ac.jp; Yoshida, Rika, E-mail: yoshidar@med.shimane-u.ac.jp; Kitagaki, Hajime, E-mail: kitagaki@med.shimane-u.ac.jp [Shimane University Faculty of Medicine, Department of Radiology (Japan)

    2016-03-15

    PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.

  20. Quantitative Portal Vein Velocity of Liver Cancer Patients with Transcatheter Arterial Chemoembolization on Angiography

    Directory of Open Access Journals (Sweden)

    Yung-Jen Ho

    2012-01-01

    Full Text Available Objective. We applied optical flow method (OFM to quantify relative velocities of blood flow using digital subtraction angiography (DSA in the vascular analysis of hepatocellular carcinoma (HCC patients who underwent transarterial chemoembolization (TACE treatment. Methods. A total of 40 HCC patients treated by TACE were analyzed in this study. DSA imaging with a 12-inch field of view, 1024 × 1024 pixels and 4 frames/second was acquired. OFM developed for motion estimation is applied for blood flow estimation. Two acrylic phantoms were built to validate the method. Results. The relationship between the OFM and Doppler measurements was found linear with R2=0.99 for both straight and curved tube phantoms. Quantitative blood flow distribution images of the portal vein region were presented. After TACE, the minimum, maximum and mean velocities in the portal vein all decreased (P<0.05. Additionally, the velocity in the portal vein is significantly lower with a higher Child-Pugh score (P<0.01. Conclusions. The present technique provides add-on quantitative information of flows to DSA and the hemodynamic analysis in relative quantifications of blood flow in portal vein of hepatocellular carcinoma patients using DSA.

  1. Anomalous branching pattern of common hepatic artery: a case report

    Directory of Open Access Journals (Sweden)

    Sushant S. Das

    2014-08-01

    Full Text Available A number of hepatic artery variations exists which is continuously proving a hindrance for the surgeons and radiologists. During routine dissection in the subhepatic region in 50 year old male cadaver for undergraduate teaching, a variation in the branching pattern of common hepatic artery was noticed. We observed an unusual branching of the common hepatic artery into seven terminal branches, of which two were left hepatic arteries, two were right gastric arteries and the remaining three were right hepatic artery, cystic artery and gastroduodenal artery. Hepatic artery proper was absent. Embryological basis of these variations were discussed. The present case is a rarity and will further throw light on the knowledge of the hepatic artery variations, thus assisting surgeons and radiologists in various surgical and diagnostic procedures. [Int J Res Med Sci 2014; 2(4.000: 1740-1742

  2. Transarterial chemoembolization through collateral vessels in hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hye; Han, Joon Koo; Chung, Jin Wook; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1993-11-15

    We performed 70 procedures of transarterial chemoembolization (TAE) through extrahepatic collateral vessels (n=27) or parasitic feeders (n=18) in 45 hepatocellular carcinoma patients. The collaterals developed after interruption of the hepatic artery due to repeated TAE (n=17), surgical ligation (n=7)and primary celiac occlusion (n=3). Radiologic findings suggest the existence of parasitic or collateral supply for hepatocellular carcinoma were 1) a focal defect of Lipiodol retention on CT or plain film after TAE via the hepatic artery, 2) dilated and tortuous vessels around the mass on angiography, 3) persistent elevation of the level of serum alpha-fetoprotein or continuous clinical symptoms in spite of sufficient devascularization of the tumor via the hepatic artery, and 4) radiological findings of direct invasion into adjacent organ. The sites of the catheter placement were the inferior phrenic artery(n=19), omental branches(n=16), periportal collaterals (n=6), pancreaticodenal arcade (n=3), gastroduodenal artery(n=3), internal mammary artery (n=2), intercosal artery (n=2), lateral thoracic artery (n=1), bronchial artery (n=1), and colic branches (n=1). Masses feeded by the inferior phrenic and chest wall collaterals were usually located at the dome area of the liver, and the omental and gastroduodenal collaterals developed in the masses located at the inferior tip of the liver. After TAE via collateral vessels, 37 patients underwent follow-up study. In 18 cases(48%), the tumor favorably responded to TAE. Specific complications of collateral TAE were epigastric soreness (n=10), severe shoulder pain (n=4), and embolization of the spinal artery during embolization through the intercostal artery (n=1). In conclusion, various extrahepatic collateals are important alternative or addition routes for effective chemoembolization in patients with advanced hepatoma, and early recognition of the parasitic supply and the effort to perform TAE via collaterals is very

  3. Transcatheter arterial chemoembolization plus {sup 131}I-labelled metuximab versus transcatheter arterial chemoembolization alone in intermediate/advanced stage hepatocellular carcinoma: A systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Ze Xin; Liao, Ming Heng; Huang, Ji Wei [Dept. of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu (China); Wang, Xiao Xue [Dept. of Dermatovenereology, West China Hospital, Sichuan University, Chengdu (China)

    2016-11-15

    The aim of the study was to compare transcatheter arterial chemoembolization (TACE) plus 131I-labelled metuximab with TACE alone for hepatocellular carcinoma (HCC). A comprehensive search was conducted in PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Chinese BioMedical Literature Database with published date from the earliest to February 29th, 2016. No language restrictions were applied, but only prospective randomized controlled trials (RCTs) or non-RCTs were eligible for a full-text review. The primary outcome was the overall survival (OS) and effective rate (the rate of partial atrophy or complete clearance of the tumor lesion). The odds ratios (ORs) were combined using either the fixed-effects model or random-effects model. Eight trials (3 RCTs and 5 non-RCTs) were included, involving a total of 1121 patients. Patients receiving combined therapy of TACE plus {sup 131}I-labelled metuximab showed significant improvement in effective rate [OR = 4.00, (95% confidence interval [CI]: 2.40-6.66], p < 0.001), 1-year OS (OR = 2.03 [95% CI: 1.55-2.67], p < 0.001) and 2-year OS (OR = 2.57 [95% CI: 1.41-4.66], p = 0.002]. TACE plus {sup 131}I-labelled metuximab is more beneficial for treating advanced HCCs than TACE alone in terms of tumor response and OS. Large, multi-center, and blinded randomized trials are required to confirm these findings.

  4. Hepatic arterial buffer response fails to restore hepatic oxygenation after temporary liver dearterialization in canines.

    Science.gov (United States)

    Cruz, R J; Ribeiro, E A; Poli de Figueiredo, L F; Cantos, O R; Rocha e Silva, M

    2005-12-01

    Hepatic artery thrombosis is a rare but extremely troublesome condition after liver transplantation. Recently, urgent arterial revascularization has been used as rescue therapy, leading to improved graft and patient survivals. Hepatic artery ligation produces a progressive reduction in portal vein blood flow. Theoretically, a hyperemic response may be expected following hepatic artery reperfusion (hepatic artery buffer response, HABR). In this study, we tested the hypothesis that HABR can maintain adequate liver oxygenation after temporary liver dearterialization. Seven dogs (19.7 +/- 1.2 kg) subjected to 60 minutes of hepatic artery occlusion were observed for 120 minutes thereafter. Systemic hemodynamics was evaluated through Swan-Ganz and arterial catheters, and splanchnic perfusion by portal vein and hepatic artery blood flows (PVBF and HABF) via an ultrasonic flowprobe. Liver enzymes (ALT and LDH) and systemic and hepatic oxygen delivery (DO2hepat) were calculated using standard formulae. Hepatic artery occlusion induced a progressive reduction in PVBF and DO2hepat. A complete restoration of HABF after hepatic artery declamping was observed; however, the DO2hepat (33.3 +/- 5.9 to 16.5 +/- 5.9 mL/min) did not return to the baseline levels. Temporary hepatic artery occlusion induced a progressive decrease in portal vein blood flow during ischemia, an effect that continued during the reperfusion period. The hepatic artery blood flow was promptly restored after declamping. However, HABR was not able to restore hepatic oxygen delivery to baseline levels during the reperfusion period.

  5. Prognostic factors for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma complicated by portal vein tumor thrombus

    Directory of Open Access Journals (Sweden)

    ZHANG Cheng

    2016-01-01

    Full Text Available ObjectiveTo investigate the therapeutic effect of transcatheter arterial chemoembolization (TACE in patients with hepatocellular carcinoma (HCC complicated by portal vein tumor thrombus, and to identify related prognostic factors. MethodsThe clinical data of 152 HCC patients with portal vein tumor thrombus who were admitted to Xijing Hospital of Fourth Military Medical University and received TACE from January 2006 to December 2010 were analyzed retrospectively. The occurrence of post-TACE liver failure, upper gastrointestinal bleeding, and post-embolization syndrome was observed, and survival data and prognostic factors were analyzed. The Kaplan-Meier method was used to calculate cumulative survival rate, the log-rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. ResultsThe median survival time was 5.0 months, and the 6-, 12-, and 18-month cumulative survival rates were 37%, 18%, and 9%, respectively. Univariate analysis showed that tumor size, tumor type, involvement of both liver lobes, distant metastasis, and Child-Pugh class were the prognostic factors for TACE in HCC patients with portal vein tumor thrombus (χ2=5.108, 11.542, 6.036, 12.319, and 22.574, respectively, all P<0.05; multivariate analysis showed that tumor size, tumor type, distant metastasis, and Child-Pugh class were the independent prognostic factors (Wald values=11.243, 5.021, 7.651, and 25876, respectively, all P<0.05; Child-Pugh class was the only influencing factor for liver failure in HCC patients with portal vein tumor thrombus (P=0.015. ConclusionTACE is safe and effective in HCC patients with portal vein thrombus and good liver function. Tumor size, tumor type, distant metastasis, and Child-Pugh class are the main factors influencing survival, which provides a basis for clinicians to select appropriate interventional therapies.

  6. Transcatheter arterial chemoembolization combined with CT-guided percutaneous thermal ablation versus hepatectomy in the treatment of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Liang Zhang; Zhi-Mei Huang; Pei-Hong Wu

    2015-01-01

    Introduction:Transcatheter arterial chemoembolization (TACE) plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma (HCC). In this study, we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC. Methods:The clinical data of 137 HCC patients who sequentially received TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment (combination group) and 148 matched HCC patients who received hepatectomy (surgery group) between 2004 and 2011 were collected and analyzed. After TACE, multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver. Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis. Results:Of all 285 patients, 225 (79.0%) had cancerous lesions≤5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was 1–4 for each patient. The 1-, 3-, and 5-year overal survival rates were 95, 74%, and 67%in the combination group and 88, 66, and 47%in the surgery group, respectively (P=0.004);the corresponding recurrence-free survival rates for the two groups were 92, 69, and 61%and 75, 58, and 44%, respectively (P=0.001). In the multivariate analysis, treatment al ocation was an independent prognostic factor for survival. Only 60 patients in the combination group had sufficient imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients, whereas 20 new lesions were found in 11 of 148 patients in the surgery group. Conclusion:The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.

  7. Clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization in treatment of breast cancer with liver metastases

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    LI Liye

    2016-01-01

    Full Text Available ObjectiveTo investigate the clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization (TACE in the treatment of breast cancer with liver metastases. MethodsA total of 86 female breast cancer patients with liver metastases who were treated in the Affiliated Hospital of Shandong Academy of Medical Sciences from December 2012 to December 2014 were selected and equally divided into experimental group and control group. The patients in the control group received systemic chemotherapy, and those in the experimental group received systemic chemotherapy combined with TACE. The clinical effect, changes in lesions, and patients′ quality of life (QOL scores after treatment were compared between two groups. The t-test was applied for comparison of continuous data between the two groups, and the chi-square test was applied for comparison of categorical data between the two groups. ResultsThe experimental group had a significantly higher overall response rate than the control group (90.70% vs 58.14%, χ2=13.07, P=0.001. Compared with the control group, the experimental group had significantly smaller diameters of tumors and lymph nodes after treatment (t=4.26 and 4.63, both P<0.001, as well as significantly higher QOL scores at 3 and 6 months after treatment (t=6.30 and 3.89, both P<0001. ConclusionSystemic chemotherapy combined with TACE has a significant therapeutic effect in breast cancer patients with liver metastases, and can improve patients′ symptoms, reduce adverse drug reactions, and improve QOL. As a safe and reliable therapeutic method, it is worthy of clinical application.

  8. Idiopathic hepatic arterial malformation: a case report

    Institute of Scientific and Technical Information of China (English)

    郑蔚巍; 周康荣; 王佩芬; 陈祖望

    2003-01-01

    @@ Hepatic arterial malformation is a rare disorder which either origi nates idiopathically or may be associated with hereditary hemorrhagic telangiect asia (also known as Osler-Weber-Rendu disease). Although previous reports presented only descriptions of sonographic and angiographic findings,1-6 we present a case of splenic infarct caused by this disorder with CT and CTA findi ngs.

  9. 化学栓塞治疗血吸虫病大肠癌肝转移40例报道%REPORT OF SELECTIVE CHEMOEMBOLIZATION IN THE TREATMENT OF 40 SCHISTOSOMIASIS PATIENTS WITH HEPATIC METASTASES OF LARGE INTESTINAL CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    肖小炜

    2000-01-01

    为探讨血吸虫病大肠癌切除术后肝转移的化学治疗.对40例血吸虫病大肠癌肝转移患者行化学栓塞治疗,通过肝动脉的选择性血管造影术识别转移的营养血管,向该血管注射化学乳剂(由100 mg 5-Fu,10 mg MMC和10 ml超液化碘化罂粟油),然后用止血棉塞栓塞,直到血液不流动为止.结果显示,从第一次化学栓塞起,总的中数生存期为10个月.当肝硬化程度按Child-Pugh分级时,A级与B级的中数生存期较有肝外转移者高(P<0.02),分别为14个月和3个月;血管多的转移癌中数生存期较血管少的转移癌的中数生存期高,有显著差异(P<0.01);最常见的副作用是短暂的发热、腹痛和疲劳;在化疗过程中有3人死亡.血吸虫病大肠癌肝转移全身化疗的疗效不佳,且副作用较多,选择性化学栓塞治疗不仅疗效好,且副作用少,可预防肝功能衰竭,延长生存期.%In order to study the therapy of chemoembolization in schistosomiasis patients with hepatic metastases from large intestinal carcinoma.Forty schistosomiasis patients were treated with chemoembolization of metastatic liver lesion from colorectal carcinoma.Selective angiography of the hepatic artery was performed to identify the feeding vessels of the metastatic lesion.The injected chemoemulsion consisted of 100 mg of 5-fluorouracil,10 mg of mitomycin C and 10 ml of lipiodol ultra-fluide in a total volume of 30 ml .Gelfoam embolization then followed until stagnation of blood flow was achieved.The results indicated that overall median survival from the date of first chemoembolization was ten months.According to Child-Pugh classification,median survival of cirrhotic patients with class A and B were 24 and 3 months respectively,there were significant difference in median survival of cirrhotic patients with class A and B(P<0.01).Patients with metastatic disease confined to the liver did better than those who also had extrahepatic disease,with median survivals of

  10. First jejunal artery, an alternative graft for right hepatic artery reconstruction.

    Science.gov (United States)

    Aryal, Bibek; Komokata, Teruo; Kadono, Jun; Motodaka, Hiroyuki; Ueno, Tetsuya; Furoi, Akira; Imoto, Yutaka

    2015-04-01

    Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision and safe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery (JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.

  11. Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    De-Hua Wu; Li Liu; Long-Hua Chen

    2004-01-01

    AIM: To evaluate the therapeutic efficacy of threedimensional conformal radiotherapy (3D-CRT) combined with transcatheter arterial chemoembolization (TACE) on the patients with hepatocellular carcinoma (HCC).METHODS: Between 1998 and 2001, 94 patients with HCC received 3D-CRT combined with TACE. A total 63 patients had a Okuda stage Ⅰ lesion and 31 patients had stage Ⅱ. The median tumor size was 10.7 cm (range 3.0-18 cm), and liver cirrhosis was present in all the patients. There were 43 cases of class A and 51 class B. TACE was performed using lipiodol,5-fluorouracil, cisplatin, doxorubicin hydrochloride and mitomycin, followed by gelatin sponge cubes. Fifty-nine patients received TACE only one time, while the others 2 to 3 times. 3D-CRT was started 3-4 wk after TACE. All patients were irradiated with a stereotactic body frame and received 4-8 Gy single high-dose radiation for 8-12 times at the isocenter during a period of 17-26 d (median 22 d).RESULTS: The median follow-up was 37 mo (range 10-48 mo)after diagnosis. The response rate was 90.5%. The overall survival rate at 1-, 2-, and 3- year was 93.6%, 53.8% and 26.0% respectively, with the median survival of 25 mo. On univariate analysis, age (P=0.026), Child-Pugh classification for cirrhosis of liver (P=0.010), Okuda stage (P=0.026),tumor size (P=0.000), tumor type (P=0.029), albuminemia (P=0.035), and radiation dose (P=0.000) proved to be significant factors for survival. On multivariate analysis,age (P=0.024), radiation dose (P=0.001), and tumor size (P=0.000) were the significant factors.CONCLUSION: 3D-CRT combined with TACE is an effective and feasible approach for HCC. Age, radiation dose and tumor size were found to be significant prognostic factors for survival of patients with HCC treated by 3D-CRT combined with TACE. Further study for HCC is needed to improve the treatment efficacy.

  12. Neoadjuvant transcatheter arterial chemoembolization does not provide survival benefit compared to curative therapy alone in single hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Ming-Lun Yeh

    2015-02-01

    Full Text Available The role of transcatheter arterial chemoembolization (TACE prior to curative therapy is still unclear. The aim of our study was to elucidate the survival of single hepatocellular carcinoma (HCC and also to clarify whether TACE plus sequential curative therapy provides benefits in single HCC. A total of 470 patients with a diagnosis of single HCC between 2005 and 2010 were studied. The factors associated with clinical outcomes were analyzed. The outcomes between patients who underwent neoadjuvant TACE and those who did not were also compared. The 1-, 3-, and 5-year overall survival (OS rates of all patients were 92.6%, 73.3%, and 59.6%, respectively. Child-Pugh class A [HR: 2.04, 95% confidence interval (CI: 1.277–3.254, p = 0.003], very early stage Barcelona Clinic Liver Cancer (BCLC (HR: 2.03, 95% CI: 1.021–4.025, p = 0.043, tumor size < 5 cm (HR: 1.75, 95% CI: 1.115–2.751, p = 0.015, alpha fetoprotein (AFP level < 200 ng/mL (HR: 2.07, 95% CI: 1.346–3.182, p = 0.001, and curative-based therapy (HR: 2.16, 95% CI: 1.442–3.224, p < 0.001 were factors associated with better OS. The 1-, 3-, and 5-year disease-free survival (DFS rates of all the patients were 75.4%, 53.7%, and 36.3%, respectively. Only Child-Pugh class A (HR: 1.57, 95% CI: 1.068–2.294, p = 0.022 and curative-based therapy (HR: 1.51, 95% CI: 1.128–2.028, p = 0.006 were significantly associated with better DFS. Neoadjuvant TACE did not provide benefit compared with curative therapy alone in subgroup analysis. In conclusion, neoadjuvant TACE is not recommended in single HCC patients who may indicate for curative therapy.

  13. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...

  14. Rare anatomic variation of left gastric artery and right hepatic artery in a female cadaver.

    Science.gov (United States)

    Troupis, Theodore; Chatzikokolis, Stamatis; Zachariadis, Michael; Troupis, George; Anagnostopoulou, Sofia; Skandalakis, Panayiotis

    2008-05-01

    The present report describes a rare case in which the left gastric artery arises directly from the abdominal aorta and the right hepatic artery from the superior mesenteric artery, as observed during the dissection of a female cadaver. The left gastric artery usually rises as one of the three branches of the celiac trunk, which was originally described by Haller in 1756, whereas the right hepatic artery usually originates from the proper hepatic artery. The knowledge of the typical anatomy of the abdominal arteries, and their variations, is especially important due to the numerous interventions performed in the abdominal area.

  15. Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma

    Science.gov (United States)

    Cohen, Matan J; Bloom, Allan I; Barak, Orly; Klimov, Alexander; Nesher, Tova; Shouval, Daniel; Levi, Izhar; Shibolet, Oren

    2013-01-01

    AIM: To assess the safety and efficacy of trans-arterial chemo-embolization (TACE) in very elderly patients. METHODS: A prospective cohort study, from 2001 to 2010, compared clinical outcomes following TACE between patients ≥ 75 years old and younger patients (aged between 65 and 75 years and younger than 65 years) with hepatocellular carcinoma (HCC), diagnosed according to the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases criteria. The decision that patients were not candidates for curative therapy was made by a multidisciplinary HCC team. Data collected included demographics, co-morbidities, liver disease etiology, liver disease severity and the number of procedures. The primary outcome was mortality; secondary outcomes included post-embolization syndrome (nausea, fever, abdominal right upper quadrant pain, increase in liver enzymes with no evidence of sepsis and with a clinical course limited to 3-4 d post procedure) and 30-d complications. Additionally, changes in liver enzyme measurements were assessed [alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transpeptidase and alkaline phosphatase] in the week following TACE. Analysis employed both univariate and multivariate methods (Cox regression models). RESULTS: Of 102 patients who underwent TACE as sole treatment, 10 patients (9.8%) were > 80 years old at diagnosis; 13 (12.7%) were between 75 and 80 years, 45 (44.1%) were between 65 and 75 years and 34 (33.3%) were younger than 65 years. Survival analysis demonstrated similar survival patterns between the elderly patients and younger patients. Age was also not associated with the adverse event rate. Survival rates at 1, 2 and 3 years from diagnosis were 74%, 37% and 31% among patients < 65 years; 83%, 66% and 48% among patients aged 65 to 75 years; and 86%, 41% and 23% among patients ≥ 75 years. There were no differences between the age groups in the pre-procedural care

  16. [Study on targeting drug delivery system--the characteristics of methotrexate microsphere and experimental treatment of hepatic tumor in rats by arterial embolization].

    Science.gov (United States)

    Chen, Q H; Lu, W G; Ge, Q H; Sheng, Q; Zhang, Y; Xie, X H; Wang, Y; Wu, M C; Zhang, X H

    1991-01-01

    Preparation of methotrexate microsphere (MTX-ms) by emulsion-freezing technique was introduced and the experimental results proved that MTX entrapped in the microspheres exhibited good stabilities towards temperature, cobalt-60 radiation and light. The dissolution and inflation rate of the microspheres in pH 7.4 buffer solution at different times measured by Coulter counter was presented. Antitumor activity of MTX-ms after hepatic arterial embolization was examined in a model of liver tumor in Wistar rats. The group of rats treated with MTX-ms showed a rather significant reduction in tumor growth and more extended tumor necrosis as compared with the other groups, e.g. normal saline solution, MTX solution, placebo gelatin-ms and the results demonstrate that the effect of arterial chemoembolization used by MTX-ms is superior to that of the groups either using arterial chemotherapy or arterial embolization alone in treating rat liver cancer.

  17. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

    Institute of Scientific and Technical Information of China (English)

    HUANG Yuan; LIU Chao; LIN Jin-ling

    2013-01-01

    Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96%,including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

  18. Catheterization and embolization of a replaced left hepatic artery via the right gastric artery through the anastomosis: a case report

    Directory of Open Access Journals (Sweden)

    Miyazaki Masaya

    2011-08-01

    Full Text Available Abstract Introduction Conversion of multiple hepatic arteries into a single vascular supply is a very important technique for repeat hepatic arterial infusion chemotherapy using an implanted port catheter system. Catheterization of a replaced left hepatic artery arising from a left gastric artery using a percutaneous catheter technique is sometimes difficult, despite the recent development of advanced interventional techniques. Case presentation We present a case of a 70-year-old Japanese man with multiple hepatocellular carcinomas in whom the replaced left hepatic artery arising from the left gastric artery needed to be embolized. After several failed procedures, the replaced left hepatic artery was successfully catheterized and embolized with a microcatheter and microcoils via the right gastric artery through the anastomosis. Conclusion A replaced left hepatic artery arising from a left gastric artery can be catheterized via a right gastric artery by using the appropriate microcatheter and microguidewires, and multiple hepatic arteries can be converted into a single supply.

  19. Study of severe and rare complications of transarterial chemoembolization (TACE) for liver cancer

    Energy Technology Data Exchange (ETDEWEB)

    Xia Jinglin [Liver Cancer Institute, Zhongshan Hospital, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032 (China)]. E-mail: jlxia@zshospital.net; Ren Zhenggang; Ye Shenglong; Sharma Dilip; Lin Zhiying; Gan Yuhong; Chen Yi; Ge Ninglin; Ma Zengchen; Wu Zhiquan; Fan Jia; Qin Lunxiu; Zhou Xinda; Tang Zhaoyou; Yang Binghui [Liver Cancer Institute, Zhongshan Hospital, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032 (China)

    2006-09-15

    Objective: To study severe and rare complications of transarterial chemoembolization (TACE) for liver cancer. Methods: Clinical records of severe and rare complications following TACE in 1348 cases of liver cancer from January 1997 to February 2004 were studied retrospectively. Results: A total of 2012 TACE procedures were performed for 1348 patients. There were 3 cases of spontaneous rupture of liver cancer, 1 case of perforation of duodenum, 3 cases of liver abscess (1 of them was associated with sepsis), 1 case of pulmonary embolism, 1 case of spasm of the hepatic artery, 40 cases of hepatic artery occlusion, 3 cases of femoral nerve injury, 1 case of bilioma and 1 case of acute renal failure. Conclusion: Although the severe complications of TACE are rare, the procedure should be done cautiously including super selection of hepatic artery, slow infusion of lipiodol, careful postoperative observations and early detection and management of complications.

  20. Hepatic arterial infusion chemotherapy for patients with huge unresectable hepatocellular carcinoma.

    Science.gov (United States)

    Tsai, Wei-Lun; Lai, Kwok-Hung; Liang, Huei-Lung; Hsu, Ping-I; Chan, Hoi-Hung; Chen, Wen-Chi; Yu, Hsien-Chung; Tsay, Feng-Woei; Wang, Huay-Min; Tsai, Hung-Chih; Cheng, Jin-Shiung

    2014-01-01

    The optimal treatment for huge unresectable hepatocellular carcinoma (HCC) remains controversial. The outcome of transcatheter arterial chemoembolization (TACE) for patients huge unresectable HCC is generally poor and the survival benefit of TACE in these patients is unclear. The aim of the study is to compare the effect of hepatic arterial infusion chemotherapy (HAIC) versus symptomatic treatment in patients with huge unresectable HCC. Since 2000 to 2005, patients with huge (size >8 cm) unresectable HCC were enrolled. Fifty-eight patients received HAIC and 44 patients received symptomatic treatment. In the HAIC group, each patient received 2.4+1.4 (range: 1-6) courses of HAIC. Baseline characteristics and survival were compared between the HAIC and symptomatic treatment groups. The HAIC group and the symptomatic treatment group were similar in baseline characteristics and tumor stages. The overall survival rates at one and two years were 29% and 14% in the HAIC group and 7% and 5% in the symptomatic treatment group, respectively. The patients in the HAIC group had significantly better overall survival than the symptomatic treatment group (Phuge unresectable HCC.

  1. Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Shibata, Yoshihiro; Hashimoto, Masahiro; Yoshida, Miki; Tsuji, Kazunobu; Toshima, Fumihito [Fukuiken Saiseikai Hospital, Department of Diagnostic Radiology (Japan); Matsui, Osamu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

    2012-12-15

    Purpose: To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe. Methods: Twenty-eight HCCs with a mean {+-} SD tumor diameter of 3.4 {+-} 1.0 cm (range 1-4.4 cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1 week after TACE.ResultsTwenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3. Conclusion: This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.

  2. Transcatheter hepatic artery embolization of liver cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Yoo, Hyung Sik; Suh, Jung Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Yun, Heun Yung [Indiana University Hospital, Bloomington (United States)

    1985-12-15

    From March 1985 to September 1985, transcatheter hepatic arterial embolization was performed in 17 primary hepatoma and 8 metastasis of liver in Department of Radiology, Yonsei University College of Medicine. Metastasis cancers of liver were one nasopharyngeal cancer, one small bowel leiomyosarcoma, one gall bladder cancer and 5 colon cancers. The used embolization materials were the followings: Gelfoam particles for one primary hepatoma, 95% absolute ethanol for 4 patients, lvalon (250-590 {mu} m) for 19 patients and autologous blood clots for one metastasis. The results were summarized as the follows: 1. The devascularization of tumor vessels in post-embolization hepatic angiogram was complete in 6 primary hepatoma and one metastasis and partial in 11 primary hepatoma and 7 metastasis. 2. In the follow-up CT evaluation 3 to 4 weeks after embolization, well necrotic density was revealed in 8 primary hepatoma and one metastasis. 3. The complications were fever with higher than 38 .deg. C (92%), abdominal pain (72%) and nausea or vomiting (40%). They were subsided within one to 7 days after embolization. 4. In liver function study, sGOT and sGPT were elevated in 96% of total cases and retuned to normal within 3 to 7 days. Alkaline phosphatase was elevated in 80% of total cases and retuned to normal within 15 to 30 days. LDH was variable. In 4 cases of absolute ethanol infusion, above liver enzymes were markedly elevated as 10 times or more as normal range.

  3. RELATIONSHIP BETWEEN EFFICENCIES OF SEGMENTAL HEPATIC ARTERY CHEMOEMBOLIZATION AND PCNA LABELING INDEX IN HCC

    Institute of Scientific and Technical Information of China (English)

    李玉亮; 邵广瑞

    2004-01-01

    Objective: To evaluate the relationship between the efficiencies of subsegmental TAE and the expression of PCNA with ABC immunohistochemical staining in HCCs. Methods: Ultrasound-guided needle biopsies were performed in 43 patients (41 men, 2 women; age range: 32~75 years, mean, 55.6 years). PCNA were examined using ABC immunohistochemical staining. Tumor scores of PCNA were assessed by counting the positive nuclei per 1,000 cells. All the cases received subsegmental TAE with iodized oil and gelatin sponge. A correlation between the expression of PCNA and the efficiencies of subsegmental TAE was sought. Normality test, rank sum test and Chi-square test were used in statistical analyses with SAS package. Results: The mean PCNA labeling index was 58±29(range, 27-100%) in 43 patients. When compared with the macroscopic and pathologic parameters, PCNA labeling index was found to be significantly related to the presence and activity of cirrhosis. PCNA labeling index did not related to patients' age, sex, HbsAg status or serum α-fetoprotein level. The PCNA labeling index corresponded to the degree of histological differentiation (Edmenderson- Steiner grading). The survival rates after subsegmental TAE were respectively 86.05%, 65.12% and 51.16% in one-, two- and three-years, and were significantly higher in the low labeling index group than that in the high labeling index group. Conclusion: The PCNA labeling index was shown to be closely related to histological characteristics and survival of the patients.

  4. Multiple arterial phase MRI of arterial hypervascular hepatic lesions: improved arterial phase capture and lesion enhancement.

    Science.gov (United States)

    Ikram, Nabia S; Yee, Judy; Weinstein, Stefanie; Yeh, Benjamin M; Corvera, Carlos U; Monto, Alexander; Hope, Thomas A

    2017-03-01

    To establish if triple-phase arterial imaging improves the detection of arterial phase hyperintense lesions based on arterial phase capture, motion artifact degradation, and lesion enhancement when compared to single-phase imaging. Patients at risk for hepatocellular carcinoma were imaged at 3.0T. Seventy-three consecutive patients with a standard single-phase MRI and eighty-five consecutive patients were imaged using extracellular contrast with triple arterial phase MRI using three sequential accelerated acquisitions of 8 s. Arterial phase capture and image quality were qualitatively categorized. Forty single-phase and forty-four triple-phase studies contained arterially enhancing lesions > 1 cm with washout appearance. The contrast-to-noise ratio (CNR) of the lesions was calculated. We compared the differences in means with Student t-tests and those in arterial phase capture with a Chi squared test with Yates correction. The triple-phase acquisitions captured the early or late arterial phases more frequently than did the single-phase acquisition (99% vs 86%; P value = 0.006). Triple-phase also provided greater number of patients with early or late arterial phase imaging without motion artifact (92% vs 79%, P-value = 0.05). The lesion analysis revealed increased maximum CNR in the triple-phase imaging (704.4) vs. single-phase imaging (517.2), P-value phase acquisition provides more robust arterial phase imaging for hepatic lesions, with increased lesion CNR, compared to standard single-phase arterial phase imaging.

  5. Angiographic Findings of Extrahepatic Branches Originating from Hepatic Artery and Its Clinical Significance

    Institute of Scientific and Technical Information of China (English)

    Xiao-dong Wang; Ren-jie Yang

    2009-01-01

    Objective: To observe the presentation and variation of extrahepatic branches originating from hepatic artery by hepatic arteriography.Methods: Hepatic arteriogram of 200 cases with unresectable hepatic primary or metastatic tumors before interventional therapy were retrospectively analyzed. Two interventional radiologists independently reviewed the type, originating artery, distribution and variation of extrahepatic artery.Results: Five types of extrahepatic artery were found, with the most common type of the right gastric artery (n=156, 78%), followed by the cystic artery (n=126, 63%), accessory left gastric artery (n=19, 9.5%), hepatic falciform artery (n=5, 2.5%), and accessory left inferior phrenic artery (n=4, 2%). In 188 cases, there were extrahepatic arteries derived from hepatic proper artery or its branches, and the most frequent originating site was the right hepatic artery (130 extrahepatic branches), followed by the proper hepatic artery (103 branches), left hepatic artery (56 branches) and middle hepatic artery (3 branches). The left hepatic artery was the arising site with the multiple types of extrahepatic branches including all above branches except the cystic artery.Conclusion: Many types of extrahepatic branches usually derive from the hepatic artery or its distal branches, and its originating sites are not constant. It is important to avoid damage of extrahepatic tissue during interventional therapy for liver tumors.

  6. Relationship between the Changes of VEGF Level and Dendritic Cells in Peripheral Blood of Patients with Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

    Institute of Scientific and Technical Information of China (English)

    LIU jinwen; YI Jilin

    2007-01-01

    In order to investigate the relationship between the VEGF level and the counts of dendritic cells (DCs) in peripheral blood of patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), the peripheral blood was obtained from 37 patients with HCC who treated by TACE. The blood was obtained on the day before TACE, the first day, the 7th day and the 15th day after TACE respectively. The counts of DCs were quantified by flow cytometry. The plasma VEGF level was measured by ELESA kit. It was shown after TACE, the counts of DCs in peripheral blood were decreased significantly (P<0.05), and the VEGF level in peripheral blood was increased significantly (P<0.05). The counts of DCs in peripheral blood had an inverse correlation with the plasma VEGF level (r=-0.57, P<0.05) after TACE. It was concluded that in patients with HCC after TACE, the increased plasma VEGF level appeared to have the effect to suppress the maturation of DCs, which may contribute to reduction of the body's anti-tumor immunity effect, with a consequence of recur and metastasis of tumor.

  7. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: A time to event meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Xin; Hu, Yanan; Ren, Mudan; Lu, Xin Lan; Lu, Gui Fang; He, Shui Xiang [Dept. of Gastroenterology, First Affiliated Hospital of Xi' an Jiaotong University, Xi' an (China)

    2016-02-15

    To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.

  8. Aspartate aminotransferase-lymphocyte ratio index and systemic immune-inflammation index predict overall survival in HBV-related hepatocellular carcinoma patients after transcatheter arterial chemoembolization.

    Science.gov (United States)

    Yang, Zongguo; Zhang, Jianliang; Lu, Yunfei; Xu, Qingnian; Tang, Bozong; Wang, Qiang; Zhang, Wensi; Chen, Shishi; Lu, Lingqing; Chen, Xiaorong

    2015-12-15

    It has been suggested that lymphocytes play central roles in host antitumor immune responses and control cancer outcome. We reviewed the clinical parameters of 189 hepatocellular carcinoma (HCC) patients and investigated the prognostic significance of lymphocyte-related scores in HCC patients following transcatheter arterial chemoembolization (TACE). Survival analysis revealed that an elevated aspartate aminotransferase-lymphocyte ratio index (ALRI) > 57 and a systemic immune-inflammation index (SII) > 300 were negatively associated with overall survival in HBV-related HCC (HR = 2.181, P = 0.003 and HR = 2.453, P = 0.003; respectively). Spearman chi-square analysis showed that ALRI had a specificity of 82.4% and that SII index had a sensitivity of 71.9% for HCC overall survival. ALRI and SII had negative predictive values of 74.6% and 80%, respectively for HCC overall survival. Additionally, Barcelona Clinic Liver Cancer (BCLC) stage C patients had significantly higher ALRI and SII scores (both P SII scores (P SII should be used as negative predictive factors for overall survival in HBV-related HCC in clinical practice.

  9. Hepatic artery aneurysm: an unusual cause of upper gastrointestinal bleed.

    Science.gov (United States)

    Frank, Madeleine; Phillips, Rosemary; Aldin, Zaid; Ghosh, Deb

    2017-08-24

    An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did show a previously clipped Dieulafoy lesion. CT angiography showed an aneurysm arising from the hepatic artery. Selective coeliac artery angiogram showed aneurysmal dilatation of the distal part of the coeliac trunk and confirmed the presence of the common hepatic artery aneurysm. The aneurysm was coiled by the interventional radiologist. Final angiogram showed good flow through the hepatic artery with obliteration of the inferior patch. The procedure was uncomplicated and the patient was discharged shortly afterwards. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Spontaneous Hepatic Rupture Associated with Preeclampsia: Treatment with Hepatic Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Goo, Dong Erk; Chang, Yun Woo; Kim, Yong Jae; Hwang, In Cheol; Han, Hyo Sang; Yoon, Jong Hyun; Lee, Tae Il [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2010-02-15

    Spontaneous rupture of the liver due to preeclampsia is a rare condition of pregnant women, and it can be very dangerous if not treated. We report here on a case of successfully treating spontaneous liver rupture associated with preeclampsia by performing transcatheter hepatic arterial embolization. A 41-year-old woman with spontaneous rupture of the liver associated with preeclampsia was treated by hepatic arterial embolization

  11. Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Mingsheng; Wang, Haofan; Chen, Junwei; Bai, Mingjun; Wang, Long; Zhu, Kangshun; Jiang, Zaibo; Guan, Shouhai; Li, Zhengran; Qian, Jiesheng; Li, Mingan; Pang, Pengfei; Shan, Hong [Sun Yat-sen University, Department of Radiology, the Third Affiliated Hospital, Guangzhou (China); Sun Yat-Sen University, Department of Interventional Radiology, Ling-nan Hospital, Guangzhou (China); Sun Yat-sen University, Interventional Radiology Institute, Guangzhou (China); Lin, Qu [Sun Yat-sen University, Department of Oncology, the Third Affiliated Hospital, Guangzhou (China)

    2016-10-15

    To investigate the survival benefit of transarterial chemoembolization (TACE) plus Iodine125 seed implantation (TACE-Iodine125) in hepatitis B-related HCC patients with portal vein tumour thrombus (PVTT) and the underlying prognostic factors. A retrospective matched cohort study was performed on consecutive HCC patients with PVTT from January 2011 to June 2014. Seventy patients (TACE-Iodine125 group) who underwent TACE-Iodine125 were compared with a historical case-matched control group of 140 patients (TACE group) who received TACE alone. The survival of patients and the underlying prognostic factors were analysed. The median survival times of the TACE-Iodine125 and TACE groups were 11.0 and 7.5 months, respectively (p < 0.001). The survival probability at 12, 24, and 36 months was 50 %, 14.5 %, and 14.5 % vs. 25 %, 9 %, and 5 % in the TACE-Iodine125 and TACE groups, respectively (p < 0.001). The PVTT responders had better survival than the PVTT non-responders (p < 0.001). For the PVTT non-responders, there were no differences in the survival curves between the groups (p = 0.353). Multivariate analysis showed that type III PVTT (p < 0.001) and APS (p < 0.001) were independent predictors of poor prognosis. In contrast, the treatment modality of TACE-Iodine125 (p < 0.001) and PVTT response (p = 0.001) were favourable prognostic features. TACE combined with Iodine125 seed implantation may be a good choice for selected HB-HCC patients with PVTT. (orig.)

  12. Phase II Study of Chemoembolization With Drug-Eluting Beads in Patients With Hepatic Neuroendocrine Metastases: High Incidence of Biliary Injury

    Energy Technology Data Exchange (ETDEWEB)

    Bhagat, Nikhil, E-mail: nbhagat1@jhmi.edu; Reyes, Diane K., E-mail: dreyes@jhmi.edu [Johns Hopkins University Medical Center, Johns Hopkins Hospital, Division of Vascular and Interventional Radiology, Department of Radiology (United States); Lin, Mingde, E-mail: ming.lin@philips.com [Philips Research North America, Clinical Informatics, Interventional, and Translational Solutions (CIITS) (United States); Kamel, Ihab [Johns Hopkins University Medical Center, Johns Hopkins Hospital, Division of Vascular and Interventional Radiology, Department of Radiology (United States); Pawlik, Timothy M. [Johns Hopkins University Medical Center, Department of Surgery (United States); Frangakis, Constantine, E-mail: cfrangak@jhsph.edu [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health (United States); Geschwind, J. F., E-mail: jfg@jhmi.edu [Johns Hopkins University Medical Center, Johns Hopkins Hospital, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2013-04-15

    To evaluate safety in an interim analysis of transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEB) in 13 patients with hepatic metastases from neuroendocrine tumors (NETs) as part of a phase II trial. Institutional Review Board approval and informed consent were obtained. Thirteen patients completed preliminary safety analysis. Their mean age was 65 years, Eastern Cooperative Oncology Group status was 0/1, tumor burden range was 4-75 %, and mean targeted tumor size was 5.9 cm. Up to four DEB-TACE sessions (100-300 {mu}m beads loaded with {<=}100 mg doxorubicin) within 6 months were allowed. Tumor response was assessed by magnetic resonance imaging 1 month after treatment using contrast-enhancement [European Association for the Study of the Liver (EASL) and size Response Evaluation Criteria in Solid Tumors (RECIST)] criteria. Safety was assessed by National Cancer Institute Common Terminology Criteria. DEB-TACE was successfully performed in all 13 patients. At 1 month follow-up, there was a mean 12 % decrease in tumor size (p < 0.0003) and a 56 % decrease in tumor enhancement (p < 0.0001). By EASL criteria, the targeted lesion objective response rate was 78 %. Grade 3 to 4 toxicities were fatigue (23 %), increased alanine amino transferase (15 %), hyperglycemia (15 %), and abdominal pain (8 %). Seven patients developed bilomas (54 %); all of these patients had multiple small (<4 cm) lesions. Subsequently, four underwent percutaneous drainage, three for abscess formation and one for symptoms related to mass effect. Although biloma and liver abscess are known risks after TACE, the high incidence in our study population was unexpected and forced interruption of the trial. Although this occurred in a small group of patients, we have changed our technique and patient selection as a result of these findings, thus allowing resumption of the trial.

  13. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

    Science.gov (United States)

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-08-28

    To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. It is feasible to establish an animal model of hepatic cirrhosis and

  14. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma

    Science.gov (United States)

    Zhang, Yue-Lin; Zhou, Guan-Hui; Ai, Jing; Zhou, Tan-Yang; Zhu, Tong-Yin; Zhang, Ai-Bin; Wang, Wei-Lin; Zheng, Shu-Sen

    2015-01-01

    Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the “early leaving but late returning, hanging nut on a twig” sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both Phemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma. PMID:26287964

  15. [Transcatheter Arterial Chemoembolization with Super absorbent Polymer Microspheres for a Large Lung Cystic Adenocarcinoma in the Left Pulmonary Cavity].

    Science.gov (United States)

    Kennoki, Norifumi; Hori, Shinichi; Yuki, Takeo; Sueyoshi, Satoshi; Hori, Atsushi

    2015-11-01

    A 57-year-old woman presented with lung adenocarcinoma and carcinomatous pleurisy in January 2013. The primary lesion had been treated with 60-Gy radiation therapy. She, however, showed a recurrence of the tumor in her pulmonary cavity. She received systemic chemotherapy for 1 year but did not show any improvement. She visited our clinic in March 2014. Her performance level was 3. Her hemoglobin level was 8.5 g/dL. The CT scan showed that the size of the cystic tumor was 200 × 144 × 143 mm. The tumor severely compressed her heart. We performed TACE using a spherical embolic agent. The microcatheter was guided through the left bronchial artery; left intercostal artery 9, 10, and 11; and the left inferior phrenic artery. The anticancer drugs selected were CDDP and 5-FU. The embolic material used was SAP-MS. After 3 therapy sessions, the CT scan showed shrinkage of the target lesion to 100 × 93 × 54 mm. Her hemoglobin level increased to 13.8 g/dL; furthermore, the severity of dyspnea decreased, and she showed a performance status of 0. TACE with SAP-MS was successfully performed for the large cystic tumor in the pulmonary cavity that metastasized from the lung cancer and was refractory to standard treatments. After the treatment, the tumor size decreased and the patient's symptoms alleviated.

  16. 肝动脉栓塞化疗联合肝复乐治疗晚期肝癌临床疗效观察%Efficacy of transcatheter arterial chemoembolization combined with ganfule on advanced hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Mingzhi Hao; Hailan Lin; Qizhong Chen; Yubin Hu; Dong Zhou; Ping Huang; YunBin Ye

    2013-01-01

    Objective: The aim of this study was to evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with a Chinese compound preparation of ganfule on advanced hepatocellular carcinoma (HCC). Methods: The study population consisted of 132 advanced HCC patients with Child-pugh A/B. Tumor in all patients was involved with main trunk of portal vein and/or inferior vena cava, or local lymph node metastasis, or distant metastasis. TACE combined with ganfule were performed in 65 patients with advanced HCC (interventional treatment group), 67 patients were treated with traditional Chinese herbal drug alone (Chinese herb group). The prime end point was overall survival (OS), and prognostic factors were analyzed. Results: The median OS was 205 days [95% confidence interval (CI), 155-255 days] in interventional treatment group and 127 days (95% CI, 70-184 days) in Chinese herb group (P < 0.05). The 6-month, 1-year, and 2-year OS rates were 58.9%, 29.1%, 7.7% in interventional treatment group, and 33.3%, 12.3%, 1.8% in Chinese herb group, respectively. The portal vein thrombosis, ECOG performance status (PS) were independent prognostic factors for OS. Conclusion: Ttranscatheter arterial chemoembolization combined with a Chinese compound preparation of ganfule could greatly prolong the OS of advanced HCC patients. The portal vein thrombosis and ECOG PS were independent prognostic factors for OS.

  17. 256-Slice CT perfusion imaging in transcatheter arterial chemoembolization for hepatocellular carcinoma%256层CT全肝灌注成像在原发性肝癌肝动脉化疗栓塞术中的价值

    Institute of Scientific and Technical Information of China (English)

    黄丽娜; 倪衡建; 姜建威; 殷允娟; 侯海燕

    2015-01-01

    Objective To explore the clinical value of 256-slice CT whole hepatic perfusion imaging in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods Twenty-three patients with hepatocellular carcinoma underwent whole hepatic perfusion with the JOG technique one week before TACE.The scanning data of cancer and liver tissues were analyzed using the perfusion software.The cancer tissue perfusion was repeated 4 to 6 weeks after treatment and was compared with that before treatment.Results (1) Before TACE,the HCC lesions were shown on the hepatic arterial perfusion (HAP) map as homogeneous hyper-perfusion lesions in 8 patients and as inhomogeneous hyper-perfusion lesions in 15 patients.The HAP and hepatic arterial perfusion index (HAPI) values of the tumor were higher than those of the liver tissues,while the hepatic portal perfusion (HPP) values of the tumor was lower than that of the liver tissues.The differences were all significant (P < 0.05).(2) Mter TACE,the tumors were totally filled with lipiodol in 3 patients,partially filled with lipiodol in 13 patients,and sparsely filled with lipiodol in the remaining 3 patients.There was no blood perfusion in the lipiodol-filled areas and in the cancer necrotic tissues,but in the sparsely or partially lipiodol-filled areas blood perfusion could still be seen.21 patients received another session of TACE 6 to 8 weeks later.The results between the hepatic arterial digital subtraction angiography (DSA) and the CT perfusion were 100% matching.The HAP and HAPI values of the tumor decreased when compared with before treatment,and the difference was significant (both P <0.05).The HPP values decreased slightly with no significant difference (P > 0.05),while higher HAP and HPI and lower HPP were observed in the active cancer tissues when compared with the liver tissues after treatment (P < 0.05).Conclusion 256-slice MSCT whole liver perfusion imaging can quantitatively reflect abnormal

  18. Hepatic artery pseudoaneurysm treated using stent-graft implantation and retrograde gastroduodenal artery coil embolization

    Energy Technology Data Exchange (ETDEWEB)

    Basile, Antonio; Patti, Maria Teresa [Ospedale Ferrarotto, Department of Diagnostic and Interventional Radiology, Catania (Italy); Ragazzi, Salvatore; Piazza, Diego [Ospedale Vittorio Emanuele, Department of Surgery I, Catania (Italy); Tsetis, Dimitrios [University Hospital of Heraklion, Medical School of Crete, Department of Radiology, Heraklion (Greece); Lupattelli, Tommaso [Multimedica Holding, Department of Interventional Radiology, Sesto S. Giovanni (Italy)

    2008-11-15

    Endovascular treatment options for visceral artery pseudoaneurysms depend on lesion location and size. Exclusion methods fall into two categories, embolization and stent placement, and these procedures aim to exclude the pseudoaneurysm from the circulation and if possible to maintain distal blood flow. Embolization of the afferent artery can be used in pseudoaneurysms that arise from a donor artery without collateral supply such as a visceral branch, whereas in the case of visceral arteries with well-established collateral supply, the embolization of both proximal and distal branches to the pseudoaneurysm is mandatory in preventing backflow from the collateral circulation. A direct embolization delivering coils or glue into the sac can also be performed if the aneurismal neck is narrow. Stent-graft placement represents another option to exclude the pseudoaneurysm, in the case of wide neck, reduced arterial tortuosity and large-diameter arteries. We present a case of common hepatic artery pseudoaneurysm involving the gastroduodenal artery origin treated by a combination of techniques. An hepatic stent-graft implantation plus retrograde embolization of the gastroduodenal artery through the pancreaticoduodenal anastomosis from the superior mesenteric artery was performed. (orig.)

  19. Role of C-arm cone-beam CT in chemoembolization for hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyo Cheol [Dept. of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul (Korea, Republic of)

    2015-02-15

    With the advent of C-arm cone-beam computed tomography (CBCT), minimally-invasive procedures in the angiography suite made a new leap beyond the limitations of 2-dimensional (D) angiography alone. C-arm CBCT can help interventional radiologists in several ways with the treatment of hepatocellular carcinoma (HCC); visualization of small tumors and tumor-feeding arteries, identification of occult lesion and 3D configuration of tortuous hepatic arteries, assurance of completeness of chemoembolization, suggestion of presence of extrahepatic collateral arteries supplying HCCs, and prevention of nontarget embolization. With more improvements in the technology, C-arm CBCT may be essential in all kinds of interventional procedures in the near future.

  20. Left bronchial artery arising from a replaced left hepatic artery in a patient with massive hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Khil, Eun Kyung; Lee, Jae Myung [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2015-09-15

    A 70-year-old man with a 3-year history of bronchiectasis presented with massive hemoptysis that had lasted for 3 days. In our attempt to perform bronchial artery embolization, upper abdominal angiography was required to locate the left bronchial artery, which in this case was of anomalous origin, arising from a replaced left hepatic artery, which arose from the left gastric artery-a very unusual anatomical variant. We performed embolization with polyvinyl alcohol particles, and the patient's symptoms resolved completely, with no additional complications after conservative treatment.

  1. Subtraction MRI versus diffusion weighted imaging: Which is more accurate in assessment of hepatocellular carcinoma after Trans Arterial Chemoembolization (TACE?

    Directory of Open Access Journals (Sweden)

    Noha Abd ElShafy ElSaid

    2016-12-01

    Full Text Available This study aims to compare the role of both subtraction MRI and Diffusion weighted images in assessment of HCC after trans-arterial chemo embolization (TACE. Patients and methods: 32 patients having 54 HCC lesions underwent TACE. Ages ranged between 59 and 73 years (mean age 59.6; there were 26 males and 6 females. All examinations were performed using Philips 1.5 T MRI (Achieva. Pre contrast: T1, T2W and In phase and out phase gradient echo sequence, dynamic: eTHRIVE technique performed. Subtraction of an unenhanced T1-weighted was from the identical post enhancement sequences in early angiographic and late arterial phases. Diffusion imaging: it was performed using single-shot spin-echo echo-planar imaging with b = 0, 300, 600 mm/s2. DWI was used to create ADC maps. Two readers blinded to each other assessed subtraction of dynamic study and DWI technique to evaluate post treatment response. Results: Reader 1 subtraction dynamic MRI sensitivity = 97%, specificity = 100% PPV = 100% and NPV = 95% compared to 70.59%, 75%, 82.76% and 60% respectively in DWI. Reader 2 subtraction dynamic MRI sensitivity = 97%, specificity = 100% PPV = 100% and NPV = 95% compared to 76.5%, 90%, 92.8% and 69% respectively in DWI. Conclusion: DW-MRI had lower accuracy measures compared to subtraction MRI with increased false negative. DWI may act as a supplementary sequence to compensate for the dynamic MRI in patients who couldn't hold their breath adequately.

  2. Selective and sequential transarterial chemoembolization: Survival in patients with hepatocellular carcinoma

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    Antoch, Gerald, E-mail: antoch@med.uni-duesseldorf.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University at Duisburg-Essen, Hufelandstrasse 55, 45122 Essen (Germany); Roelle, Grit; Ladd, Susanne C.; Kuehl, Hilmar; Heusner, Till A. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University at Duisburg-Essen, Hufelandstrasse 55, 45122 Essen (Germany); Sotiropoulos, Georgios C. [Department of General Surgery and Transplantation, University Hospital Essen, University at Duisburg-Essen, Hufelandstrasse 55, 45122 Essen (Germany); Hilgard, Philip [Department of Gastroenterology and Hepatology, University Hospital Essen, University at Duisburg-Essen, Hufelandstrasse 55, 45122 Essen (Germany); Forsting, Michael; Verhagen, Ruediger [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University at Duisburg-Essen, Hufelandstrasse 55, 45122 Essen (Germany)

    2012-09-15

    Purpose: To assess the survival time of patients with HCC following transarterial chemoembolization performed in a highly selective and sequential way. Patients and methods: 124 HCC patients (102 male, 22 female; mean age 63 ± 11 years) treated with selective and sequential chemoembolization at a single center were included. Selective chemoembolization was performed through a coaxially introduced microcatheter in a segmental or subsegmental hepatic artery. Treatment was stopped after complete stasis of the blood flow in the tumor-feeding vessel. The primary endpoint of the study was overall survival. Results: The median overall survival of the entire patient population was 27.2 months (mo) (±8.9 mo, 95% CI 9.8 mo, 44.6 mo). When stratified according to liver function the median survival was 46.1 mo (±9.0 mo; 95% CI 28.5 mo, 63.7 mo) for Child-Pugh A and 11.1 mo (±4.3 mo; 95% CI 2.7 mo, 19.5 mo) for Child-Pugh B (p < .001). The median survival was 46.1 mo (±16.6 mo; 95% CI 13.5 mo, 78.7 mo) for BCLC stage A, 19.7 mo (±2.6 mo; 95% CI 14.6 mo, 24.8 mo) for BCLC stage B, and 14.4 mo (±5.0 mo; 95% CI 4.5 mo, 24.3 mo) for BCLC stage C (p < .01). Conclusion: Selective and sequential chemoembolization offers long survival times in patients with HCC. Those patients with preserved liver function benefit more than patients with limited liver reserve.

  3. Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor:A retrospective control study

    Institute of Scientific and Technical Information of China (English)

    Zheng-Gang Ren; Zhao-You Tang; Zhi-Ying Lin; Jing-Lin Xia; Sheng-Long Ye; Zeng-Chen Ma; Qing-Hai Ye; Lun-Xiu Qin; Zhi-Quan Wu; Jia Fan

    2004-01-01

    AIM: To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor.METHODS: From January 1995 to December 1998, 549consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE.RESULTS: In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%,75.85%, 62.39% in the control group and 97.39%, 70.37%,50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%,61.28%, 44.36% in the adjuvant TACE group, respectively.Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC.CONCLUSION: Postoperative adjuvant TACE can prolong the

  4. Corona Enhancement and Mosaic Architecture for Prognosis and Selection Between of Liver Resection Versus Transcatheter Arterial Chemoembolization in Single Hepatocellular Carcinomas >5 cm Without Extrahepatic Metastases

    Science.gov (United States)

    Li, Meng; Xin, Yongjie; Fu, Sirui; Liu, Zaiyi; Li, Yong; Hu, Baoshan; Chen, Shuting; Liang, Changhong; Lu, Ligong

    2016-01-01

    Abstract Corona enhancement and mosaic architecture are 2 radiologic features of hepatocellular carcinoma (HCC). However, neither their prognostic values nor their impacts on the selection of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) as treatment modalities have been established. We retrospectively analyzed 275 patients with a single HCC lesion >5 cm without extrahepatic metastasis treated with LR or TACE. In LR patients, the overall survival (OS) and time to progression (TTP) were compared between corona enhancement negative (corona−) versus positive (corona+) and mosaic architecture negative (mosaic−) versus positive (mosaic+) patients. Furthermore, by the combination of corona and mosaic, LR patients were divided into negative for both corona and mosaic patterns (LR−/−), positive for only 1 feature (LR+/−), and positive for both (LR+/+); their OS and TTP were compared to those of the TACE group. Cox regression was performed to identify independent factors for OS. In the survival plots for LR, corona− had better OS and TTP than corona+, and mosaic− had better OS than mosaic+. There was no significant difference in TTP between the subgroups. On Cox regression analysis, corona enhancement, but not mosaic architecture, was a significant factor for OS, whereas neither were a significant factor for TTP. In TACE patients, neither corona nor mosaic patterns had significant correlations with OS or TTP. In the whole population, LR−/ and LR+/− subgroups had similar OS, which was better than the LR+/+ and TACE groups. Moreover, LR−/− and LR+/− patients had better TTP than TACE patients, but there were no differences between the LR−/− versus LR+/−, LR−/ versus LR+/+, LR+/− versus LR+/+, and LR+/+ versus TACE groups. On Cox regression analysis, the presence of corona/mosaic patterns was an independent prognostic factor for OS. Our results showed that, for patients with a single HCC >5 cm without

  5. Transcatheter arterial chemoembolization of colorectal liver metastases using degradable starch microspheres (Spherex {sup registered}). Own investigations and review to the literature; Transarterielle Chemoembolisation von Lebermetastasen kolorektaler Karzinome mit abbaubaren Staerkepartikeln (Spherex {sup registered}). Eigene Beobachtungen und Literaturuebersicht

    Energy Technology Data Exchange (ETDEWEB)

    Wasser, K. [Universitaetsklinikum Mannheim (Germany). Institut fuer Klinische Radiologie; Giebel, F. [Universitaetsklinikum Koeln (Germany). Klinik fuer Anaesthesiologie und Operative Intensivmedizin; Fischbach, R. [Universitaetsklinkum Muenster (Germany). Institut fuer Klinische Radiologie; Tesch, H. [Universitaetsklinikum Koeln (Germany). Medizinische Klinik I; Onkologische Gemeinschaftspraxis, Frankfurt (Germany); Landwehr, P. [Henriettenstiftung Hannover (Germany). Klinik fuer Diagnostische und interventionelle Radiologie

    2005-07-01

    Since two decades transarterial chemoembolization (TACE) of liver metastases has been investigated in numerous studies. However, no standardized therapeutic procedure exists so far. The present study retrospectively investigated survival, response and side effects after TACE of liver metastases in 21 patients with colorectal cancer and results are compared with previous literature. A total of 68 TACE procedures were performed. A suspension of degradable starch microspheres (DSM, Spherex {sup registered}) and Mitomycin C was applied selectively into hepatic arteries via a transfemoral approach. DSM effect a temporary arterial occlusion. Follow-up studies were performed by contrast enhanced spiral computed tomography (CT). The median survival was 13.8 months. Therapeutic response (according to WHO) was observed only in three patients. The progression free interval was 5.8 months. Patients developed a postembolization-syndrome (abdominal pain, fever, nausea) and increased transaminases in 27-43% of all interventions. A gastric ulcer occurred after four, cholecystitis after two TACE. As already shown in most previous studies, regardless of the used agents, also this investigation underlines the moderate therapeutic effect of TACE on colorectal liver metastases. So far, no significant survival benefit has been shown in the literature and the response rates are rather limited. In general, complications of TACE seem to be rare, but should not to be underestimated. Compared to TACE with long or permanent arterial occlusion, postembolization syndrome seems to be less pronounced using DSM. As TACE is rather a palliative therapeutic approach, DSM therefore might be more suited. Further studies on TACE of liver metastases should focus on to the patients' quality of life. (orig.) [German] Seit Beginn der 80er Jahre ist die transarterielle Chemoembolisation (TACE) von Lebermetastasen Gegenstand zahlreicher Studien, ohne dass sich bisher ein einheitliches Therapiekonzept

  6. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma.

    Directory of Open Access Journals (Sweden)

    Jun-Hui Sun

    Full Text Available Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm in the right (n = 13, left (n = 1 or both (n = 13 lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the "early leaving but late returning, hanging nut on a twig" sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05, but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05, and the patients' condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma.

  7. Use of Ethanol in the Trans-Arterial Lipiodol Embolization (TAELE of Intermediated-Stage HCC: Is This Safer than Conventional Trans-Arterial Chemo-Embolization (c-TACE?

    Directory of Open Access Journals (Sweden)

    Francesco Somma

    Full Text Available To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE compared with conventional Trans-Arterial Chemo-Embolization (cTACE in the treatment of small intermediate-HCC (BCLC-Stage B.A random sample of 87 patients (37.93% male; 62.07% female; age range, 36-86 years with documented small intermediate-HCC and treated with TAELE (mixture 1:1 of Ethanol and Lipiodol or cTACE (mixture of 50mg-Epirubicin and 5cc-Lipiodol were retrospectively studied in an institutional review board approved protocol. The two procedures were compared with χ2-test, χ2-test with Yates correction, McNemar's exact test, ANOVA test and log-rank test.TAELE and cTACE therapies were performed in 45 and 42 patients, respectively. Thirty days after the procedure, a Multi-Detector Computed Tomography (MDCT showed no significant difference in the number of patients with partial and complete response between the two groups (p-value = 0.958, according to mRECIST. Contrary, significant differences were found in tumor-devascularization, lesion-reduction and post-embolization syndrome occurrence (p-value = 0.0004, p-value = 0.0003 and p-value = 0.009, respectively. Similar survival was observed during 36-month follow-up (p-value = 0.884.Compared to cTACE, TAELE showed a better toxicity profile with similar 36-month survival and similar one-month anti-tumor effects, which makes it better tolerated by patients, especially in case of more than one treatment.

  8. Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report

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    Masanobu Taguchi

    2015-01-01

    Conclusion: Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encouraged the growth of collateral blood supply, allowing radical resection including the vessels and obviated the need for arterial reconstruction.

  9. Implication of the presence of a variant hepatic artery during the Whipple procedure

    Directory of Open Access Journals (Sweden)

    Mercedes Rubio-Manzanares-Dorado

    2015-07-01

    Full Text Available Introduction: The anatomical variants of the hepatic artery may have important implications for pancreatic cancer surgery. The aim of our study is to compare the outcome following a pancreatoduodenectomy (PD in patients with or without a variant hepatic artery arising from superior mesenteric artery. Material and methods: We reviewed 151 patients with periampullary tumoral pathology. All patients underwent oncological PD between January 2005 and February 2012. Our series was divided into two groups: Group A: Patients with a hepatic artery arising from superior mesenteric artery; and Group B: Patients without a hepatic artery arising from superior mesenteric artery. We expressed the results as mean ± standard deviation for continuous variables and percentages for qualitative variables. Statistical tests were considered significant if p < 0.05. Results: We identified 11 patients with a hepatic artery arising from superior mesenteric artery (7.3%. The most frequent variant was an aberrant right hepatic artery (n = 7, following by the accessory right hepatic artery (n = 2 and the common hepatic artery trunk arising from the superior mesenteric artery (n = 2. In 73% of cases the diagnosis of the variant was intraoperative. R0 resection was performed in all patients with a hepatic artery arising from superior mesenteric artery. There were no significant differences in the tumor resection margins and the incidence of postoperative complications. Conclusion: Oncological PD is feasible by the presence of a hepatic artery arising from superior mesenteric artery. The complexity of having it does not seem to influence in tumor resection margins, complications and survival.

  10. Mesenteric Ischemia:An unusual presentation of fistula between superior mesenteric artery and common hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serdar Karak(o)se; Aydin Karabacakoglu; Dilek Emlik

    2004-01-01

    Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.

  11. Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Anderson Oliver

    2008-11-01

    Full Text Available Abstract Introduction This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm. Case presentation A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery. Conclusion This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.

  12. 吉西他滨热化疗灌注联合卡铂肝动脉化疗栓塞治疗原发性肝癌临床研究%Gemcitabine transcatheter arterial heated chemotherapy combined with carboplatin transcatheter arterial chemoembolization for primary hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    骆俊朋; 胡鸿涛; 姚全军; 孟艳莉; 郭晨阳; 黎海亮

    2013-01-01

    目的 探讨吉西他滨热化疗灌注联合卡铂化疗栓塞术治疗原发性肝癌的价值.方法 96例肝癌患者随机数字表法分为两组,A组热化疗灌注联合肝动脉化疗栓塞术,B组常温下化疗灌注联合肝动脉化疗栓塞术.观察介入前后及介入后30 d患者肝肾功能、免疫功能变化;治疗后第30天行平扫加多期增强CT扫描,依实体肿瘤疗效评价标准(RECIST)比较两组临床有效率;间隔4~6周重复治疗1次,第3次介入治疗后随访,比较两组总生存期.结果 治疗后第3天,两组丙氨酸氨基转移酶(ALT)及天冬氨酸氨基转移酶(AST)较治疗前均升高[A组ALT:(43±5)U/L比(84± 12)U/L,B组ALT:(41±3)U/L比(175± 10)U/L,A组AST:(44±2)U/L比(94±11)U/L,B组AST:(42±1)U/L比(173± 13)U/L,均P<0.05],B组高于A组(P值分别为0.001,0.002),但治疗后第30天较治疗前无变化[A、B组ALT:(42±6)、(40±5)U/L,A、B组AST:(45±1)、(41±3)U/L,均P<0.05].两组肾功能治疗前后无明显变化.A组CD;细胞及活化T细胞较治疗前升高[(69.35±6.88)%比(72.23±6.84)%,(11.83±4.09)%比(14.17±3.92)%,P值分别为0.005,0.002],而CD;细胞较治疗前下降[(24.18±1.85)%比(23.56±2.66)%,P=0.028].A组总有效率75.00%(36/48),B组39.58%(19/48),差异有统计学意义(P<0.01).A组患者中位生存时间24.0个月(95%CI为20 ~ 29个月),B组为18.9个月(95%CI为18 ~ 20个月),差异有统计学意义(P<0.01).结论 吉西他滨热化疗灌注联合卡铂肝动脉化疗栓塞治疗原发性肝癌是治疗肝癌的一种安全、有效的方法,其对肝功能影响较小且呈一过性.%Objective To assess the therapeutic effect of thermochemotherapy infusion combined with chemoembolization in the treatment of primary hepatocellular carcinoma.Methods Ninty six patients with hepatic carcinoma were randomly diveded into two groups.In A group,the patients underwent thermochemotherapy infusion combined with chemoembolization.In B

  13. Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery

    Institute of Scientific and Technical Information of China (English)

    Yoshitsugu Tajima; Tamotsu Kuroki; Ryuji Tsutsumi; Ichiro Sakamoto; Masataka Uetani; Takashi Kanematsu

    2007-01-01

    AIM: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery.METHODS: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 206. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome.RESULTS: The underlying diseases were all malignancies, and the surgical procedures included hepatopancreatoduodenectomy in 2 patients, hepatic resection with removal of the bile duct in 5, and pancreaticoduodenectomy in 2. A total of 11 pseudoaneurysm developed: 4in the common hepatic artery, 4 in the proper hepatic artery, and 3 in the right hepatic artery. Successful hemostasis was accomplished with the initial TAE in all patients, except for 1. Extrahepatic arterial pathways to the liver, including the right inferior phrenic artery, the jejunal branches, and the aberrant left hepatic artery,were identified in 8 of the 9 patients after the completion of TAE. The development of collaterals depended on the extent of liver mobilization during the hepatic resection,the postoperative period, the presence or absence of an aberrant left hepatic artery, and the concomitant arterial stenosis adjacent to the pseudoaneurysm. The liver tolerated TAE without significant consequences when at least one of the collaterals from the inferior phrenic artery or the aberrant left hepatic artery was present. One patient, however, with no extrahepatic collaterals died of liver failure due to total liver necrosis 9 d after TAE.CONCLUSION: When TAE is performed on ruptured hepatic artery pseudoaneurysm, reduced collateral pathways to the liver created by the primary surgical procedure and a short postoperative interval may

  14. Hepaticocystic duct and a rare extra-hepatic "cruciate" arterial anastomosis: a case report

    Directory of Open Access Journals (Sweden)

    Abeysuriya Vasitha

    2008-02-01

    Full Text Available Abstract Introduction The variations in the morphological characteristics of the extra-hepatic biliary system are interesting. Case presentation During the dissection of cadavers to study the morphological characteristics of the extra-hepatic biliary system, a 46-year-old male cadaver was found to have drainage of the common hepatic duct drains directly into the gall bladder neck. The right and left hepatic ducts were not seen extra-hepatically. Further drainage of the bile away from the gallbladder and into the duodenum was provided by the cystic duct. Formation of the common bile duct by the union of the common hepatic duct and cystic duct was absent. Further more the right hepatic artery was found to be communicating with the left hepatic artery by a "bridging artery" after giving rise to the cystic artery. An accessory hepatic artery originated from the "bridging artery" forming a "cruciate" hepatic arterial anastomosis. Conclusion Combination of a Hepaticocystic duct and an aberrant variation in the extra-hepatic arterial system is extremely rare.

  15. Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

    Institute of Scientific and Technical Information of China (English)

    Long Sun; Yong-Song Guan; Hua Wu; Wei-Min Pan; Xiao Li; Qing He; Yuan Liu

    2006-01-01

    A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives.

  16. Hepatic Artery Chemotherapy for Advanced Adenocarcinoma of the Pancreas

    Directory of Open Access Journals (Sweden)

    Robert Levin

    2016-08-01

    Full Text Available Context Seventy patients with adenocarcinoma of the pancreas with liver metastases, received chemotherapy every four weeks and their outcomes are reported in this retrospective series. Objective Advanced adenocarcinoma of the pancreas has a poor prognosis with only 2% 5-year survival reported by SEER (Surveillance, Epidemiology and End Results of the NCI. Chemotherapy given as intra-arterial perfusions is more intense than intravenous chemotherapy. Responses in perfused tumor is expected to be better than that obtained with only intravenous chemotherapy. Design Hepatic artery therapy is given monthly as a 5 hour perfusion of the hepatic artery using DDP and MIC. Also given is monthy Intravenous (IV therapy with four hours of Leucovorin (LV, with an injection of FUDR during the last hour of LV, daily x 5 days. Setting all therapy was given at Midwestern Regional Medical Center. Patients Thirty seven patients had no prior chemotherapy, while 33 patients had progressed after prior IV chemotherapy. Intervention Hepatic artery therapy with IV LV-FUDR was given for up to six months depending upon marrow tolerance and response. At that point, if response was ongoing or improving, therapy was continued monthly with only IV LV-FUDR; all therapy was stopped whenever progressive disease was evident. Results of those without prior chemotherapy, the mean overall survival (OS was 17.3 ± 30.2 months (mean±SD, ranging up to 13 years. Six patients survived more than three years with four are living in continuing complete remission for more than five years. Conclusion This therapy offers the opportunity for long term survival in a subset of patients with metastatic adenocarcinoma of the pancreas who have liver metastases, and some patients can be cured.

  17. Tissue levels of chemotherapeutic agents for hepatic metastasis during hepatic arterial and portal injection.

    Science.gov (United States)

    Kaneko, A; Naomoto, Y; Aoyama, M; Tanaka, N

    1999-01-01

    Hepatic metastasis is one of the most important prognostic factors in digestive organ cancer, and hepatic arterial infusion is aggressively performed for therapy of nonresectable metastatic liver cancer. Although comparatively high response rates have been attained in some cases, this treatment has been ineffective in not a few cases because these metastatic tumors are frequently hypovascular in nature. To develop better methods of administering chemotherapeutic agents, we performed basic experiments concerning intraportal administration which has been regarded as having a generally negative effect, focusing on a report indicating that portal supply is dominant along the borders of metastatic liver cancer tumors. VX2 carcinoma cells were inoculated into the hepatic parenchyma beneath the capsule of juvenile Japanese white rabbits. Drugs were infused 2 weeks after the inoculation, then tissue and blood were sequentially sampled. Mitomycin C (1.7 mg/kg) was infused either by bolus injection to the hepatic artery (arterial infusion group) or by bolus injection to the portal vein (portal infusion group). Five-fluorouracil (9.5 mg/kg) and Cisplatin (1.6 mg/kg) were likewise infused continuously over 60 min, and tissue levels of the drugs were compared between the two groups. Mitomycin C and 5-fluorouracil levels were measured by HPLC and Cisplatin levels were measured by atomic absorption spectrophotometry. As a result, the levels of every drug in VX2 tumor tissue did not significantly differ between the arterial infusion group and the portal infusion group, while the levels were significantly higher than those in the intravenous infusion group. Using portal infusion, we observed a drug transition which was not inferior to that of arterial infusion, suggesting that an imported antitumoral effect may be obtained with this method compared with intravenous infusion.

  18. 经导管肝动脉化疗栓塞术患者围术期抗菌药物应用方案探讨%Disscusion on Antibiotics Program for Patient Underwent Transcatheter Arterial Chemoembolization during Perioperative Period

    Institute of Scientific and Technical Information of China (English)

    戎佩佩

    2016-01-01

    OBJECTIVE:To provide reference for rational use of antibiotics during perioperative period of transcatheter arterial chemoembolization(TACE). METHODS:After full evaluation of 1 cases of primary liver cancerpatient’s conditions,the optimal clinical evidences were retrieved and evaluated,which were related to antibiotics regimen during perioperative period of TACE. Us-ing“hepatocellular carcinoma”“antibiotic prophylaxis”“hepatic cancer”“TACE”as subjects,the evidence were retrieved from Co-chrane Library(issue 4,2015),Medline(1980 to 2015)and CJFD(1990 to 2015)and then evaluated. RESULTS:1 meta-analy-sis or systematic review,10 RCTs and 2 practice guidelines were identified. This patient didn’t need to use antibiotics to prevent in-fection according to literature analysis. CONCLUSIONS:The rational treatment plan according to evidence-based medicine methods for patients can not only promote the rational use of antibiotics,reduce bacterial drug resistence and treatment cost,but also guide both doctors and patients to take the indeterminate risk of medicine.%目的:为经导管肝动脉化疗栓塞术(TACE)围术期合理使用抗菌药物提供参考。方法:临床药师在充分评估1例原发性肝癌患者的病情后,查找并评价当前与TACE围术期抗菌药物给药方案相关的最佳临床证据。以“hepatocellular carcinoma”“antibiotic prophylaxis”“肝癌”“经导管肝动脉化疗栓塞术”等为主题词,计算机检索Cochrane Library(2015年4期)、Medline (1980-2015年)、中国期刊全文数据库(1990-2015年),并对所获证据进行评价分析。结果:共筛选出与临床问题密切相关的1个系统评价/Meta分析,10个随机对照试验和2个临床指南。通过文献分析认为该患者不需要预防性使用抗菌药物。结论:采用循证医学方法,为该患者制订合理的用药方案,不仅可以促进抗菌药物的合理使用,减少细菌

  19. N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Samuelson, Shaun D.; Louie, John D.; Sze, Daniel Y., E-mail: dansze@stanford.edu [Stanford University School of Medicine, Division of Interventional Radiology (United States)

    2013-06-15

    Purpose. Avoidance of nontarget microsphere deposition via hepatoenteric anastomoses is essential to the safety of yttrium-90 radioembolization (RE). The hepatic hilar arterial network may remain partially patent after coil embolization of major arteries, resulting in persistent risk. We retrospectively reviewed cases where n-butyl cyanoacrylate (n-BCA) glue embolization was used to facilitate endovascular hepatic arterial skeletonization before RE. Methods. A total of 543 RE procedures performed between June 2004 and March 2012 were reviewed, and 10 were identified where n-BCA was used to embolize hepatoenteric anastomoses. Arterial anatomy, prior coil embolization, and technical details were recorded. Outcomes were reviewed to identify subsequent complications of n-BCA embolization or nontarget RE. Results. The rate of complete technical success was 80 % and partial success 20 %, with one nontarget embolization complication resulting in a minor change in treatment plan. No evidence of gastrointestinal or biliary ischemia or infarction was identified, and no microsphere-related gastroduodenal ulcerations or other evidence of nontarget RE were seen. Median volume of n-BCA used was <0.1 ml. Conclusion. n-BCA glue embolization is useful to eliminate hepatoenteric networks that may result in nontarget RE, especially in those that persist after coil embolization of major vessels such as the gastroduodenal and right gastric arteries.

  20. Ruptured aneurysm of the hepatic artery: a mismatching diagnosis

    Directory of Open Access Journals (Sweden)

    Vincenzo Bua

    2013-04-01

    Full Text Available Background: Hepatic aneurysms are extremely rare with very few cases reported, and most have been source of misdiagnosis and clinical pitfalls in emergency medicine. Presentation with intraabdominal hemorrhage is associated with a high mortality rate. Case report: We report the case of an adult male, referred for a severe acute pain in the left lower chest-upper quadrant abdomen pain. We present multislice contrast-enhanced CT-scanning and angiographic findings, and a life-saving emergency trancatheter embolization, using fragments of absorbable gelatin sponge. Emergency doctors should consider ruptured hepatic artery aneurysms in the differential diagnosis of acute abdominal pain and promptly cooperate with endovascular specialists to treat this life-threatening condition.

  1. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report.

    Science.gov (United States)

    Hemmati, Hossein; Karimian, Mehdi; Moradi, Habibollah; Farid Marandi, Kambiz; Haghdoost, Afrooz

    2015-07-01

    Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.

  2. Hepatic artery embolization for treatment of patients with hereditary hemorrhagic telangiectasia and symptomatic hepatic vascular malformations

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, Ajay [Hannover Medical School, Department of Diagnostic Radiology, Hannover (Germany); Klinikum Oldenburg, Department of Radiology and Nuclear Medicine, Oldenburg (Germany); Caselitz, Martin; Wagner, Siegfried; Manns, Michael [Hannover Medical School, Department of Gastroenterology and Hepatology, Hannover (Germany); Gratz, Karl-Friedrich [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Lotz, Joachim; Kirchhoff, Timm; Galanski, Michael [Hannover Medical School, Department of Diagnostic Radiology, Hannover (Germany); Piso, Plinio [Hannover Medical School, Department of Abdominal and Transplantation Surgery, Hannover (Germany)

    2004-11-01

    At present there is no established therapy for treating patients with hereditary hemorrhagic telangiectasia (HHT) and symptomatic hepatic involvement. We present the results of a prospective study with 15 consecutive patients who were treated with staged hepatic artery embolization (HAE). Branches of the hepatic artery were selectively catheterized and embolized in stages using polyvinyl alcohol particles (PVA) and platinum microcoils or steel macrocoils. Prophylactic antibiotics, analgesics and anti-emetics were administered after every embolization. Clinical symptomatology and cardiac output were assessed before and after therapy as well as at the end of follow-up (median 28 months; range 10-136 months). Five patients had abdominal pain and four patients had symptoms of portal hypertension. The cardiac output was raised in all patients, with cardiac failure being present in 11 patients. After treatment, pain resolved in all five patients, and portal hypertension improved in two of the four patients. The mean cardiac output decreased significantly (P<0.001) from 12.57{+-}3.27 l/min pre-treatment to 8.36{+-}2.60 l/min at the end of follow-up. Symptoms arising from cardiac failure resolved or improved markedly in all but one patient. Cholangitis and/or cholecystitis occurred in three patients of whom two required a cholecystectomy. One patient with pre-existent hepatic cirrhosis died as a complication of the procedure. Staged HAE yields long-term relief of clinical symptoms in patients with HHT and hepatic involvement. Patients with pre-existing hepatic cirrhosis may be poor candidates for HAE. (orig.)

  3. Multi-detector Computed Tomography Angiography of the Hepatic Artery in Liver Transplant Recipients

    Energy Technology Data Exchange (ETDEWEB)

    Boraschi, P.; Donati, F.; Cossu, M.C.; Gigoni, R.; Vignali, C.; Filipponi, F.; Bartolozzi, C.; Falaschi, F. [Pisa Univ. Hospital (Italy). 2nd Dept. of Radiology

    2005-08-01

    PURPOSE: To evaluate the ability of multi-detector row computed tomography angiography (CTA) in detecting hepatic artery complications in the follow-up of liver transplant patients, performing volume-rendering as reconstruction technique. MATERIAL AND METHODS: The anatomy of hepatic artery was studied in 27 liver transplant recipients with a four-row CT scanner using the following parameters: collimation, 1 mm; slice width, 1 mm; table feed, 6-8 mm/s; spiral reconstruction time, 0.5 s; reconstruction interval, 0.5 mm; mAs, 160; kVp, 120. Before the study, the patients received 1000 ml of water as oral contrast agent to produce negative contrast in the stomach and the small bowel. A non-ionic contrast medium was infused intravenously at a rate of 5 ml/s with a bolus tracking system. Volume-rendering of hepatic artery was performed with the 3D Virtuoso software. RESULTS: The celiac trunk, the hepatic artery, and the right and left hepatic arteries were successfully displayed in high detail in all patients. Side branches, including small collaterals, and hepatic artery anastomosis could also be readily visualized. Volume-rendered CTA detected six hepatic artery stenoses, two hepatic artery thromboses, and two intrahepatic pseudoaneurysms. In two cases, CT detected hepatic artery stenosis with a diameter reduction of less than 50%, while digital subtraction angiography showed a normal artery. CONCLUSION: Volume-rendered multi-detector CTA is a promising non-invasive technique, since it allows images of high quality to be generated with excellent anatomical visualization of the hepatic artery and its complications in liver transplant recipients.

  4. The use of coronary stent in hepatic artery stenosis after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Huang Mingsheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Shan Hong [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)]. E-mail: gzshsums@public.guangzhou.gd.cn; Jiang Zaibo [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Li Zhengran [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Zhu Kangshun [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Guan Shouhai [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Qian Jiesheng [Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Chen Guihua [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Lu Minqiang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China); Yang Yang [Transplantation Center, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province (China)

    2006-12-15

    Purpose: This retrospective study was undertaken to evaluate the effectiveness of coronary stent placement in hepatic artery stenosis after orthotopic liver transplantation (OLT). Materials and methods: Of 430 consecutive adult orthotopic liver transplant recipients between November 2003 and September 2005, 17 had hepatic artery stenosis (HAS). Fourteen of them underwent coronary stent placement in the HAS. The technical results, complications, hepatic artery patency and clinical outcome were reviewed. Results: Technical and immediate success was 100%. After a mean follow-up of 159.4 days (range, 9-375 days), all patients obtained patent hepatic arteries except 2 patients occurred hepatic artery restenoses at 26 and 45 days after stent placement, respectively. Kaplan-Meier curve of patency showed cumulated stent patency at 3, 6, and 12 months of 78%, 58% and 45%, respectively. During the follow-up, 8 patients survived, 5 died of septic multiple-organ failure, 1 received retransplantation because of refractory biliary infection. Hepatic artery dissection induced by a guiding catheter occurred in one patient and was successfully treated with a coronary stent. Conclusion: Hepatic artery stenosis after OLT can be successfully treated with coronary stent placement with low complication rate and an acceptable 1-year hepatic artery patency rate.

  5. Hepatic artery Doppler in trisomy 21 and euploid fetuses at 11-13 weeks

    NARCIS (Netherlands)

    Zvanca, Mona; Gielchinsky, Yuval; Abdeljawad, Firas; Bilardo, Caterina M.; Nicolaides, Kypros H.

    2011-01-01

    Objective To determine possible differences in hepatic artery flow between trisomy 21 and euploid fetuses at 11-13 weeks' gestation. Methods Hepatic artery pulsatility index (PI) and peak systolic velocity (PSV) were measured in fetuses at low risk of aneuploidies (n = 350) and another group at high

  6. CT findings in ischaemic hepatic failure due to intra-arterial embolisation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, O. [Dept. of Radiological Sciences, Univ. `Federico II`, Naples (Italy)

    1997-01-01

    Liver infarction is relatively uncommon. It may be secondary to several conditions such as sepsis, shock, sickle-cell anaemia, eclampsia, vasculitis, metastatic disease, bacterial endocarditis, rheumatic heart disease, trauma, portal venous occlusion or compression, oral contraception, anaesthesia, hepatic artery thrombosis, therapeutical or inadvertent hepatic artery ligation, intra-arterial chemotherapy or embolisation. A case of hepatic infraction, unusual for iatrogenic pathogenesis, submassive extension with acute hepatic failure, and CT findings of an internally branching pattern due to intravascular gas was observed. (orig./AJ)

  7. Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing

    Directory of Open Access Journals (Sweden)

    Johnrose John Grifson

    2017-01-01

    Full Text Available Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calot's coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury.

  8. Pharmacokinetics of Harmine Gelatin Microspheres after Embolization in Hepatic Artery

    Institute of Scientific and Technical Information of China (English)

    LI Yan; SUN Dianjia; BI Dianzhou; WEN Hao

    2002-01-01

    The preparation and properties of Harmine - gelatin microspheres ( HM - GMS) were reported. The characteristics of pharmacokinetics and embolization effects of HM - GMS in vivo were studied in dogs. The average diameter of the microspheres was 63. 0μm and the content was 6.09% of HM. In in vitro experiment, the release rate of drug demonstrated that the microspheres had sustained - release properties. The HM - GMS and HM solution were infused into the hepatic artery of dogs through a catheter for embolization, respectively. The plasma concentration of HM was determined by HPLC. The peak concentration of HM solution was 2.9 times as much as HM - GMS in circulating blood, while that of solution was 0.42 times as much as HM - GMS in hepatic vein. Angiograms revealed that the peripheral blood vessels decreased obviously in liver. Results showed that the HM - GMS probably can become a promising embolic agent for treatment of hepatic cancer. It could aid in the use of intensive chemotherapy with minimum systemic side effect.

  9. Hepatic intra-arterial infusion of yttrium-90 microspheres in the treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report

    Institute of Scientific and Technical Information of China (English)

    Louis Rivera; Huan Giap; William Miller; Jonathan Fisher; Donald J Hillebrand; Christopher Marsh; Randolph L Schaffer

    2006-01-01

    Hepatocellular carcinoma (HCC) recurs with a reported frequency of 12%-18% after liver transplantation.Recurrence is associated witha mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemoembolization (TACE), radiofrequency ablation (RFA),ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma.Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results. Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres (SIR-Spheres, Sirtex Medical Inc., Lake Forest, IL, USA). Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein (AFP) level. There were no adverse consequences of initial treatment.

  10. The Efficacy of Hyperthermia Combined with Transcatheter Arterial Chemoembolization in the Treatment of Advanced Liver Cancer%热疗联合肝动脉化疗栓塞治疗中晚期肝癌的疗效分析

    Institute of Scientific and Technical Information of China (English)

    王云涛; 黎斌; 何平; 曾守群

    2012-01-01

      Objective To observe the efficacy and toxicity of thermotherapy combined with transcatheter arterial chemoembolization for treating mid-late stage liver cancer.Methods Seventy-two patients with primary liver cancer were randomly divided into two grope:A group:the treatment group(37 patients)and B group:control group(35 patients);A group was treated with deep thermotherapy combined with TACE, B group was given TACE alone. Results A group the Short-term curative effect ,qualty of life were be superior to that B group (P<0.05). The toxicity ,AFP had not significant difference between the two groups.Couclusion Thermotherapy combined with transcatheter arterial chemoembolization has better curative efficacy and improve the clinical symptoms and the quality of life for treating mid-late stage primary live cancer.%  目的探讨深部热疗联合肝动脉灌注栓塞术治疗中晚期原发性肝癌的疗效及副反应.方法将72例原发性肝癌患者随机分为2组, A组为综合治疗组,37例;B组为对照组,35例.A组采用热疗联合肝动脉化疗栓塞术,B组行单独肝动脉化疗栓塞术.结果 A组在近期疗效及生活质量均明显优于B组(P<0.05),两组毒性反应、AFP下降无明显差异.结论热疗联合肝动脉栓塞术联合热疗治疗失去手术治疗机会的中晚期原发性肝癌疗效较好,可改善临床症状,提高生活质量.

  11. Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

    Energy Technology Data Exchange (ETDEWEB)

    Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Zhou, Chun Gao [First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing, Jangsu (China)

    2017-04-15

    To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

  12. 肝癌患者经导管肝动脉化学栓塞术后的睡眠障碍及其相关因素分析%Sleep disorder and its associated factors of patients with hepatocellular carcinoma after transcatheter arterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    胥常琴; 刘艺薇

    2013-01-01

    Objective To explore the occurrence of sleep disorders and its related factors in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization.Methods One hundred and twenty patients with hepatocellular carcinoma received catheter hepatic arterial chemotherapy embolization (TACE)were randomly selected in our hospital from January 2010 to June 2012.Pittsburgh sleep Quality Index scale,plagued symptom Scale,the Hospital Anxiety and Depression Scale,The Eastern Cooperative Oncology Group Scale were used to collect the relevant information.Logistic regression analysis was employed to analyze the influencing factors.Results A total of 120 questionnaires were issued,and 116 valid questionnaires were retrieved,with the effective rate of 96.67%.The incidence of sleep disorders was 48.28% (56/116).In the patients with sleep disorders,physical functional status,depression,and symptoms distress were worse than those without sleep disorders (P<0.05).Sleep disorders of patients with hepatocellular carcinoma after TACE were associated with age,distress,and depression.Conclusion Age,distress,depression may have a causal association with the occurrence of sleep disorders in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization,but further research is still needed.%目的 初步探索肝癌患者经导管肝动脉化学栓塞术后的睡眠障碍发生情况及其相关因素.方法 随机选取2010年1月至2012年6月在我院接受治疗、择期行经导管肝动脉化疗栓塞(TACE)术治疗的120癌患者为研究对象,采用自制《患者一般情况调查表》、匹兹堡睡眠质量指数量表、困扰症状量表、医院焦虑抑郁量表、功能状态评估量表收集有关信息,分析研究对象的睡眠障碍发生情况并采用Logistic回归分析其影响因素.结果 共发放120套调查问卷,回收有效问卷116份,有效回收率为96.67%.本组病例睡眠障碍发生率为48.28% (56

  13. Radiologic management of hepatic arterial stenosis or thrombosis following liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Byung Suck; Sung, Kyu Bo; Lim, Soo Mee; Yoon, Hyun Ki; Song, Ho Young [Asan Medical Center, Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-06-01

    To assess the results and usefulness of interventional procedures for hepatic arterial stenosis or thrombosis following liver transplantation. During the past five years, eight patients aged 1-59 (mean, 39) years among 187 liver transplant recipients showed elevated of liver enzyme levels (AST/ALT) and decreased arterial flow at Doppler ultrasound. Hepatic arteriography revealed luminal stenosis or occlusion at the proper hepatic artery, and six patients, one of whom required thrombolysis before the procedure, underwent percutaneous transluminal angioplasty (PTA) using a balloon. In two with thrombosis, thrombolysis without PTA was performed. In order to increase hepatic arterial flow, four patients underwent additional coil embolization of the gastroduodenal or splenic artery. Hepatic arterial flow recovered in all six patients after PTA. Three required repeat PTA for restenosis and one of these needed stent placement after repeated PTA. At follow-up, 6-17 months later, the three had good hepatic function. Within four days, the other three expired due to graft failure, hepatorenal syndrome and sepsis. One of the patients who underwent thrombolysis without PTA expired and the other required retransplantation. In this case there were no procedure - related complications. Radiologic interventions are useful for treatment of hepatic arterial stensis or thrombosis in patients with liver transplantations.

  14. Hepatic artery thrombosis in live liver donor transplantation: how to solve--a case report.

    Science.gov (United States)

    Rodrigues, S; Martins, A; Barroso, E

    2014-01-01

    The decrease in the number of cadaveric donors has proved a limiting factor in the number of liver transplants, leading to the death of many patients on the waiting list. The living donor liver transplantation is an option that allows, in selected cases, increase the number of donors. One of the most serious complications in liver transplantation is hepatic artery thrombosis, in the past considered potentially fatal without urgent re-transplantation. A white male patient, 48 years old, diagnosed with hepatocellular carcinoma in chronic liver failure caused by hepatitis B virus, underwent living donor liver transplantation (right lobe). Doppler echocardiography performed in the immediate postoperative period did not identify arterial flow in the right branch, having been confirmed thrombosis of the right hepatic artery in CT angiography. Urgent re-laparotomy was performed, which consisted of thrombectomy and re-anastomosis of the hepatic artery with segmental splenic artery allograft interposition. The patient started anticoagulation and antiplatelet therapy with acetylsalicylic acid. Serial evaluation with Doppler echocardiography showed hepatic artery patency. At present, the patient is asymptomatic. One of the most devastating complications in liver transplantation, and particularly in living liver donor, is thrombosis of the hepatic artery; thus, early diagnosis and treatment is vital. The rapid intervention for revascularization of the graft avoids irreversible ischemia of the bile ducts and hepatic parenchyma, thus avoiding the need for re-transplantation.

  15. Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yang Hyun Baek; Kyoung Tae Kim; Sung Wook Lee; Jin Sook Jeong; Byeong Ho Park; Kyung Jin Nam; Jin Han Cho

    2012-01-01

    AIM:To investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) using floxuridine (FUDR)in patients with advanced hepatocellular carcinoma (HCC) confined to the liver.METHODS:Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at our hospital between March 2005 and May 2008.Among the 34 patients,9 patients were classified as Child class C,and 18 patients had portal vein tumor thrombus (PVTT).One course of chemotherapy consisted of continuous infusion of FUDR (0.3 mg/kg during day 1-14) and dexamethasone (10 mg on day 1,4,7 and 11),and this treatment was repeated every 28 d.RESULTS:Two patients (5.9%) displayed a complete response,and 12 patients (35.3%) had a partial response.The tumor control rate was 61.8%.The median overall survival times were 15.3 mo,12.4 mo and 4.3 mo for the patients who were classified as Child class A,Child class B and Child class C,respectively (P =0.0392).The progression-free survival was 12.9mo,7.7 mo and 2.6 mo for the patients who were classified as Child class A,Child class B and Child class C,respectively (P =0.0443).The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT.In addition to hepatic reserve capacity and PVTT,the extent of HCC was an independent factor in determining a poor prognosis.The most common adverse reactions to HAIC were mucositis,diarrhea and peptic ulcer disease,but most of these complications were improved by medical treatment and/or a delay of HAIC.CONCLUSION:The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities,even in patients with advanced cirrhosis.

  16. CLINICAL CO RELATION BETWEEN ARTERIAL VERSUS VENOUS AMMONIA LEVELS IN HEPATIC ENCEPHLOPATHY IN CIRRHOSIS OF LIVER

    Directory of Open Access Journals (Sweden)

    Manjunath

    2014-05-01

    Full Text Available : INTRODUCTION: Hepatic encephalopathy is a reversible neuropsychiatry state that complicates liver disease. Pathogenesis of Hepatic Encephalopathy in chronic liver is function is widely accepted to be due to failure of hepatic clearance of toxins products from gut exact toxin involved remains controversial but ammonia is thought to be an important factor. Ammonia levels help both in diagnosis and serve as a guide in treatment. Diagnosis of Hepatic Encephalopathy can be done based on clinical criteria and the severity of Hepatic Encephalopathy can be graded by West Haven Criteria. This criterion is the simplest grading of Hepatic Encephalopathy based on clinical findings. AIMS AND OBJECTIVES: To correlate between Ammonia levels and clinical severity of Hepatic Encephalopathy in Cirrhosis of liver and correlate between Arterial versus venous ammonia levels with severity of Hepatic Encephalopathy. RESULTS: Male patients had higher incidence than females. Severity of hepatic encephalopathy was graded by West Haven grading. Arterial total ammonia and venous ammonia was correlated with the clinical severity of HE. Of the 50 patients 3 had grade 1, 18 had grade 2, 22 had grade 3 and 7 had grade 4. Arterial and venous ammonia levels co related with severity of HE. The highest level of arterial ammonia was seen in grade 3 and grade 4.It was seen that other lab parameters also increased with severity of HE. But were not significant. Serum albumin was inversely co related with severity of HE. CONCLUSIONS: Arterial total ammonia correlated better with the severity of Hepatic Encephalopathy as compared to venous ammonia levels. Venous total ammonia did not correlate with severity of Hepatic Encephalopathy and with arterial ammonia levels.

  17. Hepatic arteriolo-portal venular shunting guarantees maintenance of nutritional microvascular supply in hepatic arterial buffer response of rat livers.

    Science.gov (United States)

    Richter, S; Vollmar, B; Mücke, I; Post, S; Menger, M D

    2001-02-15

    To elucidate the hepatic microvascular response upon the hepatic arterial buffer response (HABR), we analysed blood flow (ultrasonic flowprobes) of the hepatic artery (HA) and portal vein (PV), microcirculation (intravital microscopy), and tissue oxygenation (polarography) in anaesthetized Sprague-Dawley rats and re-evaluated the role of adenosine in mediating the HABR by using 8-phenyltheophylline as a competitive antagonist. 2. Upon restriction of PV blood flow to 11 +/- 3 % of baseline values, HA blood flow increased by a factor of 1.77 (P portal venules (TPVs) decreased to only 66 % (P portal venular shunting. As a consequence, red blood cell velocity and volumetric blood flow in sinusoids were found to be reduced to only 66-68 % compared with baseline (P oxygen delivery, despite the marked reduction of total liver blood flow. Further, hepatic arteriolo-portal venular shunting guaranteed homogeneity of nutritive blood flow upon HABR, as given by an unchanged intra-acinar coefficient of variance of sinusoidal perfusion. 4. Pretreatment of animals with the adenosine antagonist 8-phenyltheophylline completely blocked the hepatic arterial buffer response with the consequence of decreased tissue oxygenation and increased heterogeneity of sinusoidal perfusion. 5. In conclusion, hepatic microhaemodynamics, in particular unchanged diameters of THAs, TPVs and sinusoids, during HABR indicate that reduction in resistance to HA flow is located upstream and functions via hepatic arteriolo-portal venular shunts resulting in equal distribution of microvascular blood flow and oxygen delivery under conditions of restricted PV blood supply.

  18. Stent grafting of acute hepatic artery bleeding following pancreatic head resection

    Energy Technology Data Exchange (ETDEWEB)

    Stoupis, Christoforos [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Kreisspital, Radiology, Maennedorf (Switzerland); Ludwig, Karin; Triller, Juergen [University of Berne, Inselspital, Department of Diagnostic, Interventional and Pediatric Radiology, Berne (Switzerland); Inderbitzin, Daniel [University of Berne, Inselspital, Clinic for Visceral and Transplantation Surgery, Berne (Switzerland); Do, Dai-Do [University of Berne, Inselspital, Clinic for Angiology, Berne (Switzerland)

    2007-02-15

    The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump. (orig.)

  19. Late hepatic artery pseudoaneurysm: A rare complication after resection of hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Javier Brice(n)o; (A)lvaro Naranjo; Rubén Ciria; Juan Manuel Sánchez-Hidalgo; Luis Zurera; Pedro López-Cillero

    2008-01-01

    We report an unusual pathological entity of a pseudoaneurysm of the right hepatic artery, which developed two years after the resection of a type n hilar cholangiocarcinoma and secondary to an excessive skeletonization for regional lymphadenectomy and neoadjuvant external-beam radiotherapy. After a sudden and massive hematemesis, a multidetector computed tomographic angiography (MDCTA) showed a hepatic artery pseudoaneurysm. Angiography with embolization of the pseudoaneurysm was attempted using microcoils with adequate patency of the hepatic artery and the occlusion of the pseudoaneurysm. A new episode of hematemesis 3 wk later revealed a partial revascularization of the pseudoaneurysm. A definitive interventional radiological treatment consisting of transarterial embolization (TAE) of the right hepatic artery with stainless steel coils and polyvinyl alcohol particles was effective and well- tolerated with normal liver function tests and without signs of liver infarction.

  20. Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in Intrahepatic Cholangiocellular Carcinoma (ICC): Results from a National Multi-Center Study on Safety and Efficacy.

    Science.gov (United States)

    Schicho, Andreas; Pereira, Philippe L; Pützler, Manfred; Michalik, Katharina; Albrecht, Thomas; Nolte-Ernsting, Claus; Stroszczynski, Christian; Wiggermann, Philipp

    2017-02-13

    BACKGROUND The aim of this study was to evaluate the safety and efficacy of DSM (degradable starch microspheres) as an embolic agent in transarterial chemoembolization in the treatment of intrahepatic cholangiocellular carcinoma (ICC). MATERIAL AND METHODS This was a national, multi-center observational cohort study on the safety and efficacy of DSM-TACE using mitomycin, gemcitabine, cisplatin, doxorubicin, and carboplatin in palliative treatment of ICC. Recruitment period for the study was from January 2010 to June 2014. Primary endpoints were toxicity, safety, and response according to mRECIST criteria. RESULTS Twenty-five DSM-TACE procedures in cases of advanced ICC were performed in seven patients. Nausea and vomiting occurred as adverse event (AE) in eight out of 25 treatments (32%), with seven of eight events (87.5%) associated with the use of gemcitabine. In 11 out of 25 treatments (44%) moderate, transient epigastric pain was registered as an adverse event (AE) within 24 hours of DSM-TACE. One case (1/25) of severe AE (4%) with thrombocytopenia led to discontinuation of the DSM-TACE-treatment. A total of 25 DSM-TACE procedures with complete clinical and imaging follow-up over a two-year-period were analyzed: objective response (OR) was achieved in three of 25 treatments (12%) Disease control (DC) was achieved in 44% (11/25) of treatments; progress was registered in 4% (1/25). CONCLUSIONS The use of DSM as an embolic agent for TACE is safe in the treatment of ICC. A standardized anti-emetic medication should be established, especially when using gemcitabine. Further prospective studies need to be conducted to find the most suitable, standardized DSM-TACE treatment regime.

  1. Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in Intrahepatic Cholangiocellular Carcinoma (ICC): Results from a National Multi-Center Study on Safety and Efficacy

    Science.gov (United States)

    Schicho, Andreas; Pereira, Philippe L.; Pützler, Manfred; Michalik, Katharina; Albrecht, Thomas; Nolte-Ernsting, Claus; Stroszczynski, Christian; Wiggermann, Philipp

    2017-01-01

    Background The aim of this study was to evaluate the safety and efficacy of DSM (degradable starch microspheres) as an embolic agent in transarterial chemoembolization in the treatment of intrahepatic cholangiocellular carcinoma (ICC). Material/Methods This was a national, multi-center observational cohort study on the safety and efficacy of DSM-TACE using mitomycin, gemcitabine, cisplatin, doxorubicin, and carboplatin in palliative treatment of ICC. Recruitment period for the study was from January 2010 to June 2014. Primary endpoints were toxicity, safety, and response according to mRECIST criteria. Results Twenty-five DSM-TACE procedures in cases of advanced ICC were performed in seven patients. Nausea and vomiting occurred as adverse event (AE) in eight out of 25 treatments (32%), with seven of eight events (87.5%) associated with the use of gemcitabine. In 11 out of 25 treatments (44%) moderate, transient epigastric pain was registered as an adverse event (AE) within 24 hours of DSM-TACE. One case (1/25) of severe AE (4%) with thrombocytopenia led to discontinuation of the DSM-TACE-treatment. A total of 25 DSM-TACE procedures with complete clinical and imaging follow-up over a two-year-period were analyzed: objective response (OR) was achieved in three of 25 treatments (12%) Disease control (DC) was achieved in 44% (11/25) of treatments; progress was registered in 4% (1/25). Conclusions The use of DSM as an embolic agent for TACE is safe in the treatment of ICC. A standardized anti-emetic medication should be established, especially when using gemcitabine. Further prospective studies need to be conducted to find the most suitable, standardized DSM-TACE treatment regime. PMID:28192388

  2. Prebiliary Right Hepatic Artery Resulting in Common Hepatic Duct Compression and Subsequent Intrahepatic Stone Formation: Myth or Reality?

    Directory of Open Access Journals (Sweden)

    Vanessa Marron Mendes

    2014-01-01

    Full Text Available The vascular anatomy of the liver is subjected to many variations. Aberrant hepatic artery is not an uncommon finding during visceral surgery; however, topographic variations are less reported in the literature. Prebiliary artery crossing anteriorly to the common hepatic duct was firstly reported in 1984. We present here a case of a 52-year-old lady who presented with obstructive jaundice and right upper quadrant pain. Paraclinical investigations were consistent with intrahepatic stones and a benign stricture on the CBD. During surgery, a prebiliary right hepatic artery compressing the CHD was noted. The liver pedicle was dissected and a hepaticojejunostomy was performed that resulted in a good outcome after 24 months of followup.

  3. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  4. Radioembolization of hepatic tumors. Flow redistribution after the occlusion of intrahepatic arteries

    Energy Technology Data Exchange (ETDEWEB)

    Lauenstein, T.C. [University Hospital Essen (Germany). Radiology; Heusner, T.A.; Antoch, G. [University Hospital Duesseldorf (Germany). Radiology; Hamami, M.; Bockisch, A. [University Hospital Essen (Germany). Dept. of Nuclear Medicine; Ertle, J.; Schlaak, J.F.; Gerken, G. [University Hospital Essen (Germany). Gastroenterology and Hepatology

    2011-11-15

    Radioembolization using 90yttrium is an emerging therapy option for unresectable liver malignancies. In order to reduce the number of yttrium injections, endovascular occlusion of a segmental hepatic artery has been proposed. The aim of this study was to assess whether sufficient vascular redistribution of the occluded liver segments through intrahepatic collaterals can be observed. 27 patients with hepatocellular carcinoma (n = 16) or hepatic metastases (n = 11) were studied. Hepatic angiography was performed on average 16 days prior to radioembolization. The segment II/III artery (n = 9) or the segment IV artery (n = 18) was occluded using coils. Technectium-99m-labeled macroaggregated albumin (99mTc-MAA) was injected into the right and the remaining part of the left hepatic artery in order to identify any hepatic volume not included in the perfused area. Patients underwent a SPECT/CT on average 1 h after the 99mTc-MAA injection. Two radiologists evaluated the SPECT/CT scans regarding the presence of non-perfused hepatic segments. Furthermore, hepatic perfusion was assessed by digital subtraction angiography (DSA) on the day of radioembolization. In 16 / 27 patients (59 %) a perfusion of the occluded liver segment was visible on the SPECT/CT scan. In 8 / 11 patients without flow redistribution at the time of the SPECT/CT, perfusion of the occluded segment through hepatic collaterals was observed during angiography prior to radioembolization. Hence, flow redistribution was eventually found in 24 / 27 patients (89 %). Flow redistribution after the occlusion of intrahepatic arteries prior to radioembolization can be successfully induced in the majority of patients with anatomical variants of the hepatic arteries. (orig.)

  5. Implantable continuous Doppler monitoring device for detection of hepatic artery thrombosis after liver transplantation

    NARCIS (Netherlands)

    de Jong, K.P.; Bekker, J.; van Laarhoven, S.; Ploem, S.; van Rheenen, P.F.; Albers, M.J.; van der Hilst, C.S.; Groen, H.

    2012-01-01

    Background. Early hepatic artery thrombosis (eHAT) after liver transplantation occurs in 3% of adults and 8% of children and often results in retransplantation. eHAT is initially asymptomatic and arterial patency is monitored with percutaneous Doppler ultrasound screening (pDUS). The aim of the stud

  6. Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yeon Hwa Yu; Joo Hyun Sohn; Tae Yeob Kim; Jae Yoon Jeong; Dong Soo Han; Yong Cheol Jeon; Min Young Kim

    2012-01-01

    Hepatic artery pseudoaneurysm (HAP) is a very rare disease but in cases of complication,there is a very high mortality.The most common cause of HAP is iatrogenic trauma such as liver biopsy,transhepatic biliary drainage,cholecystectomy and hepatectomy.HAP may also occur with complications such as infections or inflammation associated with septic emboli.HAP has been reported rarely in patients with acute pancreatitis.As far as we are aware,there is no report of a case caused by acute idiopathic pancreatitis,particularly.We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman.The woman initially presented with acute pancreatitis due to unknown cause.After conservative management,her symptoms seemed to have improved.But eight days after admission,abdominal pain abruptly became worse again.Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT.Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain.ERCP confirmed hemobilia by observing fresh blood clots at the opening of the ampulla and several filling defects in the distal common bile duct on cholangiogram.Without any particular treatment such as embolization or surgical ligation,HAP thrombosed spontaneously.Three months after discharge,abdominal CT demonstrated that HAP in the left lateral segment had disappeared.

  7. Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection.

    Science.gov (United States)

    Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

    2010-02-27

    Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique.

  8. Duplex/colour Doppler sonography: measurement of changes in hepatic arterial haemodynamics following intra-arterial angiotensin II infusion.

    Science.gov (United States)

    Leen, E; Angerson, W J; Warren, H W; Goldberg, J A; Sutherland, G R; Cooke, T G; McArdle, C S

    1993-06-01

    Angiotensin II (AT-II) has been used to target regionally-administered cytotoxic microspheres in patients with intrahepatic tumours. The optimisation of vasoconstrictor targeting requires a knowledge of the blood flow changes induced by agents such as AT-II. We therefore assessed duplex/colour Doppler sonography (DCDS) as a means of evaluating the effects of AT-II infusion on hepatic arterial blood flow (HABF) and arterial resistance in patients with intrahepatic tumours. HABF was measured continuously in nine patients using DCDS before, during and after an infusion of AT-II (15 micrograms in 3 ml of saline over 90 s) via a hepatic artery catheter. In seven patients with less than 30% hepatic replacement by tumour, the baseline level of HABF was 331 +/- 85 ml min-1 (mean +/- s.d.), and this was reduced by 75-80% within 30 s of the start of AT-II infusion. HABF recovered rapidly from the end of the infusion, and increased by up to 20% above the baseline for approximately 2 min. In two patients with greater than 50% hepatic replacement, HABF showed no reduction but rose continuously from the start of AT-II infusion, increasing by a factor of 2-2.5 after 3-4 min. Arterial resistance showed reciprocal changes in all cases. We conclude that DCDS is effective in assessing the temporal changes in hepatic arterial blood flow caused by AT-II. In order to optimise tumour targeting, the injection of microspheres loaded with cytotoxic drugs should be completed before the end of the AT-II infusion. The targeting advantage of AT-II in patients with a high percentage hepatic replacement by tumour should be re-assessed.

  9. The Degree of Lipiodol Accumulation Can Be an Indicator of Successful Treatment for Unresectable Hepatocellular Carcinoma (HCC) Patients - in the Case of Transcatheter Arterial Chemoembolization (TACE) and External Beam Radiotherapy (EBRT)

    Science.gov (United States)

    Yang, Ping; Zeng, Zhao-Chong; Wang, Bin-Liang; Zhang, Jian-Ying; Fan, Jia; Zhou, Jian; Hu, Yong

    2016-01-01

    Purpose: Transcatheter arterial chemoembolization (TACE) in combination with external beam radiotherapy (EBRT) results in improved survival due to better local control in patients with unresectable hepatocellular carcinoma (HCC). The purpose of this study was to investigate lipiodol accumulation, as it reflects tumor burden and is a potential prognostic factor, in HCC patients treated with TACE/EBRT. Methods and Materials: We retrospectively studied 147 patients with unresectable HCC treated with TACE and EBRT. Clinical features, adverse reactions, and prognostic factors were analyzed. All patients were treated with TACE 1-6 times in combination with EBRT (44-66 Gy) in dose of 2 Gy/fraction given once a day five times a week. Tumor status and laboratory findings were followed. The degree of lipiodol accumulation was assessed by computed tomography before EBRT, and was categorized as either complete/intense or low/moderate. Results: The response rate of tumor size after EBRT was 68.2%, median survival was 23.1 months, and overall survival rates were 86.6%, 49.2%, and 28.2% at 1, 2, and 3 years, respectively. Univariate analysis showed that lower hemoglobin levels, higher alkaline phosphatase levels, Child-Pugh B, negative alpha-fetoprotein (AFP) response after EBRT, poor treatment response after EBRT, tumor diameter >10 cm, and poor lipiodol accumulation were unfavorable prognostic factors. On multivariate analysis, higher hemoglobin levels, Child-Pugh A, decreased AFP levels after treatment, Helical Tomotherapy (HT) and intense lipiodol accumulation after TACE were significant favorable predictors. Conclusions: The degree of lipiodol accumulation before EBRT is a prognostic factor in patients with unresectable HCC. Increased AFP levels after EBRT are always associated with poor survival. HT is recommended as a potentially better EBRT modality than three-dimensional conformal radiation therapy (3D-CRT). PMID:27471557

  10. Preventative effects of prostaglandin E1 in combination with iodized olive oil on liver fibrosis after transcatheter arterial chemoembolization in a rabbit model of CCl4-induced liver fibrosis.

    Science.gov (United States)

    Jin, Shuqiang; Cao, Haili; Wang, Kaibing; Li, Ying; Bai, Bin

    2015-06-01

    To explore the preventative effects of prostaglandin E1 (PGE1) on a rabbit model of CCl4-induced liver fibrosis after transcatheter arterial chemoembolization (TACE), we generated a rabbit model of CCl4-induced liver fibrosis by treatment with 40% CCl4 in iodized olive oil for 16 weeks. Body mass and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), albumin:globulin ratio (A:G), total bilirubin (TBIL), and direct bilirubin (DBIL) were measured. After TACE, the levels of hyaluronic acid (HA), procollagen III (PC III), laminin (LN), and collagen IV (IV-C) were measured, and the severity of liver fibrosis as well as the morphology of liver tissues were determined. Body mass in the model group was significantly decreased from 10 to 16 weeks, and the serum levels of ALT, AST, TP, TBIL, and DBIL levels were significantly increased while the model was being generated; the levels of ALB and A:G were significantly decreased. After TACE, serum levels of HA, PC III, and LN in the group injected with 1.0 mL iodized olive oil (Group B) were higher than in the group that were injected with 1.0 mL iodized olive oil + 0.2 mL PGE1 (Group C), whereas the serum levels of IV-C were lower. The severity of liver fibrosis was ameliorated in Group C. The combination of PGE1 and iodized olive oil prevented the development of liver fibrosis following TACE.

  11. Endovascular treatment of hepatic artery aneurysm in a patient with Ehlers-Danlos syndrome. Case report.

    Science.gov (United States)

    Casana, R; Nano, G; Dalainas, I; Tealdi, D G

    2004-09-01

    Ehlers-Danlos syndrome (EDS) is a rare, variably inherited disorder affecting connective tissue. Patients with EDS often develop aneurysms of the thoracic and abdominal aorta as well as the visceral arteries. We report our experience with an elective endovascular exclusion of an hepatic artery aneurysm in a 26-year-old female patient with EDS type IV. A balloon-expandable 4x26 mm stent-graft was placed in the common hepatic artery, excluding the aneurysm. The follow-up at the 2, 6 and 18 months showed the patency of the common hepatic artery, the absence of endo-leak and the right location of the stent-graft. In EDS patients, the endovascular treatment could be preferable to open surgery because of the minimum trauma.

  12. Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance

    Science.gov (United States)

    Kannan, Rajendran; Jebakani, Christilda Felicia; Anbalagan, Jayaram

    2016-01-01

    Introduction Variations in the Right Hepatic Artery (RHA) are exceedingly common and these variations are of great importance to surgeons and interventional radiologists. A thorough knowledge of the right hepatic arterial anatomy is mandatory while performing hepatic surgery and hepatic arteriography. Aim To find out the variations in the origin and course of the RHA and its surgical significance. Materials and Methods This study was conducted in 60 embalmed adult cadavers of both sexes of age group between 50 to 80 years. Abdomen was opened by a linear midline incision extending from the xiphoid process to the pubic symphysis. The origin of RHA from the proper hepatic artery was traced. The presence of aberrant right hepatic arteries -replaced and accessory were noted. The source of origin of accessory or replaced RHA arising from the superior mesenteric artery (SMA), right renal artery and inferior mesenteric artery was traced. The course of normal and aberrant RHA from its origin to the entrance into the right lobe of the liver was followed and structures related to it were noted. Results The RHA mostly originated from the main trunk of the proper hepatic artery in 52 specimens (86.6%). Presence of aberrant RHA was found in 8 specimens (13.3%). Among 8 specimens of aberrant RHA, replaced RHA arising from SMA was found in 5 specimens (8.3%) and accessory RHA arising from SMA was observed in 3 specimens (5%). In 86.6% of specimens, the RHA coursed dorsal to the duct system to enter the Calot’s triangle. In 8.3% of specimens, the RHA coursed ventral to duct system to reach the Calot’s triangle. The caterpillar like loop of the RHA was found in two specimens (3%). The replaced and accessory RHA (13.3%) arising from the SMA had a course dorsal to duct system to reach the Calot’s triangle. Conclusion Right hepatic artery is subject to anatomical variation in its origin and course. Our study identified the variations in the origin and course of right hepatic

  13. Lessons learned from anatomic variants of the hepatic artery in 1,081 transplanted livers.

    Science.gov (United States)

    López-Andújar, Rafael; Moya, Angel; Montalvá, Eva; Berenguer, Marina; De Juan, Manuel; San Juan, Fernando; Pareja, Eugenia; Vila, Juan José; Orbis, Francisco; Prieto, Martín; Mir, José

    2007-10-01

    The aim of this study is to contribute our experience to the knowledge of the anatomic variations of the hepatic arterial supply. The surgical anatomy of the extrahepatic arterial vascularization was investigated prospectively in 1,081 donor cadaveric livers, transplanted at La Fe University Hospital from January 1991 to August 2004. The vascular anatomy of the hepatic grafts was classified according to Michels description (Am J Surg 1966;112:337-347) plus 2 variations. Anatomical variants of the classical pattern were detected in 30% of the livers (n=320). The most common variant was a replaced left artery arising from the left gastric artery (9.7%) followed by a replaced right hepatic artery arising from the superior mesenteric artery (7.8%). In conclusion, the information about the different hepatic arterial patterns can help in reducing the risks of iatrogenic complications, which in turn may result in better outcomes not only following surgical interventions but also in the context of radiological treatments.

  14. Computed tomography perfusion in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Guang Chen; Da-Qing Ma; Wen He; Bao-Feng Zhang; Li-Qin Zhao

    2008-01-01

    AIM: To prospectively assess the changes in parameters of computed tomography (CT) perfusion pre- and post-transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) in different treatment response groups,and to correlate the changes with various responses of HCC to TACE.METHODS: Thirty-nine HCC patients underwent CT perfusion examinations pre-(1 d before TACE) and post-treatment (4 wk after TACE).The response evaluation criteria for solid tumors (RECIST) were referred to when treatment responses were distributed.Wilcoxon-signed ranks test was used to compare the differences in CT perfusion parameters pre- and post-TACE for different response groups.RESULTS: Only one case had treatment response to CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signals.In the PR treatment response group,hepatic artery perfusion (HAP),hepatic arterial fracture (HAF) and hepatic blood volume (HBV) of viable tumors POst-TACE were reduced compared with pre-TACE (P = 0.001,0.030and 0.001,respectively).In the SD group,all CT perfusion parameters were not significantly different pre- and post-TACE.In the PD group,HAP,HAF,portal vein perfusion (PVP) and hepatic blood flow (HBF) of viable tumors post-TACE were significantly increased compared with pre-TACE (P = 0.005,0.012,0.035 and 0.005,respectively).CONCLUSION: Changes in CT perfusion parameters of viable tumors are correlated with different responses of HCC to TACE.Therefore,CT perfusion imaging is a feasible technique for monitoring response of HCC to TACE.

  15. Hepatic artery pseudoaneurysm after surgical treatment for pancreatic cancer: Minimally invasive angiographic techniques as the preferred treatment

    Directory of Open Access Journals (Sweden)

    Sucandy Iswanto

    2014-01-01

    Full Text Available Background: Delayed intra-abdominal bleeding related to hepatic artery pseudoaneurysm is a potentially lethal complication after pancreaticoduodenectomy for pancreatic cancer. Locally advanced tumors, which result in vessel erosion or extensive operative skeletonization, may contribute to weakness of the arterial wall. Reoperation is often technically difficult with high rate of mortality; therefore, alternative less invasive options are ideal. Aims: The study was to present an alternative endovascular treatment of a large hepatic artery pseudoaneurysm after pancreatic resection for locally advanced multicystic adenocarcinoma. Materials and Methods: Transcatheteric mesenteric angiography with deployment of detachable coils in the pseudoaneurysm sac was utilized to manage the hepatic artery pseudoaneurysm. Results: Completion angiography confirmed cessation of contrast enhancement in the pseudoaneurysm sac with preservation of normal antegrade hepatic artery flow. Conclusion: Minimally invasive angiographic technique is the preferred treatment for hepatic artery pseudoaneurysm after pancreatic resections.

  16. 介入化疗栓塞术联合体外高频热疗治疗晚期肝癌临床观察%The clinical observation of transcatheter arteria chemoembolization combined with external high frequency thermotherapy for advanced hepatic cancer

    Institute of Scientific and Technical Information of China (English)

    郑剑霄; 吴万垠; 邓宏; 龙顺钦

    2009-01-01

    Objective To evaluate the efficacy and side effects of transeatheter arteria chemoembolization combined with external high frequency thermotherapy for advanced hepatic cancer.Methods Thirty nine patients were randomly divided into 2 groups ,one group with 19 cases,the other 20 cases.The observed group was treated by transcatheter arteria.chemoembolization combined with external high frequency thermotherapy,and the control group by ordinary transcatheter arteria chemoembolization.Result The response rate with the observed group and control group were 73.7%(14/19) and 40%(8/20)respeetively(P<0.05),and its side effects was not increased.There was no significant difference in the survival rate.Conclusions The short term efficacy of the advanced hepatic cancer is improved by transcatheter arteria chemoembolization combined with external high frequency thermotherapy and its side effects is not increased.%目的 比较介入化疗栓塞术联合体外高频热疗与单纯介入化疗栓塞术治疗晚期肝癌的疗效和毒副反应.方法 39例晚期原发性肝癌患者随机分为两组,观察组19例,对照组20例.观察组行介入化疗栓塞术联合体外高频热疗,对照组行单纯介入化疗栓塞术治疗.结果 观察组总有效率73.7%(14/19);对照组总有效率40%(8/20),观察组的治疗有效率较对照组明显提高(P<0.05),毒副反应未增加.0.5年、1年生存率两组差异无显著性(P>0.05).结论 介入化疗栓塞术联合体外高频热疗提高了晚期肝癌的近期疗效,且不增加毒副作用.

  17. Hepatic arterial supply in 1297 CT-angiographies; Die arterielle Leberversorgung in 1297 CT-Angiografien

    Energy Technology Data Exchange (ETDEWEB)

    Loeschner, C.; Kausche, S.; Teichgraeber, U. [Jena University Hospital, Jena (Germany). Dept. of Radiology; Nagel, S.N. [Charite Universitaetsmedizin Berlin (Germany). Dept. of Radiology

    2015-04-15

    Analysis, evaluation and classification of hepatic arterial supply variants and determination of their frequency distribution in CT-angiographies. CT-angiographies of 1,568 patients were evaluated retrospectively for the period between January 1, 2010 and August 30, 2012. The hepatic arterial anatomy was assessed and categorized according to Michels's classification. So far unclassified variants were considered separately. Results: CT-angiographies of 1297 patients were included in the study. Type I according to Michels was seen in 937 cases (72.2%), followed by type V in 114 patients (8.8%) and type III in 83 patients (6.4%). Type X could not be found in any of the patients. Not yet classified variants were discovered in 26 patients. The most frequent variant in this connection was a right hepatic artery originating from the superior mesenteric artery with the left hepatic artery originating from the left gastric artery (n=10). Michels's classification could be largely confirmed on the basis of a radiologically examined patient population. Not yet classified variants were categorized into subgroups of the existing classification.

  18. A Controlled Clinical Study between Hepatic Arterial Infusion with Embolized Curcuma Aromatic Oil and Chemical Drugs in Treating Primary Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To evaluate the effectiveness, toxicity and prospective application of hepatic arterial infusion (HAI) with embolized Curcuma Aromatic oil (CAO) in treating primary liver cancer (PLC). Methods: In the treated group, 32 patients with PLC were treated by HAI with 1-3 ml embolized CAO and oral administration of Chinese herbal medicine. In the control group, 32 patients with PLC were treated with transcatheter artery chemoembolization (TACE). Results: In the treated group, one patient attained complete remission (CR) and 13 partial remission (PR), the total effective rate being 43.75%. The level of alpha fetal protein (AFP) turned to normal range in 7 cases and decreased in other 7. In the control group, 10 obtained PR and the total effective rate being 31.25%, AFP level turned to normal in 5 and decreased in 2. There was no statistical significance between the two groups. The incidences of post-embolism Sydrome, such as fever, abdominal pain and vomiting were similar between the two groups but no myelosuppression occurred in the treated group with significant difference as comparing with that in the control group (P<0.01). The mean survival time, median survival time, 1-, 2- and 3-year survival rate in the treated group were 11.5 months, 10 months, 37.5%, 13.3% and 6.9% respectively, while in the control group they were 7.25 months, 6 months, 15.6%, 3.2% and 0% respectively. Better result in mean survival time, median survival time and 1-year survival rate was found in the treated group than that of the control group (P<0.05). Conclusion:HAI with embolized CAO showed a similar good effect in treating PLC as that of TACE, but superior to TACE with longer survival time and milder myelosuppression.

  19. Lower gastrointestinal bleeding due to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Ajay D Mate

    2013-01-01

    Full Text Available Pseudoaneurysm of hepatic artery is a rare but known complication of laparoscopic cholecystectomy (LC. Such pseudoaneurysms may bleed in biliary tree, upper gastrointestinal (GI tract or peritoneal cavity leading to life-threatening internal haemorrhage. It is very rare for them to present as lower GI bleeding. We report an unusual case of Right hepatic artery pseudoaneurysm developed following LC, which ruptured into hepatic flexure of colon resulting in catastrophic lower GI bleeding. This was associated with partial celiac artery occlusion due to thrombosis. Due to failure of therapeutic embolisation, the patient was subjected to exploratory laparotomy to control haemorrhage. Postoperatively, patient recovered well and was discharged on postoperative day 10. A strong index of suspicion is necessary for early diagnosis of such condition and to limit resultant morbidity. Angioembolisation is the first-line treatment and surgery is indicated in selected cases.

  20. Different modalities of arterial reconstruction in hepatic retransplantation using right partial graft

    Institute of Scientific and Technical Information of China (English)

    Salvatore Gruttadauria; Fabrizio di Francesco; Marco Spada; Mariapina Milazzo; Bruno Gridelli

    2009-01-01

    Though split-liver and living-related transplantation are routinely performed, they are done almost exclusively for primary liver transplantation because of potential surgical difficulties. These difficulties are generally related to arterial revascularization, particularly if there is hepatic artery thrombosis. According to UNOS data,of the hepatic retransplantations performed between 1996 and 2007, only 8.7% were done using right or extended right grafts from deceased donors, and 14.3%using right grafts from live donors. Here we report our experience with 5 hepatic retransplantations in which right partial grafts resulting from conventional in situ splits, and one right lobe resulting from an adult-toadult living-related transplant, were successfully used with different modalities of graft arterialization.

  1. A New Technique for Superselective Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jee Hyun; Chung; Jin Wook; Jae, Hwan Jun; Lee, Whal; Park, Jae Hyung [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2007-06-15

    We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd's hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages. We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd's hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd's hook form for superselective catheterization of targeted vessels. The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection. We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd's hook hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.

  2. Surgical procedures for a rat model of partial orthotopic liver transplantation with hepatic arterial reconstruction.

    Science.gov (United States)

    Nagai, Kazuyuki; Yagi, Shintaro; Uemoto, Shinji; Tolba, Rene H

    2013-03-07

    Orthotopic liver transplantation (OLT) in rats using a whole or partial graft is an indispensable experimental model for transplantation research, such as studies on graft preservation and ischemia-reperfusion injury, immunological responses, hemodynamics, and small-for-size syndrome. The rat OLT is among the most difficult animal models in experimental surgery and demands advanced microsurgical skills that take a long time to learn. Consequently, the use of this model has been limited. Since the reliability and reproducibility of results are key components of the experiments in which such complex animal models are used, it is essential for surgeons who are involved in rat OLT to be trained in well-standardized and sophisticated procedures for this model. While various techniques and modifications of OLT in rats have been reported since the first model was described by Lee et al. in 1973, the elimination of the hepatic arterial reconstruction and the introduction of the cuff anastomosis technique by Kamada et al. were a major advancement in this model, because they simplified the reconstruction procedures to a great degree. In the model by Kamada et al., the hepatic rearterialization was also eliminated. Since rats could survive without hepatic arterial flow after liver transplantation, there was considerable controversy over the value of hepatic arterialization. However, the physiological superiority of the arterialized model has been increasingly acknowledged, especially in terms of preserving the bile duct system and the liver integrity. In this article, we present detailed surgical procedures for a rat model of OLT with hepatic arterial reconstruction using a 50% partial graft after ex vivo liver resection. The reconstruction procedures for each vessel and the bile duct are performed by the following methods: a 7-0 polypropylene continuous suture for the supra- and infrahepatic vena cava; a cuff technique for the portal vein; and a stent technique for the

  3. Clinical effects of transcatheter hepatic arterial embolization with holmium-166 poly(l-lactic acid) microspheres in healthy pigs

    NARCIS (Netherlands)

    Vente, M.A.D.; Nijsen, J.F.W.; De Wit, T.C.; Seppenwoolde, J.H.; Krijger, G.C.; Seevinck, P.R.; Huisman, A.; Zonneneberg, B.A.; Van den Ingh, T.S.G.A.M.; Van het Schip, A.D.

    2008-01-01

    Purpose The aim of this study is to evaluate the toxicity of holmium-166 poly(l-lactic acid) microspheres administered into the hepatic artery in pigs. Methods Healthy pigs (20–30 kg) were injected into the hepatic artery with holmium-165-loaded microspheres (165HoMS; n = 5) or with holmium-166-l

  4. Value of 64-slice spiral CT perfusion imaging in estimating the efficacy of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma%64排螺旋CT灌注成像在肝细胞癌介入治疗前后的评估价值

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    Objective To discuss the clinical value of 64-slice spiral CT perfusion imaging(CTPI) in estimating the efficacy of transcatheter arterial chemoembolization ( TACE ) for hepatocellular carcinoma (HCC).Methods Using 64-slice spiral CT(GE LightSpeed VCT XT),all CT plain scan and perfusion scan were performed in 30 patients with HCC 1-3 days before and 30-40 days after TACE .Using deconvolution through Infusion Software analysis , hepatic blood flow ( BF ) , blood volume ( BV ) , the mean transit time ( MTT) , hepatic arterial fraction ( HAF ) , permeability surface ( PS ) were caculated to evaluate HCC embolization hemodynamic status .Results After TACE,the tumor was totally filled with lipiodol in 12 cases and partially filled with lipiodol in 18 cases.BF,BV,MTT,HAF and PS perfusion maps showed that lack of blood perfusion was found in lipiodol-filling areas, but sparsely or insufficiently lipiodol-filled areas were hyperperfusion.BF,BV,HAF and PS of HCC after TACE were lower than those of HCC before TACE (P0.05 ) .Conclusions 64-slice spiral CT liver perfusion imaging can be used to monitor the blood supply changes in non -iodized oil deposits area non-invasively ,dynamically ,quantitatively ,which was very important in judging the tumor tissue survival and played an important role in response evaluation of HCC interventional therapy and guiding the follow -up treatment.%目的:探讨64排螺旋CT灌注成像(CTPI)在原发性肝细胞癌(HCC)肝动脉插管化疗栓塞( TACE )术前、后疗效的评估价值。方法选取30例HCC 患者,于TACE术前1~3 d、术后30~40 d应用GE LightSpeed VCT XT(64排128层螺旋CT)分别行全肝常规平扫及灌注扫描,运用灌注软件进行分析,计算肝血流量(BF)、血容量(BV)、平均通过时间(MTT)、肝动脉灌注指数(HAF)、毛细血管通透性( PS )等,统计分析相关参数,以评价 HCC 介入治疗前后的血流动力学状态。结果 TACE

  5. Is prophylactic embolization of the hepatic falciform artery needed before radioembolization in patients with {sup 99m}Tc-MAA accumulation in the anterior abdominal wall?

    Energy Technology Data Exchange (ETDEWEB)

    Ahmadzadehfar, Hojjat; Sabet, Amir; Muckle, Marianne; Haslerud, Torjan; Biersack, Hans Juergen; Ezziddin, Samer [University Hospital Bonn, Department of Nuclear Medicine, Bonn (Germany); Moehlenbruch, Markus; Meyer, Carsten; Wilhelm, Kai; Schild, Hans Heinz [University Hospital Bonn, Department of Radiology, Bonn (Germany)

    2011-08-15

    While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in {sup 99m}Tc-macroaggregated albumin ({sup 99m}Tc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of {sup 99m}Tc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours. A total of 224 diagnostic hepatic angiograms combined with {sup 99m}Tc-MAA SPECT/CT were acquired in 192 patients with different types of cancer, of whom 142 were treated with a total of 214 radioembolization procedures. All patients received a whole-body scan, and planar and SPECT/CT scans of the abdomen. Only patients with extrahepatic {sup 99m}Tc-MAA accumulation in the anterior abdominal wall were included in this study. Posttreatment bremsstrahlung SPECT/CT and follow-up results for at least 3 months served as reference standards. Tracer accumulation in the anterior abdominal wall was present in pretreatment {sup 99m}Tc-MAA SPECT/CT images of 18 patients (9.3%). The HFA was found and embolized by radiologists before treatment in one patient. In the remaining patients radioembolization was performed without any modification in the treatment plan despite the previously mentioned extrahepatic accumulation. Only one patient experienced abdominal muscle pain above the navel, which started 24 h after treatment and lasted for 48 h without any skin changes. The remaining patients did not experience any relevant side effects during the follow-up period. Side effects after radioembolization in patients with tracer accumulation in the

  6. Hepatic artery stent-grafts for the emergency treatment of acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bellemann, Nadine, E-mail: nadine.bellemann@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Sommer, Christof-Matthias; Mokry, Theresa; Kortes, Nikolas; Gnutzmann, Daniel; Gockner, Theresa; Schmitz, Anne [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Weitz, Jürgen [Department of Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany); Department for Visceral, Thoracic and Vascular Surgery at the University Hospital, Technical University Dresden (Germany); Kauczor, Hans-Ulrich; Radeleff, Boris; Stampfl, Ulrike [Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • We report our experiences with stent-grafts for the treatment of acute hemorrhage from the hepatic artery or the stump of the gastroduodenal artery. • The technical success of stent-graft implantation was 88%. • The bleeding ceased immediately after stent-graft implantation in 88%. • The complication rate was 21%. - Abstract: Purpose: We evaluated the technical success and clinical efficacy of stent-graft implantation for the emergency management of acute hepatic artery bleeding. Methods: Between January 2010 and July 2013, 24 patients with hemorrhage from the hepatic artery were scheduled for emergency implantation of balloon expandable stent-grafts. The primary study endpoints were technical and clinical success, which were defined as successful stent-graft implantation with sealing of the bleeding site at the end of the procedure, and cessation of clinical signs of hemorrhage. The secondary study endpoints were complications during the procedure or at follow-up and 30-day mortality rate. Results: In 23 patients, hemorrhage occurred after surgery, and in one patient hemorrhage occurred after trauma. Eight patients had sentinel bleeding. In most patients (n = 16), one stent-graft was implanted. In six patients, two overlapping stent-grafts were implanted. The stent-grafts had a target diameter between 4 mm and 7 mm. Overall technical success was 88%. The bleeding ceased after stent-graft implantation in 21 patients (88%). The mean follow-up was 137 ± 383 days. In two patients, re-bleeding from the hepatic artery occurred during follow-up after 4 and 29 days, respectively, which could be successfully treated by endovascular therapy. The complication rate was 21% (minor complication rate 4%, major complication rate 17%). The 30-day mortality rate was 21%. Conclusions: Implantation of stent-grafts in the hepatic artery is an effective emergency therapy and has a good technical success rate for patients with acute arterial hemorrhage.

  7. Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Leoncio L. Kaw, Jr

    2006-10-01

    Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

  8. Delayed hemorrhage from hepatic artery after ultrasound-guided percutaneous liver biopsy: A case report

    Institute of Scientific and Technical Information of China (English)

    Fen-Yu Ren; Xi-Xu Piao; Ailian Jin

    2006-01-01

    Percutaneous liver biopsy is considered one of the most important diagnostic tools to evaluate diffuse liver diseases. Pseudoaneurysm of hepatic artery is an unusual complication after ultrasound-guided percutaneous liver biopsy. Delayed hemorrhage occurs much less frequently. We report a case of pseudoaneurysm of the hepatic artery of a 46-year-old man who was admitted for abdominal pain after 4 d of liver biopsy. The bleeding was controlled initially by angiographic embolization.However, recurrent bleeding could not be controlled by repeat angiography, and the patient died 4 d after admission from multiorgan failure. The admittedly rare possibility of delayed hemorrhage should be considered whenever a liver biopsy is performed.

  9. Life-threatening hemobilia caused by hepatic artery pseudoaneurysm:A rare complication of chronic cholangitis

    Institute of Scientific and Technical Information of China (English)

    Tsu-Te Liu; Ming-Chih Hou; Han-Chieh Lin; Full-Young Chang; Shou-Dong Lee

    2003-01-01

    Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is undear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.

  10. The Relationship between Portal Venous and Hepatic Arterial Blood Flow. I. Experimental Liver Transplantation

    Directory of Open Access Journals (Sweden)

    F. Jakab

    1996-01-01

    Full Text Available The relationship between the changes in portal venous and hepatic arterial blood flows, in the liver is a much disputed question, it has tremendous significance in the practice of transplantation, and an explanation has been available since 1981, when Lautt published the so-caled “adenosine washout theory”. According to our earlier observations the decrease of portal pressure or flow consistently led to an increase in hepatic artery flow. At the same time changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantation (OLTX was carried out on mongrel dogs by Starzl's method. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient’s liver, and after completion of all vascular anastomoses to the newly inserted liver, during the recirculatory phase of OLTX. The flow probes were connected to a Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were also recorded.

  11. Hepatic artery pseudoaneurysms arising from within a hepatocellular carcinoma

    Science.gov (United States)

    Chingkoe, C M; Chang, S D; Legiehn, G M; Weiss, A

    2010-01-01

    We report a case of a 70-year-old man with a large hepatocellular carcinoma (HCC) containing two pseudoaneurysms measuring up to 2 cm in diameter. The pseudoaneurysms and part of the HCC were supplied by branches from the middle colic artery, which arises from the superior mesenteric artery. This complex arterial vasculature was visualised on CT and confirmed with conventional angiography. PMID:21088082

  12. Transcatheter Arterial Chemoembolization in Elderly Patients with Primary Hepatocellular Carcinoma%经导管动脉内化疗治疗高龄原发性肝癌患者生存分析

    Institute of Scientific and Technical Information of China (English)

    康海燕; 常中飞; 刘凤永; 段峰; 王志军; 王茂强

    2015-01-01

    Purpose Elderly patients with primary hepatocellular carcinoma (HCC) have gradually increased in recent years. Most patients also have systemic disease with poor cardiac and pulmonary function, thus can only receive non-surgical treatment. This paper is to assess the clinical efficacy of transcatheter arterial chemoembolization (TACE) and prognostic factors of HCC in elderly patients. Materials and Methods A retrospective analysis was performed in 106 patients with HCC diagnosed by US, dynamic CT or dynamic MRI [average age (74.9±3.3) years, range 71-84 years] and treated by TACE. The clinical characteristics, survival and prognosis factors were analyzed. Results Follow-up was performed at a median of 18 months (range 1–40 months). The 1-, 2-, and 3-year overall survival (OS) rates were 80.2%, 42.5% and 22.6%, respectively. Univariate analysis showed that the patient's gender and cirrhosis, HBV/HCV infection, diabetes and systemic disease were not significantly correlated with prognosis (P>0.05). Child grade, Eastern Cooperative Oncology Group (ECOG) grade, tumors size, number of tumors, serum alpha-fetoprotein level, portal vein tumor thrombus and Barcelona clinic liver cancer stage were significantly related to OS (P0.05),Child-Pugh 分级、美国东部肿瘤协作组(ECOG)评分、肿瘤大小、肿瘤数量、血清甲胎蛋白(AFP)水平、门静脉癌栓形成及 BCLC 分期是影响高龄 HCC 患者长期生存的因素(P<0.05、P<0.001)。多因素 Cox 回归分析结果显示,有无门静脉癌栓、肿瘤大小、血清 AFP水平及 ECOG 评分是影响高龄 HCC 患者预后的独立危险因素(P<0.05、P<0.001)。结论伴有全身疾病不是影响高龄 HCC 患者长期生存的因素,影响高龄肝癌患者预后的危险因素是有无门静脉癌栓、肿瘤大小、血清 AFP 水平及 ECOG 评分。

  13. Corona Enhancement and Mosaic Architecture for Prognosis and Selection Between of Liver Resection Versus Transcatheter Arterial Chemoembolization in Single Hepatocellular Carcinomas >5 cm Without Extrahepatic Metastases: An Imaging-Based Retrospective Study.

    Science.gov (United States)

    Li, Meng; Xin, Yongjie; Fu, Sirui; Liu, Zaiyi; Li, Yong; Hu, Baoshan; Chen, Shuting; Liang, Changhong; Lu, Ligong

    2016-01-01

    Corona enhancement and mosaic architecture are 2 radiologic features of hepatocellular carcinoma (HCC). However, neither their prognostic values nor their impacts on the selection of liver resection (LR) versus transcatheter arterial chemoembolization (TACE) as treatment modalities have been established.We retrospectively analyzed 275 patients with a single HCC lesion >5 cm without extrahepatic metastasis treated with LR or TACE. In LR patients, the overall survival (OS) and time to progression (TTP) were compared between corona enhancement negative (corona-) versus positive (corona+) and mosaic architecture negative (mosaic-) versus positive (mosaic+) patients. Furthermore, by the combination of corona and mosaic, LR patients were divided into negative for both corona and mosaic patterns (LR-/-), positive for only 1 feature (LR+/-), and positive for both (LR+/+); their OS and TTP were compared to those of the TACE group. Cox regression was performed to identify independent factors for OS.In the survival plots for LR, corona- had better OS and TTP than corona+, and mosaic- had better OS than mosaic+. There was no significant difference in TTP between the subgroups. On Cox regression analysis, corona enhancement, but not mosaic architecture, was a significant factor for OS, whereas neither were a significant factor for TTP. In TACE patients, neither corona nor mosaic patterns had significant correlations with OS or TTP. In the whole population, LR-/ and LR+/- subgroups had similar OS, which was better than the LR+/+ and TACE groups. Moreover, LR-/- and LR+/- patients had better TTP than TACE patients, but there were no differences between the LR-/- versus LR+/-, LR-/ versus LR+/+, LR+/- versus LR+/+, and LR+/+ versus TACE groups. On Cox regression analysis, the presence of corona/mosaic patterns was an independent prognostic factor for OS.Our results showed that, for patients with a single HCC >5 cm without extrahepatic metastasis, corona and mosaic patterns are

  14. [The surgical treatment of an aneurysm of the celiac trunk and hepatic artery].

    Science.gov (United States)

    Rodríguez-Camarero, S J; Menéndez, A I; Rodero, J I; Alvarez, J L; Cermeño, B; Viana, M M

    1993-01-01

    We report a case of splenic aneurysms with double location, at the celiac trunks and at the common hepatic artery, in the same patient that was treated by a surgical procedure. We also review literature about the hepatic aneurysms at the celiac trunks, with special attention on the aspects of etiology, natural evolutions and different surgical procedures available. It is remarkable on this kind of pathology that special attention should be paid in order to avoid the simple ligature-exclusion of the aneurysm, it involves realizing an endoaneurysmorrhaphy followed by an aorto-hepatic by-pass.

  15. Dextran Microsphere Hepatic Artery Embolization for Hepatoma: Pathological Assessment of Its Efficacy in Resected Cases

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective To evaluate the therapeutic effect and the mechanism of dextran microsphere hepatic artery embolization for hepatoma. Methods Partial hepatectomy was performed in 11 patients with hepatoma pretreated with dextran microsphere hepatic artery embolization. All specimens were for histopathologic studies in order to observe the destiny of dextran microspheres and necrotic degree of the tumor. Results complete necrosis of the tumor was found in seven cases and incomplete necrosis of the tumor in the rest 4. Tumors in the later were near to areas rich in arterial collateral anastomoses. The extent of tumor necrosis was unrelated to the presence and thickness of tumor capsule and capsular invasions. Dextran microspheres could cause permanent embolization of distal arterioles. The microspheres were very biocompatible and cause little foreign body reaction. No inflammatory changes were seen both inside and outside of the embolized artery 191 days after embolization. Dextran microspheres were not absorbed and the vessel recanalization was also not seen. Dextran microsphere was not found in portal veins. Conclusion Some hepatomas distant from the collateral circulation of arteries could be cured with dextran microsphere hepatic artery embolization alone.

  16. Liver microcirculation after hepatic artery embolization with degradable starch microspheres in vivo

    Institute of Scientific and Technical Information of China (English)

    Jian Wang; Satoru Murata; Tatsuo Kumazaki

    2006-01-01

    AIM: To observe the dynamic changes of liver microcirculation in vivo after arterial embolization with degradable starch microspheres (DSM).METHODS: DSM were injected into the proper hepatic artery through a silastic tube inserted retrogradely in gastroduodenal artery (GDA) of SD rats. Fluorescent microscopy was used to evaluate the dynamic changes of blood flow through the terminal portal venules (TPVs), sinusoids and terminal hepatic venules (THVs).The movements of DSM debris were also recorded. Six hours after injection of DSM, percentages of THVs with completely stagnant blood flow were recorded.RESULTS: Two phases of blood flow change were recorded. In phase one: after intra-arterial injection of DSM, slow or stagnant blood flow was immediately recorded in TPVs, sinusoids and THVs. This change was reversible, and blood flow resumed completely. In phase two: after phase one, blood flow in TPVs changed again and three patterns of blood flow were recorded. Six hours after DSM injection, 36.9% ± 9.2% of THVs were found with completely stagnant blood flow.CONCLUSION: DSM can stop the microcirculatory blood flow in some areas of liver parenchyma. Liver parenchyma supplied by arteries with larger A-P shunt is considered at a higher risk of total microcirculatory blood stagnation after injection of DSM through hepatic artery.

  17. Meta-analysis of the efficacy of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer%肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能切除肝癌疗效的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    顾国文; 李相成

    2009-01-01

    目的 评价肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能手术切除肝癌的疗效和安全性.方法 计算机检索MEDLINE、EMBASE、Cochrane图书馆和中国生物医学文献数据库、中国期刊全文数据库和万方数据库中的相关文献,语种不限,所有检索均截止至2008年06月10日.检索所有有关肝动脉化疗栓塞联合经皮无水乙醇注射治疗不能切除肝癌的随机对照试验,由2名评价员筛选和提取资料,并用Jadad量表进行质量评估,对符合纳入标准的研究采用RevMan4.2软件进行分析.结果 共纳入14个随机对照试验,12篇中文,2篇英文,总共857例肝癌患者.荟萃分析结果显示:与单用肝动脉化疗栓塞治疗不能手术切除肝癌组相比,肝动脉化疗栓塞联合经皮无水乙醇注射治疗可以明显提高总生存率、AFT转阴率和下降率,还可以明显提高瘤灶显效率:1、2、3年总生存率的相对危险度RR值(95%CI)分别为1.37(1.21~1.56)、1.74(1.49~2.04)、2.26(1.70~3.02);AFP转阴率、AFP下降率、瘤灶显效率的RR(95%CI)分别为1.69(1.38~2.07)、1.39(1.24~1.56)、1.56(1.38~1.77).有11篇研究报道了与治疗相关的不良反应,主要为轻中度发热、肝功能损害,消化道反应和暂时性肝区疼痛,没有与治疗相关严重并发症或死亡的报道.结论 现有证据显示相对于单用肝动脉化疗栓塞治疗不能切除肝癌,肝动脉化疗栓塞联合经皮无水乙醇注射治疗可以明显提高总生存率、AFP转阴率及下降率,还可以提高瘸灶坏死率和缩小率,且安全性较好.但由于纳入的研究多数方法学质量偏低,需更多高质最的临床随机对照试验进一步评估其疗效和安全性.%Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer. Methods MEDLINE (1966 - June 2008), EMBASE (1974 - June 2008

  18. Hemorrhage associated with hepatic artery pseudoaneurysms after regional chemotherapy with floxuridine: case report.

    Science.gov (United States)

    Samaras, Panagiotis; Pfammatter, Thomas; Pestalozzi, Bernhard C

    2008-07-11

    Pseudoaneurysms of the hepatic artery are a rare complication in patients with primary or secondary liver tumors treated with intra-arterial chemotherapy. We present two patients who developed this complication after placement of a catheter system into the gastroduodenal artery and initiation of regional chemotherapy with floxuridine. Diagnosis was made after symptomatic bleeding occurred, necessitating emergency angiography with coil embolization. Pseudoaneurysms usually occur after mechanical damage of the vessel wall, but the chemical toxicity of floxuridine may add to the development of vascular impairment.

  19. Evaluation of 70-150-μm doxorubicin-eluting beads for transcatheter arterial chemoembolization in the rabbit liver VX2 tumour model.

    Science.gov (United States)

    Gholamrezanezhad, Ali; Mirpour, Sahar; Geschwind, Jean-Francois H; Rao, Pramod; Loffroy, Romaric; Pellerin, Olivier; Liapi, Eleni A

    2016-10-01

    To evaluate the pharmacokinetic profile (PK) and embolization effect of 70-150-μm doxorubicin eluting beads (DEBs) following intra-arterial injection (i.a.) in the rabbit liver VX2 tumour model. In this ACUC-approved study, 25 white New Zealand rabbits were randomly assigned into a small DEB group (SDB, n = 7, 70-150-μm DEBs), large DEB group (LDB, n = 7, 100-300-μm DEBs), untreated controls (n = 7), and doxorubicin controls (n = 4, without tumour, received i.a. 12.5 mg doxorubicin). Plasma PK was assessed up to 180 min post-injection. Drug tissue and liver enzyme levels, radiologic tumor response and histopathologic tumour necrosis were assessed at 7 days. Mean tumour doxorubicin concentrations were 922.83 nM (SD = 722.05) and 361.48 nM (SD = 473.23) for the SDB and LDB, respectively (p = 0.005). There was no statistically significant difference in tumour doxorubicinol, plasma doxorubicin and doxorubicinol PK values. More beads were observed in the SDB tumours (p = 0.01). Liver enzymes increased and gradually declined over the observation period, with significantly higher values in the SDB. In this preclinical study, plasma PK of i.a.-injected 70-150-μm DEBs was not different than that of 100-300-μm DEBs. More beads and higher tissue doxorubicin levels were observed in the SDB tumours. • Small and large doxorubicin-eluting beads show similar plasma pharmacokinetic profiles. • Higher tissue doxorubicin levels were observed in the small bead group. • Liver enzymes were overall significantly higher in the small bead group.

  20. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    Science.gov (United States)

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  1. Preclinical studies on holmium-166 poly(L-lactic acid) microspheres for hepatic arterial radioembolization

    NARCIS (Netherlands)

    Vente, M.A.D.

    2009-01-01

    Hepatic arterial radioembolization with radioactive holmium-166 loaded poly(L-lactic acid) microspheres (166Ho-PLLA-MS) constitutes the subject of this thesis. This technique represents a potential treatment option for patients with unresectable liver malignancies. 166Ho-PLLA-MS are believed to be a

  2. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Violari, Elena G., E-mail: eviolari@live.com; Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States); Reidy, Diane L. [Memorial Sloan-Kettering Cancer Center, Department of Medicine, Gastrointestinal Oncology Service (United States); Jarnagin, William R. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, Hepatopancreatobiliary Service (United States); Brown, Karen T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States)

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  3. The effect of Yangzhengxiaoji capsule on life quality after transcatheter arterial chemoembolization of HCC%养正消积胶囊对肝癌经动脉化疗栓塞后生活质量的影响

    Institute of Scientific and Technical Information of China (English)

    冯景见; 檀军丽; 郭燕; 王贵法; 赵敬霞; 吴小良; 王晓燕; 高彤

    2014-01-01

    Objective To observe the effect of Yangzhengxiaoji capsule on quality of life in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).Methods 60 patients with primary liver cancer were random-ly divided into control group and the treatment group with 30 patients in each group , control group only accept TACE .In treat-ment group, patients received TACE +Yangzhengxiaoji capsule;treatment lasted 28 d.Preoperative and postoperative QOL using the core scale ( QLQ-C30) assesses five functional areas , three main symptoms areas and six individual entries .Rseults Two cases were removed in treatment group and control group excluded three cases ,treatment groups'clinic benefit ( CB) rate was 89.3%(25/28), the control group's CB rate was 92.6%(25/27), the difference was not statistically significant ( P >0.05).2 groups of patients function scores showed no significant difference ( P >0.05).In the treatment group, fatigue, nausea, vomiting, pain, sleep disorders, loss of appetite, diarrhea score significantly improved compared with before treat-ment ( P <0.05, P <0.01).In control group, only fatigue, loss of appetite were improvement than before treatment ( P <0.05).Control group's fatigue, nausea, vomiting,pain,sleep disorders, loss of appetite, diarrhea scores were decreased 7.83%,4.01 %2,.78%,7.41%,7.41%,2.74%,the treatment group decreased by 11.91%,5.07%, 13.99%,15.47%, 15.47%,9.53%,improvement in the treatment group was more significantly than the control group ( P <0.05).TACE post-operative bone marrow suppression , WBC lower than the control group treated group ( P <0.05), ALT, AST 2 group differ-ence was also statistically significant ( P <0.05).Conclusion Yangzhengxiaoji capsule can significantly improve quality of life in hepatocellular carcinoma after transcatheter arterial chemoembolization .%目的:观察养正消积胶囊对肝癌经动脉化疗栓塞( TACE)后生活质量的影响。方法将原发性肝癌患者60例随

  4. Hemobilia due to hepatic artery aneurysm as the presenting sign of fibro-muscular dysplasia

    Institute of Scientific and Technical Information of China (English)

    Noam Shussman; Yair Edden; Yoav Mintz; Anthony Verstandig; Avraham I Rivkind

    2008-01-01

    Fibro-muscular dysplasia (FMD) is a rare but well documented disease with multiple arterial aneurysms. The patients, usually women, present with various clinical manifestations according to the specific arteries that are affected. Typical findings are aneurysmatic dilatations of medium-sized arteries. The renal and the internal carotid arteries are most frequently affected, but other anatomical sites might be affected too. The typical angiographic picture is that of a "string of beads". Common histological features are additionally described. Here we present a case of a 47-year-old woman, who was hospitalized due to intractable abdominal pain. A routine work-up revealed a liver mass near the portal vein. Before a definite diagnosis was reached, the patient developed massive upper gastrointestinal bleeding. In order to control the hemorrhage, celiac angiography was performed revealing features of FMD in several arteries, including large aneurysms of the hepatic artery. Active bleeding from one of these aneurysms into the biliary tree indicated selective embolization of the hepatic artery. The immediate results were satisfactory, and the 5 years follow-up revealed absence of any clinical symptoms.

  5. Hepatic artery complications after orthotopic liver transplantation: interventional treatment or retransplantation?

    Institute of Scientific and Technical Information of China (English)

    YANG Yang; YI Shu-hong; ZHANG Jian; ZHANG Jun-feng; YI Hui-min; JIANG Nan; JIANG Hua; ZHU Kang-shun; JIANG Zai-bo; SHAN Hong; CHEN Gui-hua; LI Hua; FU Bin-sheng; ZHANG Qi; ZHANG Ying-cai; LU Ming-qiang; CAI Chang-jie; XU Chi; WANG Gen-shu

    2008-01-01

    Background The main therapeutic treatments for hepatic artery complications after orthotopic liver transplantation (OLT) include thrombolysis, percutaneous transluminal angioplasty, stent placement, and liver retransplantation. The prognosis of hepatic artery complications after OLT is not only related to the type, extent, and timing but also closely associated with the selection and timing of the therapeutic methods. However, there is no consensus of opinion regarding the treatment of these complications. The aim of this study was to determine optimal treatment for hepatic artery complications after OLT.Methods The clinical data of 25 patients diagnosed with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS) between October 2003 and March 2007 were retrospectively reviewed. Treatments included liver retransplantation and interventions which contain thrombolysis, percutaneous transluminal angioplasty and stent placement. Results Among five patients with HAT, 3 were treated with thrombolysis. One recovered, one died after thrombolysis and another one died of multi-organ failure after retransplantation because of recurrent HAT. The remaining 2 patients underwent successful retransplantation and have survived after that. Among 12 patients presented with HAS within 1 month postoperatively, 2 patients underwent retransplantation due to irreversible liver failure and another 10 patients were treated with interventions. The liver function failed to improve in 3 patients and retransplantations were performed in 4 patients after stent placement because of ischemic cholangitis. Among 6 patients undergoing liver retransplantations, two died of intracranial hemorrhage and infection respectively. Eight patients presented with HAS after 1 month postoperatively, 5 patients were treated with interventional management and recovered after stent placement. Among another 3 patients presented with HAS, 2 patients' liver function was stable and one patient received late

  6. Intra-procedural Transcatheter Intraarterial Perfusion MRI as a Predictor of Tumor Response to Chemoembolization for Hepatocellular Carcinoma

    Science.gov (United States)

    Wang, Dingxin; Gaba, Ron C.; Jin, Brian; Riaz, Ahsun; Lewandowski, Robert J.; Ryu, Robert K.; Sato, Kent T.; Ragin, Ann B.; Kulik, Laura M.; Mulcahy, Mary F.; Salem, Riad; Larson, Andrew C.; Omary, Reed A.

    2011-01-01

    Rationale and Objectives To prospectively test the hypothesis that transcatheter intraarterial perfusion magnetic resonance imaging (TRIP-MRI) measured semi-quantitative perfusion reductions during transcatheter arterial chemoembolization of hepatocellular carcinoma (HCC) are associated with tumor response. Materials and Methods Twenty eight patients (mean age 63 years; range 47–87 years) with 29 tumors underwent chemoembolization in a combined MR-interventional radiology suite. Intra-procedural tumor perfusion reductions during chemoembolization were monitored using TRIP-MRI. Pre- and post-–chemoembolization semi-quantitative area under the time-signal enhancement curve (AUC) tumor perfusion was measured. Mean tumor perfusion pre- and post-chemoembolization were compared using a paired t-test. Imaging follow-up was performed one to three months after chemoembolization. We studied the relationship between short-term tumor imaging response and intra-procedural perfusion reductions using univariate and multivariate analysis. Results Intra-procedural AUC perfusion value decreased significantly after chemoembolization (342.1 versus 158.6 arbitrary unit, P < 0.001). Twenty six patients with 27 HCCs (n = 27) had follow-up imaging at mean 39 days post-chemoembolization. Favorable response was present in 67% of these treated tumors according to necrosis criteria. 15 of 16 (94%) tumors with 25–75% perfusion reductions showed necrosis treatment response compared to only 3 of 11 (27%) tumors with perfusion reductions outside the above range (P = 0.001). Multivariate logistic regression indicated that intra-procedural tumor perfusion reduction and Child-Pugh class were independent factors associated significantly with tumor response (P = 0.012 and 0.047, respectively). Conclusion TRIP-MRI can successfully measure semi-quantitative changes in HCC perfusion during chemoembolization. Intra-procedural tumor perfusion reductions are associated with future tumor response. PMID

  7. Significance of hepatic arterial responsiveness for adequate tissue oxygenation upon portal vein occlusion in cirrhotic livers.

    Science.gov (United States)

    Mücke, I; Richter, S; Menger, M D; Vollmar, B

    2000-11-01

    We investigated sinusoidal blood flow and hepatic tissue oxygenation during portal vein occlusion in cirrhotic rat livers to examine the effect of cirrhosis on the properties of hepatic microvascular blood flow regulation. After 8 weeks of CCl4/phenobarbital sodium treatment to induce cirrhosis Sprague-Dawley rats were prepared surgically to allow assessment of portal venous and hepatic arterial inflow using miniaturized flow probes with simultaneous analysis of hepatic microcirculation and tissue oxygenation by fluorescence microscopy and polarographic oxymetry. Age-matched noncirrhotic animals served as controls. Upon portal vein occlusion in cirrhotic livers (flow reduction to portal vein occlusion did not cause a deterioration in hepatic tissue pO2 (11 +/- 3 vs. 10 +/- 3 mmHg at baseline). Sinusoidal diameters were found unchanged, disproving a major role of the sinusoidal tone in the regulation of HABR. Microvascular response of cirrhotic livers did not generally differ from that in noncirrhotic livers upon portal inflow restriction. We conclude that HABR in cirrhotic livers operates sufficiently to meet the liver tissue oxygen demand, most probably by an increased relative contribution of arterial perfusion of hepatic sinusoids.

  8. Transcatheter Arterial Chemoembolization Combined with Radiofrequency Ablation for Primary Hepatocellular Carcinoma%经导管动脉化疗栓塞联合射频消融治疗原发性肝癌

    Institute of Scientific and Technical Information of China (English)

    王立刚; 郑延波; 宋雪鹏; 刘胜; 姜文进; 孙博琳; 王涛

    2015-01-01

    目的:探讨经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合 CT 引导下水循环冷却式射频消融(radiofrequency ablation,RFA)治疗原发性肝癌的临床疗效。方法2011年10月~2014年8月对32例原发性肝癌41个病灶(直径<3.0 cm 病灶7个,3.0~4.0 cm 6个,>4.0~5.0 cm 9个,>5.0 cm 19个)采用 TACE 联合 CT 导向下水循环冷却式射频消融治疗,联合治疗后第1、3个月行螺旋 CT 双期增强扫描评价疗效。结果肿瘤影像学评价,完全缓解(complete remission,CR)11个,部分缓解(partial remission,PR)24个,稳定(no change,NC)5个,进展(progressive disease,PD)1个。32例随访10~22个月,31例存活,1例术后13个月因上消化道大出血死亡。结论 TACE 联合 CT 引导下水循环冷却式 RFA 是治疗原发性肝癌安全、微创、有效的方法。%Objective To analyze the clinical efficacy of transcatheter arterial chemoembolization (TACE)combined with CT-guided water circulatory-cooling radiofrequency ablation (RFA)in the treatment of primary hepatocellular carcinoma. Methods A retrospective analysis was undertaken in 32 patients with 41 nodules of primary hepatocellular carcinoma from October 201 1 to August 2014.Seven nodules were less than 3.0 cm in diameter,6 nodules between 3.0 -4.0 cm,9 nodules between 4.0 -5.0 cm,and 19 larger than 5.0 cm.All the patients were treated by TACE combined with CT-guided water circulatory-cooling RFA.All the patients underwent follow-up with enhanced CT scanning after 1 and 3 months. Results According to the results of the CT scanning,there were 1 1 complete remission (CR),24 partial remission (PR),5 no change (NC)and 1 progressive disease (PD)in all of the nodules.Follow-up reviews for 10 -22 months in the 32 patients showed 31 survived and 1 patient died of upper gastrointestinal bleeding. Conclusion TACE combined with CT-guided water

  9. Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hoven, Andor F. van den, E-mail: a.f.vandenhoven@umcutrecht.nl; Leeuwen, Maarten S. van, E-mail: m.s.vanleeuwen@umcutrecht.nl; Lam, Marnix G. E. H., E-mail: m.lam@umcutrecht.nl; Bosch, Maurice A. A. J. van den, E-mail: mbosch@umcutrecht.nl [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine (Netherlands)

    2015-02-15

    PurposeCurrent anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification.MethodsThe hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA.ResultsThe hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four.ConclusionsThe hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification.

  10. ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS.

    Science.gov (United States)

    Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Rabelo, Priscylla; Melo, Paulo Sérgio Vieira de; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

    2017-01-01

    The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure. A incidência das variações anatômicas da artéria hepática varia de 20-50% em diferentes casuísticas. Elas s

  11. Segmentation of hepatic artery in multi-phase liver CT using directional dilation and connectivity analysis

    Science.gov (United States)

    Wang, Lei; Schnurr, Alena-Kathrin; Zidowitz, Stephan; Georgii, Joachim; Zhao, Yue; Razavi, Mohammad; Schwier, Michael; Hahn, Horst K.; Hansen, Christian

    2016-03-01

    Segmentation of hepatic arteries in multi-phase computed tomography (CT) images is indispensable in liver surgery planning. During image acquisition, the hepatic artery is enhanced by the injection of contrast agent. The enhanced signals are often not stably acquired due to non-optimal contrast timing. Other vascular structure, such as hepatic vein or portal vein, can be enhanced as well in the arterial phase, which can adversely affect the segmentation results. Furthermore, the arteries might suffer from partial volume effects due to their small diameter. To overcome these difficulties, we propose a framework for robust hepatic artery segmentation requiring a minimal amount of user interaction. First, an efficient multi-scale Hessian-based vesselness filter is applied on the artery phase CT image, aiming to enhance vessel structures with specified diameter range. Second, the vesselness response is processed using a Bayesian classifier to identify the most probable vessel structures. Considering the vesselness filter normally performs not ideally on the vessel bifurcations or the segments corrupted by noise, two vessel-reconnection techniques are proposed. The first technique uses a directional morphological operator to dilate vessel segments along their centerline directions, attempting to fill the gap between broken vascular segments. The second technique analyzes the connectivity of vessel segments and reconnects disconnected segments and branches. Finally, a 3D vessel tree is reconstructed. The algorithm has been evaluated using 18 CT images of the liver. To quantitatively measure the similarities between segmented and reference vessel trees, the skeleton coverage and mean symmetric distance are calculated to quantify the agreement between reference and segmented vessel skeletons, resulting in an average of 0:55+/-0:27 and 12:7+/-7:9 mm (mean standard deviation), respectively.

  12. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography*

    Science.gov (United States)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; de Mello Júnior, Carlos Fernando; Silva Neto, Eulâmpio José; Negromonte, Gustavo Ramalho Pessoa; Duarte, Cláudia Martina Araújo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca

    2015-01-01

    Objective To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. PMID:26811552

  13. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Severino Aires Araujo Neto

    2015-12-01

    Full Text Available Abstract Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT branches and hepatic arterial system (HAS, as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5% and 2 (3.3% patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08. A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS.

  14. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; Mello Junior, Carlos Fernando de; Silva Neto, Eulampio Jose; Negromonte, Gustavo Ramalho Pessoa; Duarte, Claudia Martina Araujo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2015-11-15

    Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials And Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. (author)

  15. Dermatomyositis associated with hepatocellular carcinoma in an elderly female patient with hepatitis C virus-related liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Nobuyuki Toshikuni; Rikako Torigoe; Mikio Mitsunaga; Akiyoshi Omoto; Koji Nakashima

    2006-01-01

    A 79-year-old female patient with hepatitis C virusrelated liver cirrhosis was diagnosed as having hepatocellular carcinoma (HCC) with a diameter of 2.0 cm. She refused therapy for HCC. Nine months after the diagnosis, she developed dermatomyositis when the HCC enlarged to a diameter of 6.0 cm. She underwent therapy for dermatomyositis, and then transcatheter arterial chemoembolization for HCC. Although the manifestations of dermatomyositis improved and entire tumor necrosis was achieved, she died of pneumonia 2 mo after the treatment of HCC. HCC and/or chronic hepatitis C virus infection might be involved in the pathogenesis of dermatormyositis.

  16. Haemodynamic changes in hepatocellular carcinoma and liver parenchyma under balloon occlusion of the hepatic artery

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Fumie; Murata, Satoru; Ueda, Tatsuo; Yasui, Daisuke; Yamaguchi, Hidenori; Miki, Izumi; Kumita, Shin-ichiro [Nippon Medical School, Department of Radiology, Center for Advanced Medical Technology, Tokyo (Japan); Kawamoto, Chiaki [Nippon Medical School, Department of Internal Medicine, Tokyo (Japan); Uchida, Eiji [Nippon Medical School, Department of Surgery, Tokyo (Japan)

    2017-06-15

    To investigate haemodynamic changes in hepatocellular carcinoma (HCC) and liver under hepatic artery occlusion. Thirty-eight HCC nodules in 25 patients were included. Computed tomography (CT) during hepatic arteriography (CTHA) with and without balloon occlusion of the hepatic artery was performed. CT attenuation and enhancement volume of HCC and liver with and without balloon occlusion were measured on CTHA. Influence of balloon position (segmental or subsegmental branch) was evaluated based on differences in HCC-to-liver attenuation ratio (H/L ratio) and enhancement volume of HCC and liver. In the segmental group (n = 20), H/L ratio and enhancement volume of HCC and liver were significantly lower with balloon occlusion than without balloon occlusion. However, in the subsegmental group (n = 18), H/L ratio was significantly higher and liver enhancement volume was significantly lower with balloon occlusion; HCC enhancement volume was similar with and without balloon occlusion. Rate of change in H/L ratio and enhancement volume of HCC and liver were lower in the segmental group than in the subsegmental group. There were significantly more perfusion defects in HCC in the segmental group. Hepatic artery occlusion causes haemodynamic changes in HCC and liver, especially with segmental occlusion. (orig.)

  17. Transcatheter Arterial Chemoembolization Combined with Thermotherapy for Treating Mid-Late Stage Liver Cancer in 31 Cases%动脉灌注栓塞术联合热疗治疗中晚期肝癌31例

    Institute of Scientific and Technical Information of China (English)

    彭杰; 胡章华; 杜驰

    2011-01-01

    目的 探讨动脉灌注栓塞术(TACE)联合深部热疗治疗中晚期原发性肝癌的疗效及毒副反应.方法 将63例患者随机分为治疗组31例和对照组32例,治疗组采用深部热疗加动脉灌注栓塞术,热疗每周2次,每次治疗间隔时间72 h以上,每5次热疗为1个疗程.对照组采用单纯动脉灌注栓塞术.热疗5次加介入治疗1次为1个疗程.评价患者疗效、生活质量和毒副反应.结果 治疗组与对照组有效率分别为70.97%和46.88%,两组近期疗效比较差异有显著意义(P=0.029);两组治疗后生活质量有显著性差异(P=0.011);主要不良反应均为消化道反应和血液学毒性,两组之间毒性反应无明显差异.结论 动脉灌注栓塞术联合热疗治疗原发性肝癌的疗效较好,可改善患者生活质量,且毒副反应低,值得临床推广.%Objective To observe the efficacy and toxicity of transcatheter arterial chemoembolization (TACE) combined with thermotherapy for treating mid-late stage primary liver cancer. Methods Sixty- three patients with primary liver cancer were randomly divided into the treatment group (31 cases) and the control group (32 cases).The treatment group was treated with deep thermotherapy combined with TACE. The thermotherapy was given twice a week after TACE with interval time of over 72 h, 5 times for a treatment cycle. The control group was given TACE alone. The effective rate, quality of life and toxicity were evaluated between the two groups. Results The rate of response (RR) in treatment group and control group were 70.97% and 46.88% respective, showing significant differences in the short- term efficacy between the two groups(P =0. 029). The quality of life after treatment in both groups had significant difference(P =0. 011). The major adverse reactions were gastrointestinal and hematologic toxicity with no significant differences between the two groups. Conclusion TACE combined with thermtherapy has better efficacy and

  18. Microsurgical reconstruction of hepatic artery in A-A LDLT:124 consecutive cases without HAT

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To retrospectively investigate microsurgical hepatic artery(HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation(A-A LDLT).METHODS:From January 2001 to September 2009,182 recipients with end-stage liver disease underwent A-A LDLT.Ten of these patients received dual grafts.The 157 men and 25 women had an age range of 18 to 68 years(mean age,42 years).Microsurgical techniques and running sutures with back-wall first techniques were performed in all a...

  19. Asparagus polysaccharide and gum with hepatic artery embolization induces tumor growth and inhibits angiogenesis in an orthotopic hepatocellular carcinoma model.

    Science.gov (United States)

    Weng, Ling-Ling; Xiang, Jian-Feng; Lin, Jin-Bo; Yi, Shang-Hui; Yang, Li-Tao; Li, Yi-Sheng; Zeng, Hao-Tao; Lin, Sheng-Ming; Xin, Dong-Wei; Zhao, Hai-Liang; Qiu, Shu-Qi; Chen, Tao; Zhang, Min-Guang

    2014-01-01

    Liver cancer is one of leading digestive malignancies with high morbidity and mortality. There is an urgent need for the development of novel therapies for this deadly disease. It has been proven that asparagus polysaccharide, one of the most active derivates from the traditional medicine asparagus, possesses notable antitumor properties. However, little is known about the efficacy of asparagus polysaccharide as an adjuvant for liver cancer chemotherapy. Herein, we reported that asparagus polysaccharide and its embolic agent form, asparagus gum, significantly inhibited liver tumor growth with transcatheter arterial chemoembolization (TACE) therapy in an orthotopic hepatocellular carcinoma (HCC) tumor model, while significantly inhibiting angiogenesis and promoting tumor cell apoptosis. Moreover, asparagine gelatinous possessed immunomodulatory functions and showed little toxicity to the host. These results highlight the chemotherapeutic potential of asparagus polysaccharide and warrant a future focus on development as novel chemotherapeutic agent for liver cancer TACE therapy.

  20. Toxicity of Doxorubicin on Pig Liver After Chemoembolization with Doxorubicin-loaded Microspheres: A Pilot DNA-microarrays and Histology Study

    Energy Technology Data Exchange (ETDEWEB)

    Verret, Valentin, E-mail: valentin.verret@archimmed.com; Namur, Julien; Ghegediban, Saieda Homayra [ArchimMed (France); Wassef, Michel [University of Paris 7-Denis Diderot, Department of Pathology, Faculty of Medicine, AP-HP Hopital Lariboisiere (France); Moine, Laurence [Universite Paris Sud, Faculte de Pharmacie, UMR CNRS 8612, IFR 141-ITFM (France); Bonneau, Michel [AP-HP/INRA, Centre de Recherche En Imagerie Interventionnelle (France); Pelage, Jean-Pierre [AP-HP Hopital Ambroise Pare, Department of Interventional Radiology (France); Laurent, Alexandre [AP-HP/INRA, Centre de Recherche En Imagerie Interventionnelle (France)

    2013-02-15

    The potential mechanisms accounting for the hepatotoxicity of doxorubicin-loaded microspheres in chemoembolization were examined by combining histology and DNA-microarray techniques.The left hepatic arteries of two pigs were embolized with 1 mL of doxorubicin-loaded (25 mg; (DoxMS)) or non-loaded (BlandMS) microspheres. The histopathological effects of the embolization were analyzed at 1 week. RNAs extracted from both the embolized and control liver areas were hybridized onto Agilent porcine microarrays. Genes showing significantly different expression (p < 0.01; fold-change > 2) between two groups were classified by biological process. At 1 week after embolization, DoxMS caused arterial and parenchymal necrosis in 51 and 38 % of embolized vessels, respectively. By contrast, BlandMS did not cause any tissue damage. Up-regulated genes following embolization with DoxMS (vs. BlandMS, n = 353) were mainly involved in cell death, apoptosis, and metabolism of doxorubicin. Down-regulated genes (n = 120) were mainly related to hepatic functions, including enzymes of lipid and carbohydrate metabolisms. Up-regulated genes included genes related to cell proliferation (growth factors and transcription factors), tissue remodeling (MMPs and several collagen types), inflammatory reaction (interleukins and chemokines), and angiogenesis (angiogenic factors and HIF1a pathway), all of which play an important role in liver healing and regeneration. DoxMS caused lesions to the liver, provoked cell death, and disturbed liver metabolism. An inflammatory repair process with cell proliferation, tissue remodeling, and angiogenesis was rapidly initiated during the first week after chemoembolization. This pilot study provides a comprehensive method to compare different types of DoxMS in healthy animals or tumor models.

  1. Rupture of hepatic artery aneurysm associated with ischemic hepatitis Rotura de arteria hepática aneurismática asociada con hepatitis isquémica

    Directory of Open Access Journals (Sweden)

    V.M. Santos

    2010-08-01

    Full Text Available Hepatic artery aneurysms are scarcely reported, mainly because of non-specific symptoms. More often, they are incidental findings during imaging studies to investigate other acute or chronic abdominal conditions. These aneurysms are usually detected in the sixth decade of life, predominantly among males. We report the case of a 69 year-old female with an unsuspected huge hepatic artery aneurysm associated with ischemic hepatitis. Suspicion of aneurysm arose during imaging studies to clarify the origin of jaundice and abdominal pain. After establishment of the diagnosis, but before open surgery, there was a spontaneous rupture of the aneurysm, which caused hemoperitoneum and death. The necropsy study confirmed ischemic hepatitis. Hepatic artery aneurysms are second among the visceral aneurysms, and may cause abdominal pain, jaundice, and hemorrhagic events. One should suspect abdominal aneurysms in elderly patients with unclear abdominal pain, and this hypothesis should be ruled out by imaging studies.La publicación de trabajos sobre aneurismas en la arteria hepática es escasa, debido a los síntomas no específicos y a que constituyen hallazgos incidentales durante investigación de otras condiciones abdominales agudas o crónicas. Estos aneurismas son más frecuentes en varones y en la sexta década de la vida. Presentamos el caso de una mujer de 69 años de edad que ingresa en el hospital con un aneurisma de arteria hepática no sospechado previamente, asociado con hepatitis isquémica. La sospecha de aneurisma empezó durante estudio de imágenes para aclaramiento del origen de ictericia y dolor abdominal. Después de confirmado el diagnóstico, pero antes de la operación planeada, ocurrió rotura espontánea del aneurisma causando hemoperitoneo y muerte. El estudio de necropsia confirmó hepatitis isquémica. Los aneurismas de la arteria hepática son los segundos entre los aneurismas viscerales y pueden causar dolor abdominal, ictericia

  2. Transarterial chemoembolization of liver metastases in patients with uveal melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, P.E., E-mail: huppert@klinikum-darmstadt.d [Department of Diagnostic and Interventional Radiology, Klinikum Darmstadt, Darmstadt (Germany); Fierlbeck, G., E-mail: gerhard.fierlbeck@med.uni-tuebingen.d [Department of Dermatology, University of Tuebingen, Liebermeisterstrasse 25, D-72076 Tuebingen (Germany); Pereira, P., E-mail: philippe.pereira@slk-kliniken.d [Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen (Germany); Schanz, S., E-mail: stefan.schanz@med.uni-tuebingen.d [Department of Dermatology, University of Tuebingen, Liebermeisterstrasse 25, D-72076 Tuebingen (Germany); Duda, S.H., E-mail: stephan.duda@t-online.d [Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen (Germany); Wietholtz, H., E-mail: hubertus.wietholtz@klinikum-darmstadt.d [Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt (Germany); Rozeik, C., E-mail: rozeik.christoph@klinloe.d [Department of Diagnostic and Interventional Radiology, Klinikum Darmstadt, Darmstadt (Germany); Claussen, C.D., E-mail: claus.claussen@med.uni-tuebingen.d [Department of Diagnostic Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D-72076 Tuebingen (Germany)

    2010-06-15

    Summary: Metastases from uveal melanoma are often confined to the liver. Palliative hepatic chemoembolization has been considered to be a reasonable treatment approach. We enrolled 14 patients with hepatic metastases from uveal melanoma into a pilot trial of transarterial chemoembolization (TACE). All patients received additional systemic immuno-chemotherapy or best supportive care. In 31 procedures 100 mg/m{sup 2} of cisplatine was continuously infused by means of a power injector preceding embolization by manual injection of polyvinyl alcohol particles. In three procedures cisplatine was replaced by 200 mg/m{sup 2} carboplatine because of increased serum creatinine levels. Tumor response was evaluated using RECIST criteria. Fourteen patients received 34 TACE's (mean: 2.4 treatments). Eight patients (57%) achieved partial response (PR), four patients (29%) had stable disease and two patients (14%) tumor progression. Median time to progression was 8.5 months (5-35 months). Median survival after first TACE was 14.5 months in responders compared to 10 months in non-responders (p = 0.18, not significant) and 11.5 months (3-69 months) in all patients. In seven patients with metastases occupying less than 25% of liver volume median survival was 17 months compared to 11 months in seven patients with tumor involvement of more than 25% (p = 0.02) with partial response rate of 86% and 29%, respectively. TACE of liver metastases from uveal melanoma is well tolerated and may prolong survival in patients with limited tumor extension.

  3. Hepatic artery aneurysm: incidental diagnosis with abdominal ultrasonography and treatment by coil embolization

    OpenAIRE

    Andrade, Luis Jesuino de Oliveira; Silva,Antonio Carlos Botelho da; França,Larissa Santos; França,Luciana Santos; Souza,José Rebouças de

    2012-01-01

    Hepatic artery aneurysm (HAA) was first reported at autopsy in 1809, represents one fifth of visceral aneurysms and the mortality from spontaneous rupture is high in most of cases. We are reporting a case of an asymptomatic 48-year-old woman with an extrahepatic HAA, diagnosed initially and incidentally with abdominal ultrasonography, confirmed by a three-dimensional contrast-enhanced magnetic resonance imaging and angiography. Endovascular treatment was considered feasible and was successful...

  4. Hemobilia in a child due to right hepatic artery pseudoaneurysm: Multidetector-row computed tomography demonstration

    Directory of Open Access Journals (Sweden)

    Nisar A Wani

    2011-01-01

    Full Text Available We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography (CT angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings.

  5. 异甘草酸镁在治疗明胶海绵微粒TACE术后肝损伤中的临床应用%Application of magnesium isoglycyrrhizinate in restoring liver function after transcatheter arterial chemoembolization with gelatin sponge particles

    Institute of Scientific and Technical Information of China (English)

    赵广生; 周军; 敖劲; 李闯; 唐顺雄; 王文清; 张跃伟

    2012-01-01

    目的:观察异甘草酸镁对原发性肝癌TACE术后肝功能恢复的治疗效果.方法:2009年6月-2010年12月,我院应用异甘草酸镁治疗TACE术后患者40例,32例TACE术后患者应用古拉定治疗做为对照组,观察异甘草酸镁治疗原发性肝癌TACE术后肝损伤的临床疗效.结果:72例TACE术后患者肝脏功能恢复总有效率为86.1%,治疗组7d有效率为100%,对照组为68.7%,两组间有统计学差别(P<0.05),治疗组术后7 d TBIL,ALT与术前比较均无统计学差别,没有发现与与异甘草酸镁有关的药物过敏、心悸、头晕、皮疹等不良反应.结论:新型明胶海绵颗粒作为一种最新研发的栓塞剂,治疗原发性肝癌显示出了良好效果,异甘草酸镁在治疗术后肝损伤方面疗效确切,但相关的作用机制尚需进一步探讨.%Objective: To observe the effect of magnesium isoglycyrrhizinate on liver function recovery in patients with primary hepatic carcinoma (PHC) after transcatheter arterial chemoembolization (TACE) with gelatin sponge particles. Methods; From June 2009 to December 2010, 40 PHC patients were treated with magnesium iso-glycyrrhizinate after TACE in our hospital, and 32 patients with Dracula after TACE as control. Clinical efficacy of magnesium isoglycyrrhizinate on liver injury in PHC patients after TACE was observed. Results; Total effective rate of liver function recovery after TACE was 86. 1% (61/72 patients) in all the patients. The effective rate was 100% after treatment with magnesium isoglycyrrhizinate for 7 days, and 68.7% in control group (P<0.05). There no statistical difference of TBIL and ALT before and after treatment for 7 days. No related adverse reactions were found, such as drug allergy, heart palpitations, dizziness, skin rashes and other adverse reactions. Conclusion; As a newly developed embolization, gelatin sponge embolization has shown better efficacy in treating PHC, and magnesium isoglycyrrhizinate is effective in

  6. Hepatic artery administration of docetaxel in liver metastases from breast carcinoma: a feasibility study.

    Science.gov (United States)

    Cocconi, Giorgio; Gamboni, Alessandro; Gasparro, Donatello; Leonardi, Francesco; Salvagni, Stefania; Vasini, Giovanna; Larini, Pietro; Marcato, Carla; Camisa, Roberta; Cascinu, Stefano

    2005-01-01

    Taxanes are largely metabolized and almost exclusively excreted in the feces by the liver through the biliary pathway, thus providing a rationale for investigating the activity of their hepatic artery delivery in case of liver metastases. The aim of this study was to assess the feasibility of administering docetaxel via the hepatic artery in advanced breast cancer patients in whom the liver was the only or the predominant site of metastatic involvement. The dose was increased cycle by cycle in a prospective manner. Ten eligible patients were enrolled. The median administered dose in the last cycle was 65 mg/m2 (range, 40-100 mg/m2). The treatment was generally well tolerated, and only one patient stopped after two cycles because of toxicity. Four of the 9 eligible patients with assessable liver tumors achieved an objective response. After a median follow-up of 41 months, 4 of the 10 eligible (and 11 treated) patients were alive with a median overall survival of 46 months. The administration of docetaxel via the hepatic artery is feasible. The highly interesting response and survival results observed in this limited series of patients warrant further studies.

  7. Treatment of hepatoma with liposome-encapsulated adriamycin administered into hepatic artery of rats

    Institute of Scientific and Technical Information of China (English)

    Dong-Sheng Sun; Jiang-Hao Chen; Rui Ling; Qing Yao; Ling Wang; Zhong Ma; Yu Li

    2006-01-01

    AIM: To observe the therapeutic effects of liposomeencapsulated adriamycin (LADM) on hepatoma in comparison with adriamycin solution (FADM) and adriamycin plus blank liposome (ADM + BL) administered into the hepatic artery of rats.METHODS: LADM was prepared by pH gradient-driven method. Normal saline, FADM (2 mg/kg), ADM+BL (2 mg/kg), and LADM (2 mg/kg) were injected via the hepatic artery in rats bearing liver W256 carcinosarcoma,which were divided into four groups randomly. The therapeutic effects were evaluated in terms of survival time,tumor enlargement ratio, and tumor necrosis degree.The difference was determined with ANOVA and Dunnett test and log rank test.RESULTS: Compared to FADM or ADM + BL, LADM produced a more significant tumor inhibition (tumor volume ratio: 1.243 ± 0.523 vs 1.883 ± 0.708, 1.847 ± 0.661,P < 0.01), and more extensive tumor necrosis. The increased life span was prolonged significantly in rats receiving LADM compared with FADM or ADM+BL (231.48 v's 74.66, 94.70) (P < 0.05).CONCLUSION: The anticancer efficacies of adriamycin on hepatoma can be strongly improved by liposomal encapsulation through hepatic arterial administration.

  8. Effects of radiotherapy combined with transcatheter arterial chemoembolization on patients with advanced unresectable primary hepatocellular carcinoma%肝动脉栓塞化疗联合放疗治疗不能手术的原发性肝癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    古金耀; 熊雪峰; 李道生

    2011-01-01

    目的 观察肝动脉栓塞化疗(TACE)联合直线加速器或全身伽玛刀治疗不能手术的原发性肝癌(PHC)的疗效及毒副反应.方法 2005年7月至2008年6月,108例不能手术的PHC患者中50例行TACE联合直线加速器放疗(加速器组),58例行TACE联合全身伽玛刀放疗(伽玛刀组).TACE灌注化疗药物包括丝裂霉素(MMC)10~20mg、氟尿嘧啶(5-FU)1000~1500mg、表阿霉素(E-ADM)30~50mg,栓塞剂为40%超液态碘化油5~20ml.直线加速器治疗用6MV-X,95%等剂量线包绕PTV,40~60Gy/15~25f,3~5f/周;伽玛刀治疗用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统(LUNATM-260),40%~60%等剂量线包绕PTV,单次剂量3~6Gy,3~5f/周,照射总量30~50Gy.联合应用TACE为1~3个疗程.结果 加速器组及伽玛刀组的中位生存期分别为14个月和16个月,中位肿瘤进展时间(TTP)分别为7.6个月和8.1个月;2年局部控制率分别为45.4%和43.6%(X2=0.020,P=0.887),3年局部控制率分别为36.5%和37.9%(X2=0.040,P=0.841);2年生存率分别为41.1%和39.6%(X2=0.021,P=0.885),3年生存率分别为34.3%和30.2%(X2=0.368,P=0.544).加速器组中出现1例放射诱发的肝病,伽玛刀组未见相关病例.结论 直线加速器和伽玛刀联合TACE治疗PHC均安全可靠,疗效相当.%Objective To evaluate the effects of transcatheter arterial chemoembolization (TACE) combined with radiation therapy on patients with advanced unresectable primary hepatocellular carcinoma ( PHC ). Methods From July 2005 to June 2008,108 patients with advanced unresectable PHC were divided into 2 groups. Fifty patients were treated with linear accelerator combined with TACE(accelerator group) , and 58 patients were treated with body gamma knife combined with TACE( gamma knife group). For accelerator group, 6MV-X ray was used, ≥95% isodose included PTV, and the total treatment dosage was 40-60Cy with 3-5 times per week. For gamma knife

  9. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants *

    Science.gov (United States)

    Araujo Neto, Severino Aires; de Mello Júnior, Carlos Fernando; Franca, Henrique Almeida; Duarte, Cláudia Martina Araújo; Borges, Rafael Farias; de Magalhães, Ana Guardiana Ximenes

    2016-01-01

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. PMID:26929461

  10. Resection of hilar cholangiocarcinoma with left hepatectomy after pre-operative embolization of the proper hepatic artery

    DEFF Research Database (Denmark)

    Yasuda, Yoshikazu; Larsen, Peter N; Ishibashi, Toshimitsu

    2010-01-01

    Right or right-extended hepatectomy including the caudate lobe is the most common treatment for hilar cholangiocarcinoma (HC). A 5-year survival of up to 60% can be achieved using this procedure if R0-resection is obtained. However, for some patients a left-sided liver resection is necessary to o......-operative embolization of the proper hepatic artery in an effort to induce development of arterial collaterals thus allowing the resection of the proper and right hepatic artery without vascular reconstruction....

  11. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

    Energy Technology Data Exchange (ETDEWEB)

    Araujo-Neto, Severino Aires; Mello-Junior, Carlos Fernando de; Franca, Henrique Almeida; Duarte, Claudia Martina Araujo; Borges, Rafael Farias; Magalhaes, Ana Guardiana Ximenes de, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2016-01-15

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. (author)

  12. Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and radiofrequency ablation

    Directory of Open Access Journals (Sweden)

    van Coevorden Frits

    2005-11-01

    Full Text Available Abstract Background Hepatic metastases of carcinoid tumors cause incapacitating symptoms, but are usually diffuse and therefore unresectable. In this article we evaluate our experiences with local treatment techniques in the management of carcinoid patients with hepatic metastases and failing systemic treatment. Methods Fifteen consecutive carcinoid patients (11 men and 4 women; median age 60 years; range 45–71 years were treated with either hepatic artery embolization (HAE with Ivalon particles or radiofrequency ablation (RFA (percutaneously or intra-operatively. Follow-up evaluation was performed by CT scan and 24-hours urinary 5-HIAA excretions. Results A total of 18 HAE's was performed in 13 patients, while 10 lesions in 3 patients were treated with RFA. Median follow-up was 12.5 months (2 – 25 months. Median duration of symptoms was 22 months (8 – 193 months. Median overall decrease of 5-HIAA excretion 2 months after HAE was 32% with tumor regression on CT-scan in 4 patients (30% and improvement of symptoms with a median duration of 15 months in 3 of them (23%. Embolization led to fatal hepatic failure in one patient. The 3 patients treated with RFA showed a decrease of urinary 5-HIAA values of 34, 81 and 93% respectively, with tumor regression in all of them. Improvement of symptoms was reported in 2 patients up to 25 months. Conclusion Liver embolization performed late in the clinical course had limited effect on symptoms and biochemical and radiological parameters. First experiences with RFA are favorable and might encourage to apply RFA more widely in metastatic carcinoid.

  13. Surgical technique of orthotopic liver transplantation in rats: the Kamada technique and a new splint technique for hepatic artery reconstruction.

    Science.gov (United States)

    Ishii, Eiichi; Shimizu, Akira; Takahashi, Mikiko; Terasaki, Mika; Kunugi, Shinobu; Nagasaka, Shinya; Terasaki, Yasuhiro; Ohashi, Ryuji; Masuda, Yukinari; Fukuda, Yuh

    2013-01-01

    Orthotopic liver transplantation (OLT) in rats is technically feasible and useful for the assessment of clinical liver transplantation and analysis of inflammatory liver diseases. OLT in rats was pioneered by Lee et al. in 1973 using hand-suture techniques of all vessels. This model has not been widely used due to the long operative time and technical demand. The cuff method was introduced by Kamada in 1979, and today, the Kamada technique is the one most commonly used worldwide. However, this technique does not include hepatic artery reconstruction, although this procedure is routinely performed in clinical transplantation. Nevertheless, several techniques for hepatic artery reconstruction in rat OLT have been reported recently, and our group also developed a simple splint technique from recipient right renal artery to donor celiac axis bearing the hepatic artery. In the present article, we describe the Kamada technique, as a standard surgical method for rat OLT. In addition, we also describe our splint technique for hepatic artery reconstruction. Then, we compare the features of Kamada technique and our splint technique for hepatic artery reconstruction and all other surgical techniques currently in use for rat OLT. The widespread use of the rat OLT model should help to provide full assessment of transplant immunology and the mechanism and treatment of inflammatory liver diseases.

  14. Transarterial Chemoembolization (TACE) in hepatocellular carcinoma: Technique, indication and results; Transarterielle Chemoembolisation (TACE) des hepatozellulaeren Karzinoms: Technik, Indikationsstellung und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Zangos, S.; Balzer, J.O.; Nabil, M.; Rao, P.; Eichler, K.; Abdelkader, A. [Inst. fuer Diagnostische und Interventionelle Radiologie, J.W. Goethe-Univ., Frankfurt (Germany); Bechstein, W.O. [Klinik fuer Allgemeinchirurgie, J.W. Goethe-Univ., Frankfurt (Germany); Zeuzem, S. [Klinik fuer Innere Medizin, Hepatologie, J.W. Goethe-Univ., Frankfurt (Germany)

    2007-11-15

    To present current data on technique, indications and results of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The principle of TACE is the intra-arterial injection of chemotherapeutic drug combinations like doxorubicin, cisplatin and mitomycin into the hepatic artery, followed by lipiodol injection, Gelfoam for vessel occlusion and degradable microspheres. The side effects and complications after TACE range from fever, upper abdominal pain and vomiting to acute or chronic liver cell failure. The palliative effect in unresectable HCC using TACE allows local tumor control in 15 to 60% of cases and 5-year survival rates ranging from 8 - 43%. The potentially curative treatment option allows local tumor control from 18 - 63%. The neoadjuvant treatment option of TACE in combination with other treatment options like percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA) reach local tumor control rates between 80 - 96%. The bridging effect of TACE before liver transplantation reaches 5-year survival rates from 59 - 93%. The symptomatic therapy option of TACE is used to counteract pain directly caused by HCC and acute/subacute bleeding in the HCC. The local tumor response reaches up to 88% and the bleeding control is from 83 to 100%. (orig.)

  15. Clinical Study of Transarterial Chemoembolization for Primary Hepatic Carcinoma with Lipiodol-arsenic Trioxide Emulsion%亚砷酸-碘油乳剂经动脉栓塞治疗原发性肝癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    周玉斌; 吴丹明; 柳青峰

    2009-01-01

    Objective To evaluate the effect and toxicity of lipiodol-arsenic trioxide emulsion on the treatment of primary hepatic carcinoma. Methods Arsenic trioxide 20mg and lipiodol were fully mixtured into lipiodol-arsenic trioxide emulsion,which were injected into hepatic artery by catheters in 58 patients with primary hepatic carcinoma. If the patients' conditions progressed(tumor got larger or AFP increased),Anthracyctine would be used simultaneously. The effect and toxicity were observed. Results After 1~3 times of thera-py only with lipiodol-arsenic trioxide emulsion in all of 58 patients,objective response rate was 20.7% with 12 eases of PR,36 cases of NC and 10 cases of PD. AFP decreased from(11109.36±2920.82) IU/mL to(10001.61±2880.67) IU/mL averagely(P>0.05). An-thracycline was applied in 22 patients,and tumors got smaller in 16 cases after that. AFP decreased from (13901.11±4862.26) IU/mL to(5470.63±2597.79) IU/mL averagely(P0.05.22例患者在治疗中加用蒽环类药物,16例病灶有不同程度的缩小,AFP平均由(13901.11±4862.26)IU/mL降至(5470.63±2597.79)IU/mL,P<0.05.主要毒副反应为发热、恶心呕吐、肝区疼痛、血细胞减少及转氨酶升高等,全组未见不可逆毒副反应.结论 经肝动脉途径应用亚砷酸一碘油乳剂栓塞治疗原发性肝癌疗效较好,毒副反应较小,是一种较理想的微创治疗原发性肝癌的方法.

  16. Nonalcoholic Hepatic Steatosis Is a Strong Predictor of High-Risk Coronary-Artery Plaques as Determined by Multidetector CT.

    Directory of Open Access Journals (Sweden)

    Kazuhiro Osawa

    Full Text Available Nonalcoholic fatty liver disease is associated with a risk of coronary artery disease (e.g., diabetes mellitus, dyslipidemia, metabolic syndrome. We evaluated whether nonalcoholic hepatic steatosis is associated with high-risk plaques as assessed by multidetector computed tomography (CT.This retrospective study involved 414 participants suspected of having coronary artery disease. Nonalcoholic hepatic steatosis was defined as a liver-to-spleen fat ratio of <1.0 and the presence and appropriate characteristics of coronary-artery plaques as assessed by coronary CT angiography. High-risk plaques were identified, as were low-density plaques, positive remodeling, and spotty calcification.Compared with patients who did not have nonalcoholic hepatic steatosis, patients with nonalcoholic hepatic steatosis had more low-density plaques (21% vs. 44%, p<0.01, positive remodeling (41% vs. 58%, p = 0.01, and spotty calcification (12% vs. 36%, p<0.01. The number of high-risk plaques in patients with nonalcoholic hepatic steatosis was greater than in those without nonalcoholic hepatic steatosis (p<0.01. Patients with nonalcoholic hepatic steatosis were more likely to have high-risk plaques than were those with only an elevated level of visceral adipose tissue (≥86 cm2; 35% vs. 16%, p<0.01. Multivariate analyses that included nonalcoholic hepatic steatosis, amount of visceral adipose tissue, and the presence/absence of traditional risk factors demonstrated that nonalcoholic hepatic steatosis was an independent predictor of high-risk plaques (odds ratio: 4.60; 95% confidence interval: 1.94-9.07, p<0.01.Diagnosis of nonalcoholic hepatic steatosis may be of value when assessing the risk of coronary artery disease.

  17. Predicting tumor response in patient with metastatic liver cancer to hepatic artery infusion chemotherapy. Evaluation with {sup 99m}Tc-MAA SPECT hepatic artery perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Linfeng; Nakagawa, Tetsuya; Higashi, Kotaro; Okimura, Tetsuro; Yamamoto, Itaru [Kanazawa Medical Univ., Uchinada, Ishikawa (Japan)

    1996-09-01

    {sup 99m}Tc-MAA planar and SPECT hepatic artery perfusion scintigraphy were performed in 25 patients with metastatic liver cancer. A total of 42 metastatic nodules were evaluated on SPECT. Twenty five of 42 metastatic nodules showed positive uptake; 17 showed negative uptake. The results indicate that there is no significant quantitative correlation between the {sup 99m}Tc-MAA uptake ratio of metastatic nodules and the regression of metastatic nodules determined by CT scan. However, there is a statistically significant difference in the regression of metastatic nodule between the {sup 99m}Tc-MAA of uptake positive group and negative group. It means that a positive uptake of {sup 99m}Tc-MAA of tumor predicts a trend of better response to chemotherapy. (author)

  18. Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy.

    Science.gov (United States)

    de Santibañes, Eduardo; Ardiles, Victoria; Alvarez, Fernando A; Pekolj, Juan; Brandi, Claudio; Beskow, Axel

    2012-01-01

    En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement. © 2011 International Hepato-Pancreato-Biliary Association.

  19. 支气管动脉化疗栓塞联合125I放射性粒子植入术治疗老年非小细胞肺癌的效果分析%Effect analysis of bronchial arterial chemoembolization combined with 125I active particle implantation in the treatment of elderly non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    杨海

    2015-01-01

    目的:分析支气管动脉化疗栓塞联合125I放射性粒子植入术治疗老年非小细胞肺癌的效果。方法选取2011年1月~2013年1月本院收治的90例无法进行根治性切除术的老年非小细胞肺癌患者,将其随机分为观察组、对照组,每组45例。观察组进行支气管动脉栓塞化疗联合125I放射性粒子植入治疗3~6个疗程,对照组行吉西他滨联合顺铂化疗(GP方案)4~6个疗程,比较两组患者的疗效、不良反应发生率、生存时间。结果观察组的有效率为73.33%,对照组为44.44%,两组比较,差异有统计学意义(P<0.05)。随访17个月后,观察组死亡4例,对照组死亡1例,观察组、对照组的中位生存时间分别为(399.2±19.5)、(331.5±16.4)d,组间比较,差异有统计学意义(P<0.05)。结论支气管动脉化疗栓塞联合125I放射性粒子植入术治疗无法进行根治性切除术的老年非小细胞肺癌的短期效果优于GP方案化疗。%Objective To analyze the effect of bronchial arterial chemoembolization combined with 125I active particle implantation in the treatment of elderly non-small cell lung cancer. Methods From January 2011 to January 2013,90 elderly patients with non-small cell lung cancer which could not undergo radical resection operation admitted into our hospital were selected.They were evenly divided into observation group and control group in random.In observation group,bronchial arterial chemoembolization combined with 125I active particle implantation was applied for 3-6 courses of treatment.Control group was provided with gemcitabine combined with cis-platinum chemotherapy (GP scheme) for 4-6 courses of treatment.The therapeutic effect,incidence rate of adverse reaction,and survival time between two groups was compared respectively. Results The effective rate in observation group and control group was 73.33%,44.44% re-spectively and there was a statistical difference between two groups (P<0

  20. [CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

    Science.gov (United States)

    Guliaev, N I; Kuznetsov, V V; Poltareĭko, D S; Qleksiuk, I B; Gordienko, A V; Barsukov, A V

    2015-01-01

    The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

  1. Heterotopic auxiliary rat liver transplantation with flow-regulated portal vein arterialization in acute hepatic failure.

    Science.gov (United States)

    Schleimer, Karina; Kalder, Johannes; Grommes, Jochen; Jalaie, Houman; Tawadros, Samir; Greiner, Andreas; Jacobs, Michael; Kokozidou, Maria

    2014-01-01

    In acute hepatic failure auxiliary liver transplantation is an interesting alternative approach. The aim is to provide a temporary support until the failing native liver has regenerated.(1-3) The APOLT-method, the orthotopic implantation of auxiliary segments- averts most of the technical problems. However this method necessitates extensive resections of both the native liver and the graft.(4) In 1998, Erhard developed the heterotopic auxiliary liver transplantation (HALT) utilizing portal vein arterialization (PVA) (Figure 1). This technique showed promising initial clinical results.(5-6) We developed a HALT-technique with flow-regulated PVA in the rat to examine the influence of flow-regulated PVA on graft morphology and function (Figure 2). A liver graft reduced to 30 % of its original size, was heterotopically implanted in the right renal region of the recipient after explantation of the right kidney.  The infra-hepatic caval vein of the graft was anastomosed with the infrahepatic caval vein of the recipient. The arterialization of the donor's portal vein was carried out via the recipient's right renal artery with the stent technique. The blood-flow regulation of the arterialized portal vein was achieved with the use of a stent with an internal diameter of 0.3 mm. The celiac trunk of the graft was end-to-side anastomosed with the recipient's aorta and the bile duct was implanted into the duodenum. A subtotal resection of the native liver was performed to induce acute hepatic failure. (7) In this manner 112 transplantations were performed. The perioperative survival rate was 90% and the 6-week survival rate was 80%. Six weeks after operation, the native liver regenerated, showing an increase in weight from 2.3±0.8 g to 9.8±1 g. At this time, the graft's weight decreased from 3.3±0.8 g to 2.3±0.8 g. We were able to obtain promising long-term results in terms of graft morphology and function. HALT with flow-regulated PVA reliably bridges acute hepatic failure

  2. Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI

    Science.gov (United States)

    Chouhan, Manil D.; Bainbridge, Alan; Atkinson, David; Punwani, Shonit; Mookerjee, Rajeshwar P.; Lythgoe, Mark F.; Taylor, Stuart A.

    2017-02-01

    Liver dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling could be useful in the assessment of diffuse liver disease and focal liver lesions, but is compromised by errors in arterial input function (AIF) sampling. In this study, we apply cardiac output correction to arterial input functions (AIFs) for liver DCE MRI and investigate the effect on dual-input single compartment hepatic perfusion parameter estimation and reproducibility. Thirteen healthy volunteers (28.7  ±  1.94 years, seven males) underwent liver DCE MRI and cardiac output measurement using aortic root phase contrast MRI (PCMRI), with reproducibility (n  =  9) measured at 7 d. Cardiac output AIF correction was undertaken by constraining the first pass AIF enhancement curve using the indicator-dilution principle. Hepatic perfusion parameters with and without cardiac output AIF correction were compared and 7 d reproducibility assessed. Differences between cardiac output corrected and uncorrected liver DCE MRI portal venous (PV) perfusion (p  =  0.066), total liver blood flow (TLBF) (p  =  0.101), hepatic arterial (HA) fraction (p  =  0.895), mean transit time (MTT) (p  =  0.646), distribution volume (DV) (p  =  0.890) were not significantly different. Seven day corrected HA fraction reproducibility was improved (mean difference 0.3%, Bland–Altman 95% limits-of-agreement (BA95%LoA)  ±27.9%, coefficient of variation (CoV) 61.4% versus 9.3%, ±35.5%, 81.7% respectively without correction). Seven day uncorrected PV perfusion was also improved (mean difference 9.3 ml min‑1/100 g, BA95%LoA  ±506.1 ml min‑1/100 g, CoV 64.1% versus 0.9 ml min‑1/100 g, ±562.8 ml min‑1/100 g, 65.1% respectively with correction) as was uncorrected TLBF (mean difference 43.8 ml min‑1/100 g, BA95%LoA  ±586.7 ml min‑1/ 100 g, CoV 58.3% versus 13.3 ml min‑1/100 g, ±661.5 ml min‑1/100 g, 60

  3. Meta-analysis on Efficacy and Safety of Cinobufacini Combined with Transcatheter Arterial Chemoembolization for Primary Liver Cancer%华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的疗效与安全性Meta分析

    Institute of Scientific and Technical Information of China (English)

    田怀平; 高蕙敏; 杨萍; 唐跃年

    2016-01-01

    Objective: To assess the efficacy and safety of cinobufacini combined with transcatheter arterial chemoembolization (TACE) on patients with primary liver cancer by Meta-analysis.Methods:Databases, such as PubMed, The Cochrane Library, EMbase, VIP, WanFang Data, CBM and CNKI from to October, 2015 were searched for clinical trials on cinobufacini combined with transcatheter arterial chemoembolization for primary liver cancer .Two reviewers independently screened literature according to the inclusion and exclusion criteria , extracted data , and assessed methodological quality .Meta-analysis was performed by RevMan 5.2.Results:Nineteen trials were included with a total of 1481 patients.The results of meta-analysis showed that the treatment group was superior to the TACE group in terms of short-term efficacy and long-term efficacy, improving the quality of life and cau-sing less adverse reaction partly .Conclusion: Cinobufacini combined with TACE are comparatively more efficient and safer for primary liver cancer .%目的:采用Meta分析的方法,评价华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的疗效及安全性.方法:计算机检索PubMed、The Cochrane Library、EMbase、VIP、WanFang Data、CBM和CNKI数据库,检索时限为从建库至2015年10月,收集华蟾素联合肝动脉化疗栓塞治疗原发性肝癌的临床试验.由两位研究者按照纳入与排除标准,独立进行文献筛选、资料提取和评价纳入研究的方法学质量,采用RevMan 5.2软件进行Meta分析,并对发表偏倚进行检验.结果:共纳入19项研究,1481例肝癌患者.Meta分析结果显示:华蟾素联合肝动脉化疗栓塞治疗原发性肝癌,可以提高近期疗效和远期疗效,改善生活质量,部分减少不良反应.结论:华蟾素联合肝动脉化疗栓塞治疗原发性肝癌优于单纯TACE治疗.

  4. The safety and clinical outcomes of chemoembolization in child-pugh class C patients with hepatocellular carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Tae Won; Kim, Hyo Cheol; Lee, Jeong Hoon; Yu, Su Jong; Kang, Beom Sik; Hur, Sae Beom; Lee, Myung Su; Jae, Hwan Jun; Chung, Jin Wook [Seoul National University College of Medicine, Seoul National University Hospital, Seoul (Korea, Republic of)

    2015-12-15

    To evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC). The study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors. Thirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months). Even in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.

  5. Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Johnathan; C; Chung; Neel; K; Naik; Robert; J; Lewandowski; Mary; F; Mulcahy; Laura; M; Kulik; Kent; T; Sato; Robert; K; Ryu; Riad; Salem; Andrew; C; Larson; Reed; A; Omary

    2010-01-01

    AIM: To investigate whether intra-procedural diffusion- weighted magnetic resonance imaging can predict response of hepatocellular carcinoma (HCC) during trans- catheter arterial chemoembolization (TACE). METHODS: Sixteen patients (15 male), aged 59 ±11 years (range: 42-81 years) underwent a total of 21 separate treatments for unresectable HCC in a hybrid magnetic resonance/interventional radiology suite. Ana- tomical imaging and diffusion-weighted imaging (b = 0, 500 s/mm2) were performed on a 1.5-T unit. ...

  6. Rare Type of Course and Distribution of an Additional Right Hepatic Artery: A Possible Source of Iatrogenic Injury During Hepato-biliary and Pancreatic Surgeries

    Directory of Open Access Journals (Sweden)

    Prakashchandra Shetty

    2017-07-01

    Full Text Available Celiac artery shows frequent variations in its branching pattern. Knowledge of its possible variations is useful in gastric, pancreatic and hepato-biliary surgeries. During our dissection classes, we observed a rare variation of the branching pattern of celiac trunk. It divided normally into its three branches; left gastric, splenic and common hepatic arteries. Left gastric and splenic arteries were normal in their course and distribution. The common hepatic artery trifurcated to give hepatic artery proper, gastroduodenal artery and an additional right hepatic artery. The branching pattern of hepatic artery proper and gastroduodenal arteries was normal. The additional right hepatic artery gave origin to a right gastric artery and a large pancreatic branch to the head of the pancreas. It coursed parallel to the bile duct, being on its right side, passed through the Calot’s triangle and entered the right lobe of liver through the fossa for gall bladder. In the Calot’s triangle, it gave a cystic branch to the gall bladder. We discuss the clinical importance of this rare variation in this paper.

  7. The Relation Between Perfusion Pattern of Hepatic Artery Perfusion Scintigraphy and Response to Y-90 Microsphere Therapy

    Directory of Open Access Journals (Sweden)

    Bilge Volkan-Salancı

    2013-12-01

    Full Text Available Objective: Hepatic artery perfusion scintigraphy is a routine procedure for patient evaluation before Y-90 radiomicrosphere therapy and mostly used for prediction of extrahepatic leakage. Moreover, it also displays perfusion pattern of tumours, which is an important parameter on success of the therapy. The aim of this study is to assess the relation between the perfusion pattern on hepatic artery perfusion scintigraphy and radiomicrosphere therapy response. Methods: A total of 99 radiomicrosphere therapy applications were carried out in 80 patients (M/F: 55/25. Results: Heterogeneous and diffuse perfusion patterns were observed in 47 patients and 52 patients, respectively. The patients with diffuse perfusion pattern had better therapy response both on FDG PET/CT (p= 0.04 and CT (p=0.008 when compared to those with heterogenous perfusion pattern. Conclusion: Perfusion pattern observed on hepatic artery perfusion scintigraphy may be a successful predictor of early response to radiomicrosphere therapy

  8. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  9. Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Wei-Jian Guo; Er-Xin Yu; Lu-Ming Liu; Jie Li; Zhen Chen; Jun-Hua Lin; Zhi-Qiang Meng; Yi Feng

    2003-01-01

    AIM: To investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with radiotherapy for unresectable large hepatocellular carcinoma (HCC).METHODS: From June 1994 to June 1999, a total of 76patients with large unresectable HCC were treated with TACE followed by external-beam irradiation. 89 patients with large HCC, who underwent TACE alone during the same period,served as the control group. Clinical features, therapeutic modalities, acute effects and survival rates were analyzed and compared between TACE plus irradiation group and TACE alone group. A multivariate analysis of nine clinical variables and one treatment variable (irradiation) was performed by the Cox proportional hazards model.RESULTS: The clinical features and therapeutic modalities except irradiation between the two groups were comparable (P>0.05). The objective response rate (RR) in TACE plus irradiation group was higher than that in TACE alone group (47.4 % vs28.1%, P<0.05). The overall survival rates in TACE plus irradiation group (64.0 %, 28.6 %, and 19.3 %at 1, 3, 5 years, respectively) were significantly higher than those in TACE alone group (39.9 %, 9.5 %, and 7.2%,respectively, P=0.0001). Cox proportional hazards model analysis showed that tumor extension and Child grade were significant and were independent negative predictors of survival, while irradiation was an independent positive predictor of survival.CONCLUSION: TACE combined with radiotherapy is more effective than TACE alone, and is a promising treatment for unresectable large HCC.

  10. Hilar Inflammatory Pseudotumour with Hepatic Artery Atheroma- mimicker of Klatskin Tumour.

    Science.gov (United States)

    Rastogi, Archana; Bihari, Chhagan; Gupta, Nalini; Deka, Pranjal; Kumar, Arvind; Negi, Sanjay Singh; Arora, Ankur

    2015-03-01

    Inflammatory pseudotumour of hilar biliary structures is an extremely rare benign lesion that can mimic hilar cholangiocarcinoma. Clinical presentation and imaging findings often pose diagnostic difficulties. Main histopathological findings are the presence of myofibroblastic spindle cells, plasma cells, macrophages, and lymphocytes without cellular atypia or atypical mitotic figures. We describe a case of 62 year old male who presented with surgical obstructive jaundice. Imaging revealed a mass lesion involving the biliary confluence with upstream dilatation of biliary tree. Diagnosis of hilar cholangiocarcinoma with type III hilar block was made. Intraoperately hilar mass lesion was found which was encasing right hepatic artery with no evidence of metastasis. The patient underwent Right hepatectomy with caudate lobectomy with complete common bile duct (CBD) excision with Roux en Y hepaticojejunostomy. Unexpectedly histopathological examination showed no evidence of malignancy and revealed hilar inflammatory pseudotumour with hepatic artery atherosclerosis. Preoperative imaging, operative management, pathologic diagnosis and literature review are being presented in view of rarity of the case.

  11. Hepatic arterial infusion pump chemotherapy for colorectal liver metastases: an old technology in a new era.

    Science.gov (United States)

    Ko, Y J; Karanicolas, P J

    2014-02-01

    Aggressive treatment of colorectal cancer (crc) liver metastases can yield long-term survival and cure. Unfortunately, most patients present with technically unresectable metastases; conventional therapy in such patients consists of systemic therapy. Despite advances in the effectiveness of systemic therapy in the first-line setting, the tumour response rate and median survival remain low in the second-line setting. The preferential blood supply from the hepatic artery to crc liver metastases allows for excellent regional delivery of chemotherapy. Here, we review efficacy and safety data for hepatic artery infusion (hai) pump chemotherapy in patients with metastatic crc from the 5-fluorouracil era and from the era of modern chemotherapy. In selected patients with liver-only or liver-dominant disease who have progressed on first-line chemotherapy, hai combined with systemic agents is a viable therapeutic option when performed at experienced centres. Furthermore, significantly improved survival has been demonstrated with adjuvant hai therapy after liver resection in the phase iii setting. The complication rates and local toxicities associated with hai pump therapy are infrequent at experienced centres and can be managed with careful follow-up and early intervention. The major obstacles to the wide adoption of hai therapy include technical expertise for pump insertion and maintenance, and for floxuridine dose modification. The creation of formal preceptor-focused education and training in hai therapy for interdisciplinary medical professionals might encourage the creation and expansion of this liver-directed approach.

  12. High-Flow Arterio-Hepatic Venous Shunt in Hepatocellular Carcinoma: Use of Multi-Electrode Radiofrequency for Shunt Obliteration

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2015-10-15

    Intra-tumoral arterio-hepatic venous shunting (AHVS) poses an impediment to transarterial chemoembolization of liver tumors. Not only does it present a potential hazard for systemic shunting and embolization, but also the altered flow dynamics may also result in poor delivery of drug/embolics to the target tumor bed. Current available techniques to overcome AVHS include arterial embolization (particles, coils, glue, etc.) or temporary venous occlusion using balloons. We hereby illustrate the use of radiofrequency ablation to obliterate a complex AHVS consisting of a varix-like venous aneurysm.

  13. 外照射配合肝动脉栓塞治疗不能手术切除的原发性肝癌的临床研究%Radiotherapy combined with transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma-a prospective clinical trial

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective: This study evaluated the therapeutic effect of external beam radiotherapy(RT)combined with transcatheter arterial chemoembolization(TACE)on the patients with unresectable hepatocellular carcinoma(HCC).Methods: From June 1994 to April 2002, 114 patients with unresectable HCC were nonrandomized prospectively stepped into our study.All patients received TACE as initial therapy, except 54 also received combination therapy with external beam therapy.Survival failure patterns were analyzed and compared between the two groups.Results: Overall survival rates in the patients in the radiotherapy group were 65%, 47%, 38% at 1, 2, 3 years, respectively, improved over the non-radiotherapy group rates of 54%, 36.5%, 18% at 1, 2, 3 years, respectively.There was significant difference between two groups(P<0.05).The survival rates correlated with tumor size, number of tumors, and portal vein embolus.Conclusion: TACE combined with RT is a more effective treatment than TACE alone in patients with unresectable HCC.

  14. Long-term results of interventional treatment of large unresectable hepatocellular carcinoma (HCC): significant survival benefit from combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) compared to TACE monotherapy; Langzeitergebnisse der interventionellen Therapie von grossen, inoperablen hepatozellulaeren Karzinomen (HCC): signifikanter Ueberlebensvorteil von transarterieller Chemoembolisation (TACE) und perkutaner Ethanolinjektion (PEI) gegenueber der TACE-Monotherapie

    Energy Technology Data Exchange (ETDEWEB)

    Lubienski, A.; Bitsch, R.G.; Grenacher, L.; Kauffmann, G.W. [Radiologische Universitaetsklinik Heidelberg, Abt. Radiodiagnostik, Heidelberg (Germany); Schemmer, P. [Chirurgische Universitaetsklinik Heidelberg (Germany); Duex, M. [Radiologisches Zentralinstitut Krankenhaus Nordwest Frankfurt (Germany)

    2004-12-01

    Purpose: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC). Methods and Materials: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared. Results: The 6-, 12-, 24- and 36-month survival rates were 61%, 21%, 4%, and 4% for TACE monotherapy and 77%, 55%, 39% and 22% for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p=0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group. (orig.)

  15. Transarterial chemoembolization for primary and metastatic liver tumors

    Directory of Open Access Journals (Sweden)

    Popov M.V.

    2016-12-01

    Full Text Available The literature review presents the methodology of transarterial chemoembolization (TACE — widely used method of treatment of primary and secondary liver tumors. The TACE role as a neoadjuvant therapy and the role in the management of unresectable primary and secondary liver tumors are shown. The morphofunctional basis of TACE, benefits of superselective intra-arterial administration of cytostatic agents especially in combination with ischemic impact on a tumor are described. The subject of the choice of the chemotherapeutic agent is also touched; modern drug-loaded microspheres which allow the use of higher doses of the chemotherapeutic drug without increasing systemic effect and prolong its effect on tumor are described. Lack of correlation of presence and severity of a post-embolization syndrome with success of the procedure is noted.

  16. Discrepant imaging findings of portal vein thrombosis with dynamic computed tomography and computed tomography during arterial portography in hepatocellular carcinoma: possible cause leading to inappropriate treatment selection.

    Science.gov (United States)

    Toyoda, Hidenori; Kumada, Takashi; Tada, Toshifumi; Mizuno, Kazuyuki; Kobayashi, Natsuko; Inukai, Yosuke; Takeda, Akira; Sone, Yasuhiro

    2017-04-01

    We encountered a patient with hepatocellular carcinoma who had discrepant imaging findings on portal vein thrombosis with portal phase dynamic computed tomography (CT) and CT during arterial portography (CTAP). CTAP, via the superior mesenteric artery and via the splenic artery, both showed a portal perfusion defect in the right hepatic lobe, indicating portal vein thrombosis in the main trunk of the right portal vein. Portal phase dynamic CT clearly depicted portal perfusion of the same hepatic area. Transarterial chemoembolization was successfully performed, but it was associated with severe liver injury. Clinicians should be cautious about this possible discrepancy based on imaging technique. The inaccurate evaluation of portal vein thrombosis may result in inappropriate treatment selection, which can worsen patient prognosis.

  17. Arterial ammonia with Blood Ammonia Checker II and with indophenol reaction to assess presence of hepatic encephalopathy

    NARCIS (Netherlands)

    Huizenga, [No Value; vanDam, GM; Gips, CH

    1996-01-01

    Hepatic encephalopathy (HE) is associated with elevated arterial ammonia levels. The relationship is variable, in part due to ammonia methodology. One method, based on the indophenol reaction (IPh), is interfered with a number of amino acids including all aromatic amino acids. We have determined

  18. Giant hepatic artery aneurysm associated with immunoglobulin G4-related disease successfully treated using a liquid embolic agent

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Michele; Virgilio, Edoardo; Laurino, Florindo; Orgera, Gianluigi; Mene, Paolo; Pirozzi, Nicola; Ziparo, Vincenzo; Cavallini, Marco [St. Andrea Hospital, Rome (Italy)

    2015-08-15

    The occurrence of a giant hepatic artery aneurysm (GHAA) in a patient with systemic vasculitis is very rare. Herein, we describe our endovascular treatment experience of a GHAA associated with immunoglobulin G4-related disease (IgG4-RD) consisting primarily of a liquid embolic injection and deployment of a vascular plug.

  19. Combined resection of aberrant right hepatic artery without anastomosis in panceaticoduodenectomy for pancreatic head cancer: A case report

    Directory of Open Access Journals (Sweden)

    Atsushi Nanashima

    2016-01-01

    Conclusion: By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.

  20. An implantable rat liver tumor model for experimental transarterial chemoembolization therapy and its imaging features

    Institute of Scientific and Technical Information of China (English)

    Xin Li; Chuan-Sheng Zheng; Gan-Sheng Feng; Chen-Kai Zhuo; Jun-Gong Zhao; Xi Liu

    2002-01-01

    AIM: To establish an ideal implantable rat liver tumor model for interventional therapy study and examine its angiographic signs and MRI, CT features before and after embolization. METHODS: Forty male Wistar rats were implanted with Walker256 tumor in the left lateral lobe of liver. Digital subtraction angiography (DSA) and transarterial chemoembolization were performed on day 14 after implantation. Native computer tomography (CT, n=8) and native magnetic resonance (MR,n=40) were performed between the day 8 and day 21 after implantation. The radiological morphological characteristics were correlated with histological findings.RESULTS: Successful implantation was achieved in all forty rats, which was confirmed by CT and MRI. MR allowed tumor visualization from day 8 while CT from day 11 after implantation. The tumors were hypodensity on CT, hypointense on MR T1-weighted and hyperintense on T2-weighted. The model closely resembled human hepatocardnoma in growth pattem and the lesions were rich in vasculature on angiography and got its filling mainly from the hepatic artery. Before therapy, tumor size was 211.9±48.7 mm3. No ascites, satellite liver nodules or lung metastasis were found. One week after therapy, tumor size was 963.6±214.8 mm3 in the control group and 356.5±78.4mm3 in TACE group. Ascites (4/40), satellite liver nodules (7/40) or lung metastasis (3/40) could be seen on day 21.CONCLUSION: Walker-256 tumor rat model is suitable for the interventional experiment. CT and MRI are helpful in animal optioning and evaluating experimental results.

  1. Development of a New Technique for Reconstruction of Hepatic Artery during Liver Transplantation in Sprague-Dawley Rat.

    Directory of Open Access Journals (Sweden)

    Xingmu Liu

    Full Text Available Sleeve anastomosis is the most common technique used to rearterialize orthotopic liver transplants (OLT. However, this technique has a number of disadvantages, including difficulty of performance of the technique visually unaided. We herein describe a novel rearterialized OLT model in the rat.Forty-six male Sprague Dawley rats (300-400 g were used as donors and recipients. Based on Kamada's cuff technique, the new model involved performing a modified "sleeve" anastomosis between the celiac trunk of the donor and common hepatic artery of the recipient to reconstruct blood flow to the hepatic artery. An additional ten male Sprague Dawley rats underwent liver transplantation without artery reconstruction. Liver grafts were retrieved from the two groups and histological examination was performed following surgery.Total mean operating times were ~42 minutes for the donor liver extraction and 57 minutes for the recipient transplantation. Graft preparation took an additional 15 minutes and the time to fix the arterial bracket was ~3 minutes. During transplantation, the anhepatic phase lasted 18 ± 2.5 min and the artery reconstruction only required ~3 minutes. The patency rate was 94.44% and the 4-week survival rate was 90%. Histology indicated obvious fibrosis in the liver grafts without artery reconstruction, while normal histology was observed in the arterialized graft.This new method allows for the surgical procedure to be performed visually unaided with good survival and patency rates and represents an alternative model investigating OLT in rats.

  2. Experimental study on inhibitory effect of bridgy duct of hepatic artery on apoptosis of liver and bile duct cells

    Institute of Scientific and Technical Information of China (English)

    Hongwei Lu; Yiming Li; Hong Ji; Jinkai Xu

    2006-01-01

    Objective: To investigate whether the method of bridgy duct established between the recipient's spleen artery and the donor's gastroduodenal artery could inhibit the apoptosis of liver and bile duct cells caused by hepatic artery ischemia.Methods: Twenty-four mongrel dogs from Xi'an area were used to establish simplified models of dog orthotopic liver transplantation and divided into three groups randomly: HAI group (hepatic artery ischemia group),BBB group (bypassing the blood by a bridgy duct) and control group. After cold perfusion, The samples were collected from liver and bile duct in each group at different time and fixed in glutaraldehyde and 4% polyformaldehyde respectively. At last, the apoptosis of liver and bile duct cells were observed and the apoptotic indexes were calculated. Results: Two hours after cold perfusion, apoptotic phenomenon was common in HAI group, rare in BBB group, while no apoptotic phenomenon was observed in control group. TUNEL staining showed that there was no significant difference in apoptotic index among the three groups immediately after cold perfusion. However, with time going, the apoptotic cells were increased in three groups, and the difference in apoptotic index was significant among three groups (P < 0.01 ). Conclusion: Bridgy duct of hepatic artery can inhibit the apoptosis of liver and bile duct cells caused by HAI significantly.

  3. Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans.

    Science.gov (United States)

    Boas, F Edward; Kamaya, Aya; Do, Bao; Desser, Terry S; Beaulieu, Christopher F; Vasanawala, Shreyas S; Hwang, Gloria L; Sze, Daniel Y

    2015-04-01

    Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  4. Performance of unenhanced respiratory-gated 3D SSFP MRA to depict hepatic and visceral artery anatomy and variants

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    Puippe, Gilbert D., E-mail: gilbert.puippe@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland); Alkadhi, Hatem, E-mail: hatem.alkadhi@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland); Hunziker, Roger, E-mail: roger.hunziker@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland); Nanz, Daniel, E-mail: daniel.nanz@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland); Pfammatter, Thomas, E-mail: thomas.pfammatter@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland); Baumueller, Stephan, E-mail: stephan.baumueller@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland, Raemistrasse 100, CH-8091 Zurich (Switzerland)

    2012-08-15

    Objectives: To prospectively evaluate the performance of unenhanced respiratory-gated magnetization-prepared 3D-SSFP inversion recovery MRA (unenhanced-MRA) to depict hepatic and visceral artery anatomy and variants in comparison to contrast-enhanced dynamic gradient-echo MRI (CE-MRI) and to digital subtraction angiography (DSA). Methods: Eighty-four patients (55.6 {+-} 12.4 years) were imaged with CE-MRI (TR/TE 3.5/1.7 ms, TI 1.7 ms, flip-angle 15 Degree-Sign ) and unenhanced-MRA (TR/TE 4.4/2.2 ms, TI 200 ms, flip-angle 90 Degree-Sign ). Two independent readers assessed image quality of hepatic and visceral arteries on a 4-point-scale. Vessel contrast was measured by a third reader. In 28 patients arterial anatomy was compared to DSA. Results: Interobserver agreement regarding image quality was good for CE-MRI ({kappa} = 0.77) and excellent for unenhanced-MRA ({kappa} = 0.83). Unenhanced-MRA yielded diagnostic image quality in 71.6% of all vessels, whereas CE-MRI provided diagnostic image quality in 90.6% (p < 0.001). Vessel-based image quality was significantly superior for all vessels at CE-MRI compared to unenhanced-MRA (p < 0.01). Vessel contrast was similar among both sequences (p = 0.15). Compared to DSA, CE-MRI and unenhanced-MRA yielded equal accuracy of 92.9-96.4% for depiction of hepatic and visceral artery variants (p = 0.93). Conclusions: Unenhanced-MRA provides diagnostic image quality in 72% of hepatic and visceral arteries with no significant difference in vessel contrast and similar accuracy to CE-MRI for depiction of hepatic and visceral anatomy.

  5. Severe Pulmonary Arterial Hypertension in Patients Treated for Hepatitis C With Sofosbuvir.

    Science.gov (United States)

    Renard, Sébastien; Borentain, Patrick; Salaun, Erwan; Benhaourech, Sanaa; Maille, Baptiste; Darque, Albert; Bregigeon, Sylvie; Colson, Philippe; Laugier, Delphine; Gaubert, Martine Reynaud; Habib, Gilbert

    2016-03-01

    Development of direct-acting antiviral agents against hepatitis C virus (HCV) has changed the management of chronic HCV infection. We report three cases of newly diagnosed or exacerbated pulmonary arterial hypertension (PAH) in patients treated with sofosbuvir. All patients had PAH-associated comorbidities (HIV coinfection in two, portal hypertension in one) and one was already being treated for PAH. At admission, all patients presented with syncope, World Health Organization functional class IV, right-sided heart failure, and extremely severe hemodynamic parameters. After specific PAH therapy, the clinical and hemodynamic properties for all patients were improved. Severity and acuteness of PAH, as well as chronology, could suggest a causal link between HCV treatment and PAH onset. We hypothesize that suppression of HCV replication promotes a decrease in vasodilatory inflammatory mediators leading to worsening of underlying PAH. The current report suggests that sofosbuvir-based therapy may be associated with severe PAH.

  6. Radiological management of multiple hepatic artery pseudoaneurysms associated with cholangitic abscesses

    Directory of Open Access Journals (Sweden)

    Ankur Goyal

    2016-01-01

    Full Text Available Hepatic artery pseudoaneurysms (HAP are uncommon, occurring mostly as a complication of trauma (accidental or iatrogenic. Liver abscess rarely causes HAP and multiple HAP associated with cholangitic abscesses have not been reported in the literature. We present a patient of acute necrotizing pancreatitis with stent block cholangitis and multiple cholangitic abscesses who developed hemorrhagic output through drainage catheter in the liver abscess. A multiphasic CT angiography demonstrated three HAP, which were treated with a combination of endovascular coil embolization and percutaneous thrombin injection. The fact that cholangitic abscesses may be associated with pseudoaneurysms should not be neglected, considering the potentially catastrophic complication and relatively easy radiological management. CT angiography permits accurate diagnosis and lays down the roadmap for endovascular procedures.

  7. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting

    Institute of Scientific and Technical Information of China (English)

    Cynthia Sudar Singh; Kamini Giri; Renuka Gupta; Mohammed Aladdin; Harinder Sawhney

    2006-01-01

    A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm × 2.3 cm)was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.

  8. Atypical presentation of a hepatic artery pseudoaneurysm: A case report and review of the literature

    Science.gov (United States)

    Luckhurst, Casey M; Perez, Chelsey; Collinsworth, Amy L; Trevino, Jose G

    2016-01-01

    Classically, hepatic artery pseudoaneurysms (HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominal pain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended. PMID:27366305

  9. Atypical presentation of a hepatic artery pseudoaneurysm:A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Casey; M; Luckhurst; Chelsey; Perez; Amy; L; Collinsworth; Jose; G; Trevino

    2016-01-01

    Classically, hepatic artery pseudoaneurysms(HAPs) arise secondary to trauma or iatrogenic causes. With an increasing prevalence of laparoscopic procedures of the hepatobiliary system the risk of inadvertent injury to arterial vessels is increased. Pseudoaneurysm formation post injury can lead to serious consequences of rupture and subsequent hemorrhage, therefore intervention in all identified visceral pseudoaneurysms has been advocated. A variety of interventional methods have been proposed, with surgical management becoming the last step intervention when minimally invasive therapies have failed. The authors present a case of a HAP in a 56-year-old female presenting with jaundice and pruritis suggestive of a Klatskin’s tumor. This presentation of HAP in a patient without any significant past medical or surgical intervention is atypical when considering that the majority of HAP cases present secondary to iatrogenic causes or trauma. Multiple minimally invasive approaches were employed in an attempt to alleviate the symptomology which included jaundice and associated inflammatory changes. Ultimately, a right hepatic trisegmentectomy was required to adequately relieve the mass effect on biliary outflow obstruction and definitively address the HAP. The presentation of a HAP masquerading as a malignancy with jaundice and pruritis, rather than the classic symptoms of abdominalpain, anemia, and melena, is unique. This presentation is only further complicated by the absent history of either trauma or instrumentation. It is important to be aware of HAPs as a potential cause of jaundice in addition to the more commonly thought of etiologies. Furthermore, given the morbidity and mortality associated with pseudoaneurysm rupture, intervention in identifiable cases, either by minimally invasive or surgical interventions, is recommended.

  10. Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Phongkitkarun, S. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: rasih@mahidol.ac.th; Kobayashi, S. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Varavithya, V. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Huang, X. [Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Curley, S.A. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Charnsangavej, C. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2005-06-01

    AIM: To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. METHODS: Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data. RESULTS: Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. CONCLUSION: Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.

  11. Arterialization of the portal vein improves hepatic microcirculation and tissue oxygenation in experimental cirrhosis.

    Science.gov (United States)

    Yang, W; Koti, R; Glantzounis, G; Davidson, B R; Seifalian, A M

    2003-10-01

    Arterialization of the portal vein (APV) has shown beneficial effects on liver regeneration and function in selected patients undergoing liver resection and transplantation. Whether APV improves liver perfusion and function in cirrhosis is unclear. This study investigated the effect of APV on hepatic haemodynamics and liver function in a rat model of cirrhosis. Male Sprague-Dawley rats (250-300 g) were divided into three groups: normal controls (n = 7), cirrhosis with sham laparotomy (sham; n = 7) and cirrhosis with APV (APV; n = 9). Portal venous blood flow, portal vein pressure and hepatic parenchymal microcirculation (HPM) were measured before and after APV. Hepatic parenchymal oxygenation was assessed by near-infrared spectroscopy and hepatocellular injury by standard liver function tests. Measurements were taken at baseline, after APV and 7 days after surgery. APV increased portal blood flow and pressure in cirrhotic rats without altering intrahepatic portal resistance. APV increased the HPM in cirrhotic rats by a mean(s.e.m.) of 28.5(0.1) per cent on day 0 and 54.6(0.1) per cent by day 7 (P = 0.001). Liver tissue oxygenation was increased by APV and the plasma gamma-glutamyltranspeptidase level was reduced (mean(s.e.m.) 6.0(0.5) versus 3.8(0.3) units/l before and after APV respectively; P = 0.006) at day 7. APV increases portal blood flow, tissue perfusion and oxygenation in cirrhosis. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  12. Time courses of PIVKA-II and AFP levels after hepatic artery embolization and hepatic artery infusion against hepatocellular carcinoma: relation between the time course and tumor necrosis.

    Science.gov (United States)

    Kishi, K; Sonomura, T; Mitsuzane, K; Nishida, N; Kimura, M; Satoh, M; Yamada, R; Kodama, N; Kinoshita, M; Tanaka, H

    1992-01-01

    We examined 35 untreated patients with unresectable hepatocellular carcinoma who exhibited positivity for both plasma PIVKA-II and serum AFP, and studied the weekly course of these markers from the pre-TAE or -HAI period to the third week of treatment. We correlated changes in these markers with the tumor necrosis rate and the time course on X-ray CT images. One week after TAE, the tumor necrosis rate and the time course of PIVKA-II showed a significant correlation (r = 0.7), while the correlation was between the time course of AFP and the tumor necrosis rate was insignificant (r = 0.2). At two and three weeks after TAE, both the time course of AFP and PIVKA-II showed significant correlations with the tumor necrosis rate. In 16 patients with tumor necrosis rates of not less than 90%, the mean of the actual half-life (AHL) of PIVKA-II was 3.2 days, the shortest was 1.83 days, and 75% of all AHLs clustered from two days to four days, while the mean and shortest AHLs of AFP were six days and 2.98 days, respectively, exhibiting a broader distribution. On the other hand, in three out of the nine cases of hepatocellular carcinoma complicated with portal tumor thrombi, PIVKA-II increased after HAI in spite of a reduction in tumor size. It was suggested that the PIVKA-II level requires careful interpretation in cases of portal vein obstruction after intensive hepatic arterial infusion of anticancer agents.

  13. Hypofractionated three-dimensional conformal radiotherapy plus transcatheter arterial chemoembolization for primary liver cancer%大分割三维适形放疗联合TACE治疗原发性肝癌的临床观察

    Institute of Scientific and Technical Information of China (English)

    潘平生; 邹瑜斌; 万林林; 梅华; 陈丽萍; 李小兵

    2013-01-01

    目的:观察大分割三维适形放疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗效果,分析其预后因素.方法:对50例不能手术的原发性肝癌(PLC)进行大分割3DCRT,分割剂量3~6 Gy,生物效应剂量(BED) 52~84 Gy,中位剂量61 Gy.放疗前行TACE治疗1~3次.结果:50例肝癌患者中,完全缓解(CR) 16% (8/50),部分缓解(PR)62%(31/50),无变化(NC) 14% (7/50),进展(PD) 8% (4/50),总有效率(CR+ PR)78%.1、2、3年生存率分别为74%(37/50)、58%(29/50)和34%(17/50),中位生存期22.5个月.多因素分析结果显示,肿瘤数目、大体肿瘤体积(GTV)、Child-pugh分级是影响生存率的主要预后因素.结论:大分割3DCRT联合TACE治疗中晚期肝癌值得临床推广应用,不良反应可以耐受,特别是对于肿瘤数目少、肿瘤体积小和肝功能较好的肝癌患者不失为一种非手术治疗的理想选择.%OBJECTIVE: To evaluae the therapeutic effect and prognostic factors of hypofractionated three-dimen sional conformal radiotherapy (3DCRT) combined with transcathether arterial chemoembdization(TACE). METHODS: Fifty patients with primary liver cancer(PLC) who were not suitable for surgery conducted hypofractionated 3DCRT,divi sion dose 3 — 6 Gy,biological effectiveness dose 52 — 84 Gy, Median dose 61 Gy. The patients acceped TACE treatment 1 — 3 times before radiotherapy. RESULTS: In the fifty patients with hepatic cancer complete remission(CR) was 16% (8/50), partial remission(PR) was 62%(31/50) ,no change(NC) was 14%(7/50) .advance was 8% (4/50), and total ef fective rate(CR+PR) was 78%. And 1,2,3 year survival rate was 74% (37/50) , 58% (29/50) and 34%(17/50) respec tively. Median survival time was 22. 5 months. Multivariate analysis demonstrated that the amount of tumor,gross tumor volume,Child-pugh scale were the major prognostic factors which influenced survival rate. CONCLUSION: Hypofraction ated 3DCRT associaed with TACE is a effective method in the treatment of

  14. Study on Treatment of Primary Hepatic Carcinoma by Arterial Perfusion Embolization with Zedoary Turmeric Oil

    Institute of Scientific and Technical Information of China (English)

    程剑华; 常纲; 吴万垠; 杨志钢; 孟凡喆; 徐凯; 李柳宁; 朱迪盈; 陈春泳; 罗海英

    2001-01-01

    To evaluate the effect, side-effect and prospect of hepatic arterial perfusion embolization (HAPE) with Zedoary turmeric oil (ZTO) in treating primary hepatic carcinoma (PHC).Methods: Clinical study was carried out by administration of 1-3 ml ZTO through arterial catheter to induce embolism in 32 patients of PHC, and compared with 32 patients treated by hepatic arterial perfusion embolization with chemical agents (HAPE-C) in the control group. The Chinese herbal medicine was given orally to both groups according to Syndrome Differentiation of TCM. In the experimental study, transplantation hepatic carcinoma model was established in 40 rats. They were randomly divided into the treated group and the control group, 20 in each group, and were perfused with 10 mg/kg ZTO and 0.2-0.3 ml normal saline respectively to observe the effect of treatment.Results: The effect of treatment in the ZTO group was CR in 1 case and PR in 13 cases, the total effective rate being 43.75%, with AFP negative reversed in 7 cases, titer decreased in 7; while in the control group it was PR in 10 cases, the total effective rate being 31.25%, AFP negative reversed in 5, titer decreased in 2, and the difference of therapeutic effect between the two groups was insignificant (P>0.05). The post-perfusion thrombotic syndrome occurrence, with the symptoms of fever, abdominal pain, vomiting, etc. in the two groups was similar, but no bone marrow inhibition occurred in the ZTO group, which was different from the control group (P<0.01, P<0.05). The mean survival time, median survival time, 1-, 2-, 3- and 4-year survival rate in the ZTO group was 13.84 months, 10 months, 37.5%, 18.87%, 9.70% and 6.4% respectively, and in the control group, 8.03 months, 6 months, 15.6%, 6.27%, 0% and 0% respectively, the mean survival time, median survival time and 1-year survival rate in the ZTO group were significantly superior to those in the control group (P<0.05). Experimental study showed that the effect in the

  15. Arterial steroid injection therapy can inhibit the progression of severe acute hepatic failure toward fulminant liver failure

    Institute of Scientific and Technical Information of China (English)

    Kazuhiro Kotoh; Tsuyoshi Tajima; Yoshiki Asayama; Kousei Ishigami; Masakazu Hirakawa; Munechika Enjoji; Makoto Nakamuta; Tsuyoshi Yoshimoto; Motoyuki Kohjima; Shusuke Morizono; Shinsaku Yamashita; Yuki Horikawa; Kengo Yoshimitsu

    2006-01-01

    AIM: To utilize transcatheter arterial steroid injection therapy (TASIT) via the hepatic artery to reduce hepatic macrophage activity in patients with severe acute hepatic failure.METHODS: Thirty-four patients with severe acute hepatic failure were admitted to our hospital between June 2002 to June 2006 providing for the possibility of liver transplantation (LT). Seventeen patients were treated using traditional liver supportive procedures, and the other 17 patients additionally underwent TASIT with 1000 mg methylprednisolone per day for 3 continuous days.RESULTS: Of the 17 patients who received TASIT, 13 were cured without any complications, 2 died, and 2 underwent LT. Of the 17 patients who did not receive TASIT, 4 were self-limiting, 7 died, and 6 underwent LT.Univariate logistic analysis revealed that ascites, serum albumin, prothrombin time, platelet count, and TASIT were significant variables for predicating the prognosis.Multivariate logistic regression analysis using stepwise variable selection showed that prothrombin time, platelet count, and TASIT were independent predictive factors.CONCLUSION: TASIT might effectively prevent the progression of severe acute hepatic failure to a fatal stage of fulminant liver failure.

  16. Intra-arterial hepatic chemotherapy for unresectable colorectal liver metastases: a review of medical devices complications in 3172 patients

    Directory of Open Access Journals (Sweden)

    Stefano Bacchetti

    2009-03-01

    Full Text Available Stefano Bacchetti, Enricomaria Pasqual, Elena Crozzolo, Alessandra Pellarin, Pier Paolo CagolDepartment of Surgical Sciences, Faculty of Medicine and Surgery, University of Udine, ItalyBackground: Hepatic artery infusion (HAI is indicated to treat unresectable colorectal hepatic metastases, with recent applications as a neoadjuvant or adjuvant treatment. Traditionally performed with the infusion of fluoropyrimidine-based chemotherapy, it has been now tested with oxaliplatin or irinotecan and associated with systemic chemotherapy.Methods: To evaluate the impact of medical devices complications we carried out a search of the published studies on HAI in unresectable colorectal liver metastases. Complications were pooled according to the applied medical system: 1 surgical catheter, 2 radiological catheter, and 3 fully implantable pump. The surgical catheter is inserted into the hepatic artery from the gastro-duodenal artery. The radiological catheter is inserted into the hepatic artery through a percutaneous transfemoral or transaxillar access. The fully implantable pump is a totally internal medical device connected to the arterial hepatic catheter during laparotomy.Results: The selection criteria were met in 47/319 studies. The complications of surgical and radiological medical devices connected to a port were found in 16 and 14 studies respectively. Meanwhile, complications with a fully implantable pump were reported in 17 studies. The total number of complications reported in studies evaluating patients with surgical or radiological catheter were 322 (322/948, 34% and 261 (261/722, 36.1% respectively. In studies evaluating patients with a fully implantable pump, the total number of complications was 237 (237/1502, 15.8%. In 18/319 studies the number of cycles was reported. The median number of cycles with surgically and radiologically implanted catheters was 8 and 6 respectively. The fully implantable pump allows a median number of 12 cycles

  17. Management of life-threatening celiac-hepatic arterial hemorrhage after pancreaticoduodenectomy: usefulness of temporary balloon occlusion

    Institute of Scientific and Technical Information of China (English)

    WANG Mao-qiang; GUO Li-ping; LIN Han-ying; DUAN Feng; LIU Feng-yong; WANG Zhi-jun

    2011-01-01

    When a large visceral artery is ruptured,uncontrolled bleeding may lead to hemodynamic collapse.Use of endovascular occlusion balloon catheter may provide rapid control of hemorrhage and facilitate definitive therapy.We reported two patients with massive hemorrhage from ruptured celiac-hepatic artery after pancreaticoduodenectomy,who were initially treated percutaneously by temporary selective balloon occlusion.They became critically hemodynamic unstable during the angiographic procedure.Through an 8Fr sheath,a 6Fr compliant latex occlusion balloon was placed proximal to the celiac trunk and inflated,and upon patient stabilization surgical revision and stent-graft placement were successfully performed in the two patients,respectively.Temporary selective balloon occlusion provides fast and effective bleeding control for patient with critically uncontrollable visceral arterial hemorrhage,permitting subsequent use of conventional techniques for management of the arterial bleeding source.

  18. Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft.

    Science.gov (United States)

    Moreno, Carlos; Sabaté, Antoni; Figueras, Joan; Camprubí, Imma; Dalmau, Antonia; Fabregat, Joan; Koo, Maylin; Ramos, Emilio; Lladó, Laura; Rafecas, Antoni

    2006-11-01

    We performed a prospective, randomized study of adult patients undergoing orthotopic liver transplantation, comparing hemodynamic and tissular oxygenation during reperfusion of the graft. In 30 patients, revascularization was started through the hepatic artery (i.e., initial arterial revascularization) and 10 minutes later the portal vein was unclamped; in 30 others, revascularization was started through the portal vein (i.e., initial portal revascularization) and 10 minutes later the hepatic artery was unclamped. The primary endpoints of the study were mean systemic arterial pressure and the gastric-end-tidal carbon dioxide partial pressure (PCO(2)) difference. The secondary endpoints were other hemodynamic and metabolic data. The pattern of the hemodynamic parameters and tissue oxygenation values during the dissection and anhepatic stages were similar in both groups At the first unclamping, initial portal revascularization produced higher values of mean pulmonary pressure (25 +/- 7 mm of Hg vs. 17 +/- 4 mm of Hg; P portal revascularization produced higher values of cardiac output and mean arterial pressure (87 +/- 15 mm of Hg vs. 79 +/- 15 mm of Hg; P portal group. During revascularization, the values of gastric and arterial pH decreased in both groups and recovered at the end of the procedure, but were more accentuated in the initial arterial revascularization group. In conclusion, we found that initial arterial revascularization of the graft increases pulmonary pressure less markedly, so it may be indicated for those patients with poor pulmonary and cardiac reserve. Nevertheless, for the remaining patients, initial portal revascularization offers more favorable hemodynamic and metabolic behavior, less inotropic drug use, and earlier normalization of lactate and pH values. (c) 2006 AASLD

  19. Right Accessory Hepatic Artery Arising From Celiac Trunk-Case Report of a Variation that Must Be Looked for During Multiorgan Procurement.

    Science.gov (United States)

    Bastos-Neves, D; da Silva Alves, J A; Guedes Dias, L G; de Rezende, M B; Salvalaggio, P R

    2016-09-01

    Knowledge of the anatomy of the hepatic artery and its variations is important to hepatobiliary and liver transplant surgeons and interventional radiologists. We report a rare anatomic variation of liver hepatic arterial supply: a right accessory hepatic artery arising directly from the celiac trunk and observed at the time of multiorgan procurement. The anatomic variation described in this case occurs in up to 2% of cases and their knowledge is essential to avoid injuries during multiorgan procurement that could require multiple anastomoses or lead to inadvertent vessel injury. This variation is very rarely reported in the medical literature. We document successful deceased-donor liver transplantation with a graft that had an accessory right accessory hepatic artery from the celiac trunk.

  20. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC)

    Energy Technology Data Exchange (ETDEWEB)

    Veltri, Andrea; Moretto, Paolo; Doriguzzi, Andrea; Carrara, Giovanna; Gandini, Giovanni [University of Turin, Institute of Diagnostic and Interventional Radiology, Torino (Italy); Pagano, Eva [University of Turin, Unit of Cancer Epidemiology, Torino (Italy)

    2006-03-15

    The treatment of unresectable ''non-early'' (according to the BCLC classification) hepatocellular carcinoma (HCC) in cirrhotic patients with transcatheter arterial chemoembolization (TACE) followed by radiofrequency ablation (RFA) is retrospectively evaluated and possible prognostic factors of this combined therapy are investigated. Forty-six consecutive cirrhotic patients (Child-Pugh class A or B) with solitary or oligonodular HCC underwent RFA after TACE. The treated lesions were 51 overall (size 30-80 mm, mean 48.9). RFA was performed by a multitined expandable electrodes device after one TACE administration. Local efficacy was evaluated with multiphasic computed tomography (CT) performed an average of 2 months after treatment and then during follow-up. Patient survival rate was also evaluated (follow-up time 1-51 months, mean 15 months). Technical success (defined as complete devascularization during the arterial phase) was achieved in 34/51 lesions (66.7%) at the first CT check and in 29/51 (56.9%) during the succeeding follow-up. Among the considered prognostic factors, only lesion diameter (< or >=50 mm) was statistically significant in the Fisher's exact test in terms of local control (85.2 vs. 45.8% at first CT, p=.0065; 70.4 vs. 41.7% during follow-up, p=.051). There were two major complications (6.5%): one hepatic failure and one death. A Kaplan-Meier analysis showed survival rates of 89.7% at 12 months and 67.1% at 24 months. Combined therapy for non-early HCC shows a relatively high complete local response (especially in lesions less than 5 cm in diameter) and promising mid-term clinical success. Its overall usefulness has yet to be established by a larger series and risk-benefit analysis. (orig.)

  1. Placement of a covered self-expandable nitinol stent for bile duct stricture that caused by ischemic injury after transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Kweon; Seo, Tae Seok; Cha, In Ho; Huh, Sik; Byun, Kwan Soo [Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2008-10-15

    The authors report here on a case of focal stricture in the common hepatic duct that was caused by ischemic bile duct injury after repeat TACE procedures for hepatocellular carcinoma, and the patient was successfully treated with a covered self-expandable nitinol stent.

  2. Liver cancer arterial perfusion modelling and CFD boundary conditions methodology: a case study of the haemodynamics of a patient-specific hepatic artery in literature-based healthy and tumour-bearing liver scenarios.

    Science.gov (United States)

    Aramburu, Jorge; Antón, Raúl; Rivas, Alejandro; Ramos, Juan Carlos; Sangro, Bruno; Bilbao, José Ignacio

    2016-11-01

    Some of the latest treatments for unresectable liver malignancies (primary or metastatic tumours), which include bland embolisation, chemoembolisation, and radioembolisation, among others, take advantage of the increased arterial blood supply to the tumours to locally attack them. A better understanding of the factors that influence this transport may help improve the therapeutic procedures by taking advantage of flow patterns or by designing catheters and infusion systems that result in the injected beads having increased access to the tumour vasculature. Computational analyses may help understand the haemodynamic patterns and embolic-microsphere transport through the hepatic arteries. In addition, physiological inflow and outflow boundary conditions are essential in order to reliably represent the blood flow through arteries. This study presents a liver cancer arterial perfusion model based on a literature review and derives boundary conditions for tumour-bearing liver-feeding hepatic arteries based on the arterial perfusion characteristics of normal and tumorous liver segment tissue masses and the hepatic artery branching configuration. Literature-based healthy and tumour-bearing realistic scenarios are created and haemodynamically analysed for the same patient-specific hepatic artery. As a result, this study provides boundary conditions for computational fluid dynamics simulations that will allow researchers to numerically study, for example, various intravascular devices used for liver disease intra-arterial treatments with different cancer scenarios. Copyright © 2016 John Wiley & Sons, Ltd.

  3. 肝动脉化疗栓塞与射频不同联合方案对不能切除肝癌的疗效比较%EFFECT OF THE DIFFERENTLY COMBINED TREATMENTS OF TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION AND PERCUTANEOUS RADIO-FREQUENCY ABLATION ON PATIENTS WITH UNRESCTABLE HEPATOCELLULAR CARCINOMA

    Institute of Scientific and Technical Information of China (English)

    宋斌; 王卫星; 董瑞; 张文

    2003-01-01

    目的:探讨射频消融(RF)术前行肝动脉化疗栓塞(TACE)与RF术后行TACE两种联合治疗方案对肝癌的疗效.方法:将接受TACE与RF联合治疗的61例不可切除性肝癌患者分为两组.一组为TACE+RF组,32例;另一组为RF+TACE组,29例.分别将两组治疗后肿瘤缩小率、消融率、瘤周血流信号、AFP值及治疗后6个月、12个生存率进行对比.结果:两组五种指标均具有显著性差异,TACE+RF组优于RF+TACE组.结论:对于中晚期不可切除性肝癌患者提倡采用TACE+RF联合治疗方案,即RF术前先行TACE,以增强两治疗方法之间互补性与疗效.%Objective:To evaluate the effect of the differently combined therapy methods of transcatheter arterial chemoembolization (TACE) and percutaneous radio-frequency ablation (RF) on patients with unresectable hepatocellular carcinoma (HCC).Methods:32 unresectable HCC patients (group TACE+RF) received the combined therapy of TACE before RF. 29 unresectable HCC patients received the combined therapy of TACE after RF. The datas of color-ultrasonography, AFP, 6-months and 12-months survival rate of two groups were compared.Results:There were remarkable difference in these datas of two groups.Conclusions:The combined method of performed TACE before RF is more effective in treating the unresectable hepatocellular carcinoma.

  4. Change in portal flow after liver transplantation: effect on hepatic arterial resistance indices and role of spleen size.

    Science.gov (United States)

    Bolognesi, Massimo; Sacerdoti, David; Bombonato, Giancarlo; Merkel, Carlo; Sartori, Giovanni; Merenda, Roberto; Nava, Valeria; Angeli, Paolo; Feltracco, Paolo; Gatta, Angelo

    2002-03-01

    Information on changes in splanchnic hemodynamics after liver transplantation is incomplete. In particular, data on long-term changes are lacking, and the relationship between changes in arterial and portal parameters is still under debate. The effect of liver transplantation on splanchnic hemodynamics was analyzed with echo-Doppler in 41 patients with cirrhosis who were followed for up to 4 years. Doppler parameters were also evaluated in 7 patients transplanted for acute liver failure and in 35 controls. In cirrhotics, portal blood velocity and flow increased immediately after transplantation (from 9.1 plus minus 3.7 cm/sec to 38.3 plus minus 14.6 and from 808 plus minus 479 mL/min to 2,817 plus minus 1,153, respectively, P changes in these parameters were related, in agreement with the hepatic buffer response theory. Portal flow returned to normal values after 2 years. Superior mesenteric artery flow normalized after 3 to 6 months. Splenomegaly persisted after 4 years, when spleen size was related to portal blood flow. In 7 patients transplanted for acute liver failure, portal flow, and hepatic arterial resistance index were normal after transplantation. In conclusion, a high portal flow was present in cirrhotics until 2 years after transplantation, probably because of maintenance of elevated splenic flow. An early increase in hepatic arterial resistance indices is a common finding, but it is transient and is related to the increase in portal blood flow. A normal time course of portal-hepatic hemodynamics was detected in patients transplanted for acute liver failure.

  5. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Roed T

    2014-01-01

    Full Text Available Torsten Roed,1 Ulrik Sloth Kristoffersen,2 Andreas Knudsen,1,2 Niels Wiinberg,3 Anne-Mette Lebech,1 Thomas Almdal,4 Reimar W Thomsen,5 Andreas Kjær,2 Nina Weis1,61Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; 2Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Physiology, Frederiksberg Hospital, Copenhagen, Denmark; 4Steno Diabetes Center, Copenhagen, Denmark; 5Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 6Faculty of Health Sciences, University of Copenhagen, Copenhagen, DenmarkObjective: Chronic hepatitis C is a global health problem and has been associated with coronary artery disease. Our aim was to examine the prevalence of coronary artery disease risk markers including endothelial biomarkers in patients with chronic hepatitis C and matched comparisons without manifest cardiovascular disease or diabetes in a cross-sectional design.Methods: Sixty patients with chronic hepatitis C (mean age 51 years were recruited from the Department of Infectious Diseases at Copenhagen University Hospital, and compared with 60 age-matched non-hepatitis C virus-infected individuals from a general population survey. We examined traditional coronary artery disease risk factors, metabolic syndrome, carotid intima media thickness, and a range of endothelial biomarkers.Results: Patients with chronic hepatitis C had more hypertension (40% versus 25%, prevalence ratio [PR] 1.6; 95% confidence interval [CI] 0.9–2.7 and smoked more (53% versus 38%, PR 1.4; 95% CI 0.9–2.1. The two groups had similar body mass index (mean 25.0 versus 25.7 kg/m2, whereas those with chronic hepatitis C had less dyslipidemia (including significantly lower low-density lipoprotein and cholesterol/high-density lipoprotein ratio, higher glycosylated hemoglobin level (mean 6.2 versus 5

  6. Hepatic arterial vascular anatomy. Normal supply and variants; Anatomia vascolare arteriosa epatica e sue varianti

    Energy Technology Data Exchange (ETDEWEB)

    De Santis, M.; Ariosi, P.; Calo' , G.F.; Romagnoli, R. [Modena e Reggio Emilia Univ., Modena e Reggio Emilia (Italy). Dipt. di Scienze Mediche, Oncologiche e Radiologiche, Sez. di Scienze Radiologiche

    2000-09-01

    It was investigated the frequency of anatomical variants of the hepatic artery, which can influence interventional angiographic procedures. It was reviewed 150 consecutive angiograms performed for the treatment of primary (112) or metastatic (38) liver tumors and evaluated the frequency of anatomical variants of the hepatic artery based on the classification proposed by Michels in 1955, which describes 10 variants. The so-called typical anatomy which is in fact only found in 55% of cases, is indicated as type I. The typical anatomy (type I variant) was seen in 78 patients (52%) and variants were seen in the other 72 (48%). It was found that 15 type II variants (10%), 23 type III (15.5.%), 1 type IV and 1 type V (0.6%), 3 type VI (2%), 1 type VII (0.6%) and finally 6 type IX (4%). There were no type VIII or X variants, but in 22 patients (14.7%) vascular anatomy did not fit Michels' classification. In this series the typical hepatic artery anatomy was found in 52%, which is in agreement with Michels' findings, while the frequency of the individual anatomical variants differed. Not all of the variants reported by Michels were seen in our series and it was found 22 patients with different variants. Disagreement might be due to the fact that Michels' was an autoptic series while the patients were cancer patients only and thus variability could be at least partly accounted for by neoplastic neovascularization. It was believed that through knowledge of the anatomical variants of the hepatic artery is fundamental to angiographic practice, in particular for interventional procedures, because such variants can influence the choice of vascular technique and of materials. [Italian] Scopo di valutare l'incidenza delle varianti anatomiche del distretto arterioso epatico, la cui presenza puo' condizionare lo svolgimento delle tecniche di angiografia interventistica. E' stata eseguita la revisione degli studi angiografici di 150 pazienti consecutivi

  7. Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

    Directory of Open Access Journals (Sweden)

    Hu Tian

    2015-01-01

    Full Text Available Background: Biliary cast syndrome (BCS was a postoperative complication of orthotopic liver transplantation (OLT, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI, and to observe pathological changes and morphology of biliary casts. Methods: Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy. Results: HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P 1 (OR = 1.300; 1.223; and 1.889, respectively. The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024. The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts. Conclusions: HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

  8. [A new method of short-term high volume (6 g of 5-FU in a week) intermittent hepatic arterial infusion using repeated transient catheter insertion].

    Science.gov (United States)

    Hasuike, Yasunori; Tanigawa, Takahiko; Yamada, Masaharu; Minami, Yukiko; Ezumi, Koji; Okada, Atsuya

    2009-11-01

    We report a case of liver metastases, which had hepatectomy twice and a partial lung resection after sigmoidectomy with partial bladder resection for advanced sigmoid colon cancer. The patient could not be tolerated the systemic chemotherapy, and percutaneous implantation of a catheter also could not have done with subcutaneous reservoir for hepatic arterial infusion because of an anomaly of hepatic artery branched-out from super mesenteric artery. Therefore, we tried an intermittent hepatic arterial infusion using a transient insertion of catheter to control the liver metastases' growth. A total amount of 6 g of 5-FU was continuously injected in a week by one insertion of catheter at the hepatic artery taking one day rest at day 4. During the next 21 months, a total of 11 courses have been done. CEA and CA19-9 were changed from 15 ng/mL, 48 U/ mL to 18, 30, respectively. The patient was able to keep working except for the duration of this treatment. This procedure could be one of the hepatic arterial infusion options.

  9. Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI?

    Energy Technology Data Exchange (ETDEWEB)

    Vermeulen, Mechteld A.R., E-mail: mar.vermeulen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Ligthart-Melis, Gerdien C., E-mail: g.ligthart-melis@vumc.nl [Department of Internal Medicine, Dietetics and Nutritional Sciences, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Buijsman, René, E-mail: renebuysman@gmail.com [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Siroen, Michiel P.C., E-mail: m.siroen6@upcmail.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Poll, Marcel C.G. van de, E-mail: mcg.vandepoll@ah.unimaas.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Boelens, Petra G., E-mail: p.boelens@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Dejong, Cornelis H.C., E-mail: chc.dejong@mumc.nl [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Schaik, Cors van, E-mail: c.vanschaik@vumc.nl [Department of Radiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Hofman, Mark B.M., E-mail: mbm.hofman@vumc.nl [Department of Physics and Medical Technology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Leeuwen, Paul A.M. van, E-mail: pam.vleeuwen@vumc.nl [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands)

    2012-09-15

    Background: Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose. Objective: To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach. Methods: In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared. Results: Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433 ± 200/423 ± 162/507 ± 96 ml/min (portal vein); 96 ± 70/74 ± 41/108 ± 91 ml/min (hepatic artery); 248 ± 139/201 ± 118/219 ± 69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent. Conclusions: Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.

  10. Cell apoptosis and regeneration of hepatocellular carcinoma after transarterial chemoembolization

    Institute of Scientific and Technical Information of China (English)

    Zhen Li; Dao-Yu Hu; Qian Chu; Jian-Hong Wu; Chun Gao; Yu-Qing Zhang; Yan-Rong Huang

    2004-01-01

    AIM: To evaluate whether cell apoptosis and regeneration were existed in normal liver cells adjacent to carcinoma after transarterial chemoembolization (TACE).METHODS: Fifty rabbits with hepatic carcinoma were divided into 5 groups at random: group A (control group),groups B and C (TACE treatment groups), groups D and E (partial hepatectomy groups). There were 10 rabbits in each group. Rabbits in groups B-E were treated by transarterial chemoembolization (TACE) and partial hepatectomy (PH)respectively. The changes of S-phase cell fraction (SPF),proliferation index (PI) and cell apoptosis in the normal liver tissue were determined with flow cytometry (FCM) after operations on the first and third days. We determined the mitosis index (MI) with histo-pathological method and the apoptosis index (AI) with TUNEL method at the same time. RESULTS: Twenty-four hours after operations, compared with control group, the rabbits in TACE group had much higher index of SPF, PI and MI (MI: t=4.89, P<0.001; SPF:t=5.27, P<0.001; PI: t=4.87, P<0.001). Moreover, the proliferation of liver cells in TACE group was much weaker than that of the cells treated by partial hepatectomy, and the differences were significant (MI: t=7.02, P<0.001;SPF:t=4.06, P<0.001; PI: t=2.70, P<0.05). Seventy-two h after operations, FCM showed a small sub-G1 peak in TACE group and PH group, compared with the control group, but there was no difference between them (t=0.41, P>0.05).TACE showed that AI in the treated rabbits was higher than that in control group (t=3.07, P<0.05), and there were no differences between TACE group and PH group, either(t=0.93, P>0.05).CONCLUSION: Cell apoptosis and regeneration exist in rabbit liver tissues after TACE in some degree, which may be associated with the selective embolization of iodised oil, chemotherapeutic drug and free radical damage.

  11. Selective Internal Radiotherapy (SIRT) of Hepatic Tumors: How to Deal with the Cystic Artery

    Energy Technology Data Exchange (ETDEWEB)

    Theysohn, Jens M., E-mail: jens.theysohn@uni-due.de [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany); Mueller, Stefan [University Hospital Essen, Department of Nuclear Medicine (Germany); Schlaak, Joerg F.; Ertle, Judith [University Hospital Essen, Department of Gastroenterology and Hepatology (Germany); Schlosser, Thomas W. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany); Bockisch, Andreas [University Hospital Essen, Department of Nuclear Medicine (Germany); Lauenstein, Thomas C. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology (Germany)

    2013-08-01

    PurposeSelective internal radiotherapy (SIRT) with the beta emitter yttrium-90 (Y90) is a rapidly developing therapy option for unresectable liver malignancies. Nontarget irradiation of the gallbladder is a complication of SIRT. Thus, we aimed to assess different strategies to avoid infusion of Y90 into the cystic artery (CA).MethodsAfter hepatic digital subtraction angiography and administration of technetium-99m-labeled human serum albumin ({sup 99}mTc-HSA), 295 patients with primary or secondary liver tumors underwent single-photon emission computed tomography/computed tomography (SPECT/CT). Different measures were taken before repeated Y90 mapping and SIRT to avoid unintended influx into the CA where necessary. Clinical symptoms, including pain, fever, or a positive Murphy sign, were assessed during patient follow-up.ResultsA significant {sup 99}mTc-HSA accumulation in the gallbladder wall (higher {sup 99}mTc-HSA uptake than in normal liver tissue) was seen in 20 patients. The following measures were taken to avoid unintended influx into the CA: temporary/permanent occlusion of the CA with gelfoam (n = 5)/microcoil (n = 1), induction of vasospasm with a microwire (n = 4), or altering catheter position (n = 10). Clinical signs of cholecystitis were observed in only one patient after temporary CA occlusion with gelfoam and were successfully treated by antibiotics. Cholecystectomy was not required for any patient.ConclusionIt is important to identify possible nontarget irradiation of the gallbladder. The risk for radiation-induced cholecystitis can be easily minimized by temporary or permanent CA embolization, vasospasm induction, or altering the catheter position.

  12. Peripheral Blood Lymphocyte Depletion After Hepatic Arterial {sup 90}Yttrium Microsphere Therapy for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carr, Brian I., E-mail: brianicarr@hotmail.com [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA and Department of Nutrition and Exptl Biology, Saverio De Bellis Medical Research Institute, Castellana Grotte, Bari (Italy); Metes, Diana M. [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA and Department of Nutrition and Exptl Biology, Saverio De Bellis Medical Research Institute, Castellana Grotte, Bari (Italy)

    2012-03-01

    Purpose: The short- and long-term effects of {sup 90}Yttrium microspheres therapy for hepatocellular carcinoma (HCC) on peripheral blood lymphocytes are unknown and were therefore examined. Methods and Materials: Ninety-two HCC patients were enrolled in a {sup 90}Yttrium therapy study and routine blood counts were examined as part of standard clinical monitoring. Results: We found an early, profound, and prolonged lymphopenia. In a subsequent cohort of 25 additional HCC patients, prospective flow cytometric immune-monitoring analysis was performed to identify specific changes on distinct lymphocyte subsets (i.e., CD3, CD4, CD8 T, and CD19 B lymphocytes) and NK cells absolute numbers, in addition to the granulocytes and platelets subsets. We found that the pretreatment lymphocyte subset absolute numbers (with the exception of NK cells) had a tendency to be lower compared with healthy control values, but no significant differences were detected between groups. Posttherapy follow-up revealed that overall, all lymphocyte subsets, except for NK cells, were significantly (>50% from pretherapy values), promptly (as early as 24 h) and persistently (up to 30 months) depleted post-{sup 90}Yttrium microspheres therapy. In contrast, granulocytes increased rapidly (24 h) to compensate for lymphocyte depletion, and remained increased at 1-year after therapy. We further stratified patients into two groups, according to survival at 1 year. We found that lack of recovery of CD19, CD3, CD8, and especially CD4 T cells was linked to poor patient survival. No fungal or bacterial infections were noted during the 30-month follow-up period. Conclusions: The results show that lymphocytes (and not granulocytes, platelets, or NK cells) are sensitive to hepatic arterial {sup 90}Yttrium without associated clinical toxicity, and lack of lymphocyte recovery (possibly leading to dysregulation of adaptive cellular immunity) posttherapy indicates poor survival.

  13. Effectiveness of transarterial chemoembolization in hepatoblastoma: a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hark Hoon; Han, Young Min; Kang, Sung Soo; Kim, Jae Chun; Lee, Dong Geun; Hwang, Pyoung Han; Kim, Chong Soo [Chonbuk National Univ., College of Medicine, Chonju (Korea, Republic of); Lee, Jeong Min [Namwon Medical Center, Namwon (Korea, Republic of)

    1998-09-01

    To evaluate the therapeutic effectiveness and useful as well as the ness, systemic effect and effectiveness, of preoperative TACE when used in patients with unresectable or high risk hepatoblastoma. We retrospectively evaluated four patients with pathologically proven hepatoblastoma. One was male and three were female, and they were aged between 8 and 27 (mean, 15) months. All underwent selective hepatic angiography and chemoembolization after superselection of tumor feeding vessels. Cisplatin 90mg/m{sup 2}(50-80mg), adriamycine 40mg/m{sup 2} (20mg) and lipiodol suspension 4cc ere used as chemotherapeutic agents. Embolization was then performed, gelfoam particles. TACE was repeated at intervals of 3 weeks, and after the second episode, all patients underwent hepatic resection. To evaluate changes in the size, volume, internal texture and margin of the mass, as well as the systemic toxicity of chemotherapeutic drugs, we performed con-trast-enhanced CT and checked AFP,CBC and GOT/GPT before and after TACE. In all patients, TACE was successfully performed and major problems related to the procedure and toxicity of chemotherapeutic agents used were not noted. The largest diameter and volume of tumors were reduced by 33% (from 8.3 to 5.6 cm) and 69% respectively. Tumor necrosis was evident in all patients. Lipiodol uptake by tumors was homogenous and tumors were well distingulished from normal parenchyma. Compared to pre-TACE, serum alpha-feto-protein was reduced from 994(range:615--1690 ng/ml) to 46 ng/ml(42-- 47ng/ml) after the second TACE, and six months after surgery was in the normal range(13ng/ml;3--23ng/ml). SGOT/SGPT levels were temporally elevated after TACE but normalized within a few weeks. TACE can be a useful technique for preoperative treatment of hepatoblestomas. In tomors which are high-risk or inoperable, the therapeutio agents involved were not shown to be toxic.=20.

  14. 供肝动脉变异的术中处理%Tactics in the management of the variation of the donor hepatic arteries

    Institute of Scientific and Technical Information of China (English)

    马毅; 何晓顺; 朱晓峰; 王国栋; 王东平; 鞠卫强; 巫林伟; 胡安斌; 邰强

    2008-01-01

    Objective To investigate the variation types and reconstruction menthod of the donor hepatic arteries prior to liver transDlantation.Methods Five hundred and twenty-six cases of liver grafts were harvested with the method of rapid procurement,and the donor hepatic arteries were classified according to Hiatt system.Hepatic artery reconstruction was performed on those with variation of hepatic artery. Spleen artery,gastroduodenal artery or superior mesenteric artery was used for re construction with variant hepatic artery.The reconstruction of hepatic artery before transplantation and anastomosis between donor and recipient artery were both completed under 3.2-3.5 fold magnification.Results Among these donors' hepatic arteries,436 cases were normal(82.6 %,Hiatt Ⅰ),and 92 cases abnormal(17.4 %)accoding to Hiatt system.Thirty-eight cases were classified into Hiatt Ⅱ(7.2 %,38/528),47 cases into Hiatt Ⅲ(8.9 %,47/528),3 cases into Hiatt Ⅳ(0.5 %,3/528),2 cases into Hiatt Ⅴ(0.4 %,2/528)and 2 cases into Hiatt Ⅵ(0.4 %,2/528)respectively.Among 92 cases of hepatic artery variation,53 cases with common originate trunk which can anastomosed to recipient artery directly had no artery reconstruction before transplantation,and the rest 39 cases were subjected to hepatic artery reconstruction prior to liver transplantation:18 cases were subjected to the anastomoses of varian hepatic artery to spleen artery,13 to anastomoses of variant hepatic artery to gastroduodenal artery,and in 8 cases,one end of superior mesenteric artery was anastomosed with donor common hepatic artery(or celiac trunk)for reconstruction,and another end of superior mesenteric artery anastomosed with the choosen recipient artery.Conclusion Hepatic artery variation is frequently encountered.Thus,accurate recognization was essential in liver graft harvesting and back-table procedure to avoid injury.All variant hepatic arteries must be retained for its integrity of liver blood flow,otherwise,it should be

  15. Clinical effects of transcatheter hepatic arterial embolization with holmium-166 poly(l-lactic acid) microspheres in healthy pigs

    Energy Technology Data Exchange (ETDEWEB)

    Vente, M.A.D.; Nijsen, J.F.W.; Wit, T.C. de; Schip, A.D. van het [University Medical Center Utrecht, Department of Nuclear Medicine, P.O. Box 85500, Utrecht (Netherlands); Seppenwoolde, J.H.; Seevinck, P.R. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Krijger, G.C. [Delft University of Technology, Department of Radiation, Radionuclides and Reactors, Faculty of Applied Sciences, Delft (Netherlands); Huisman, A. [University Medical Center Utrecht, Department of Clinical Chemistry and Haematology, Utrecht (Netherlands); Zonnenberg, B.A. [University Medical Center Utrecht, Department of Internal Medicine, Utrecht (Netherlands); Ingh, T.S.G.A.M. van den [TCCI Consultancy B.V., P.O. Box 85032, Utrecht (Netherlands)

    2008-07-15

    The aim of this study is to evaluate the toxicity of holmium-166 poly(l-lactic acid) microspheres administered into the hepatic artery in pigs. Healthy pigs (20-30 kg) were injected into the hepatic artery with holmium-165-loaded microspheres ({sup 165}HoMS; n = 5) or with holmium-166-loaded microspheres ({sup 166}HoMS; n = 13). The microspheres' biodistribution was assessed by single-photon emission computed tomography and/or MRI. The animals were monitored clinically, biochemically, and ({sup 166}HoMS group only) hematologically over a period of 1 month ({sup 165}HoMS group) or over 1 or 2 months ({sup 166}HoMS group). Finally, a pathological examination was undertaken. After microsphere administration, some animals exhibited a slightly diminished level of consciousness and a dip in appetite, both of which were transient. Four lethal adverse events occurred in the {sup 166}HoMS group due either to incorrect administration or comorbidity: inadvertent delivery of microspheres into the gastric wall (n = 2), preexisting gastric ulceration (n = 1), and endocarditis (n = 1). AST levels were transitorily elevated post-{sup 166}HoMS administration. In the other blood parameters, no abnormalities were observed. Nuclear scans were acquired from all animals from the {sup 166}HoMS group, and MRI scans were performed if available. In pigs from the {sup 166}HoMS group, atrophy of one or more liver lobes was frequently observed. The actual radioactivity distribution was assessed through ex vivo {sup 166m}Ho measurements. It can be concluded that the toxicity profile of HoMS is low. In pigs, hepatic arterial embolization with {sup 166}HoMS in amounts corresponding with liver-absorbed doses of over 100 Gy, if correctly administered, is not associated with clinically relevant side effects. This result offers a good perspective for upcoming patient trials. (orig.)

  16. Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Ni He; Wang Li; Pei-Hong Wu

    2014-01-01

    The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine (HAI-FUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR (ablation group, n=39) or systemic chemotherapy plus HAI-FUDR (FUDR group, n=22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS (P = 0.001) and survival after metastasis (P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.

  17. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C--a cross-sectional study

    DEFF Research Database (Denmark)

    Roed, Torsten; Kristoffersen, Ulrik Sloth; Knudsen, Andreas

    2014-01-01

    -infected individuals from a general population survey. We examined traditional coronary artery disease risk factors, metabolic syndrome, carotid intima media thickness, and a range of endothelial biomarkers. RESULTS: Patients with chronic hepatitis C had more hypertension (40% versus 25%, prevalence ratio [PR] 1.6; 95....../high-density lipoprotein ratio), higher glycosylated hemoglobin level (mean 6.2 versus 5.7, difference of means 0.5; 95% CI 0.3-0.8), and a higher prevalence of metabolic syndrome (28% versus 18%, PR 1.6; 95% CI 0.8-3.0). Increased carotid intima media thickness above the standard 75th percentile was seen more frequently...

  18. A clinical study concerning hepatic arterial dominant phase and arrival time of contrast media on helical dynamic CT

    Energy Technology Data Exchange (ETDEWEB)

    Matsubara, Susumu; Uchida, Chiharu; Sato, Sei; Ishida, Junichi; Masuya, Ryozo [Hiroshima Teishin Hospital (Japan); Makiguchi, Mako [Radiation Effects Research Foundation, Hiroshima (Japan); Kanamori, Isao [Gifu Coll. of Medical Technology (Japan)

    2001-10-01

    Hepatic arterial dominant phase in helical dynamic CT was optimized by measuring the arrival time of contrast media (ATCM) with time-density curve (TDC). Subjects were 1005 patients (577 males and 428 females) and 98 nodules diagnosed as advanced hepatocellular carcinoma (HCC). The CT was done with Toshiba 4MHU X-vision SP, ultrasonography with Toshiba SSH-160A and automatic infusion of the contrast medium, iopamidol or iohexol, with Nemotokyorindo Autoenhance A-50. ATCM was found correlated with pulse rate and with arterial diameter, and significantly different between the sex. Elevation slope of TDC was suggested to be made constant by a defined infusion time of the dose corrected by body weight. Fluctuation of TDC among patients , when normalized by ATCM, was found smaller and the TDC was suggested to be useful for better imaging of HCC of less than 10 mm diameter. (K.H.)

  19. 同种原位肝移植肝动脉重建技巧%Reconstruction of Hepatic Artery in Orthotopic Liver Transplantation

    Institute of Scientific and Technical Information of China (English)

    赵纪春; 卢实春; 黄富国; 严律南; 李波; 金立人; 文天夫; 汪静; 罗燕; 彭玉兰; 袁朝新

    2001-01-01

    目的 探讨和总结同种原位肝移植术中肝动脉重建技术。 方法 回顾性分析我院近一年来所施行18例原位肝移植术中肝动脉重建方式和技巧。 结果 15例行供受体肝固有动脉端端吻合,2例供体肝总动脉与受体肝固有动脉吻合,1例供体肝总动脉与受体脾动脉吻合。术后彩色多普勒超声监测显示肝动脉血流通畅,均未发现有血栓形成或肝动脉狭窄,全部病例未发生胆道并发症。 结论 成功的肝动脉重建技术是防止肝移植术后肝动脉血栓形成或肝动脉狭窄的关键。%Objective To investigate the means of reconstruction of hepaticartery in orthotopic liver transplantation (OLT). Methods Eighteen patients who underwent the reconstruction of hepatic artery in OLT during more than one year recently were collected and analyzed retrospectively. Results The donor and recipient proper hepatic arteries were reconstructed by end to end anastomcosis in 15 of 18 cases, the donor common hepatic arteries and the recipient proper hepatic arteries were reconstructed in 2 of 18 cases, the donor common hepatic artery was anastomosed to the recipient splenic artery in one case. All of the anastomosed sites were assessed by Doppler ultrasonography postoperatively, and hepatic arterial thrombosis or stenosis had not been found at follow-up period. Conclusion Successful surgical technique for reconstruction of the hepatic artery in OLT plays an important role in preventing hepatic arterial thrombosis and stenosis.

  20. Meta analysis of transcatheter arterial chemoembolization before hepatectomy for primary hepatocellular carcinoma%原发性肝癌肝切除术前经肝动脉化疗栓塞的META分析

    Institute of Scientific and Technical Information of China (English)

    尹磊; 潘泽亚; 吴伯文; 刘辉; 章琏; 周伟平

    2008-01-01

    目的 可切除原发性肝癌术前TACE对术后生存率影响的系统评价.方法 通过计算机和手工检索,获得1980年1月1日~2008年1月1日发表的可切除原发性肝癌行术前TACE的相关文献.按照人选标准选取合适的临床对照研究进行meta分析.提取纳入文献的相关资料整理后根据meta分析的统计学方法进行合并分析.分别计算术前TACE组(TACE+手术)与对照组(手术)术后1、3年无瘤生存率,并根据异质性分析选择固定效应模型或随机效应模型计算总的治疗效应.结果 有8篇论文的1288例原发性肝癌患者纳入meta分析.1、3年无瘤生存率两组无明显统计学差异.结论 可切除肝癌肝切除术前行TACE并不能改善术后生存率.%Objective This study was to systemically evaluate the efficacy of TACE before hepatectomy on resectable primary HCC.Methods The articles focused on preoperative TACE for resectable primary HCC,published from Jan.1,1980 to Jan.1,2008,were selected by computerized search of literatures and manual search of bibliographies.The clinical controlled trials meeting inclusion criteria were reviewed systematically by meta-analysis.The reported data were processed with the statistical techniques of meta analysis.The combinability of the studies was assessed in terms of clinical and statistical criteria.Tumor-free survival rate was calculated.And pooled estimates were computed according to a fixed or random effect model by heterogeneity.Results A total of 1288 patients were included in 8 trials.There was no difference between the two groups in the 1,3-year tumor-free survival rate.Conclusion Preoperative TACE for resectable primary hepatic carcinoma can't improve survival rate.

  1. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930140 Hepatocyte stimulator peptide and itsclinical significance in viral hepatitis.ZHOUWeiping(周卫平),et al.Instit Viral Hepatitis,Chongqing Med Univ,630010.Chin J InternMed 1992;31(10):626-628.Hepatocyte stimulator peptide(HSP)is anewly developed hepatic stimulator substance.Its monoclonal antibodies have been obtained inour laboratory.In this study,HSP was deter-mined in the sera of 315 subjects including pa-

  2. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010349 Relationships between serum hepatitis B virus load in mothers,free maternal DNA in peripheral blood of newborns and hepatitis B virus infection of newborns. WEI Junni(魏俊妮),et al. Dept Epidemiol,Shanxi Med Univ,Taiyuan 030001. Chin J Infect Dis 2010;28(5):297-300. Objective To study the relationships between serum hepatitis B virus (HBV) DNA level

  3. 肝动脉化疗栓塞联合索拉非尼治疗中晚期肝细胞癌的临床分析%Clinical analysis of the treatment:transcatheter arterial chemoembolization combined with sorafenib in advanced hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    李勇; 黄建文; 陆骊工; 邵培坚; 胡宝山; 黄国敏; 魏照光; 张磊

    2010-01-01

    Objective To provide more evidence sources to the standard treatment for patients with advanced hepatocellular carcinoma,the writer analyze patients' time to progression (TTP) and overall survival (OS) after patients receiving transcatheter arterial chemoembolization (TACE) combined with sorafenib as a treatment of advanced hepatocellular carcinoma (HCC);observe the healing effect embolization combined with anti-angiogenic treatment for advanced hepatocellular carcinoma;and also analyze treatment of security.MethodsThere are 36 patients,33 male and 3 female had been Pathologically or clinical diagnosis.After receiving Transcatheter Arterial Chemoembolization (TACE)therapy,in the following 3 to 7 days,this group of patients continuously take sorafenib ( brand name:Nexavar) ( per tablet 200 mg),2 tablets each time,2 times a day.Every 4 to 8 weeks is called as one period of treatment.Referring to RECIST Evaluation,the writers mainly observe patients' tumor progression (TTP) and overall survival (OS),record adverse events.Using life table method to analyze survival rate,using Kaplan-Meier method to analyze all the survival curves.Results Till March,2010,14 of 36evaluable patients died and 22 survive;the median time to tumor progression (mTTP) to 8.62 months (95%CI:6.51-10.24 months);the median survival time (mOS) of 12.41 months (95% CI:9.57-14.80months).The overall survival rate to observation period is 61.1%;36 patients had been studied,22survive.Among the survivals,there is no CR cases,and 1 case PR,15 patients SD,6 patients PD;disease control rate (DCR) (CR + PR + SD) is 44.4%.The side effects of taking Sorafenib mainly are hand-foot skin reaction,diarrhea,fatigue and loss of appetite.These side effects can be markedly eased after symptomatic treatment.Conclusion Combined with sorafenib treatment may give patients with advanced hepatocellular carcinoma a longer longevity and keep the disease in a steady state.This therapy can be added into the treatments to

  4. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients

    Energy Technology Data Exchange (ETDEWEB)

    Ippolito, Davide, E-mail: davide.atena@tiscalinet.it [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB (Italy); Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB (Italy); Fior, Davide; Bonaffini, Pietro Andrea; Capraro, Cristina [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB (Italy); Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB (Italy); Leni, Davide; Corso, Rocco [Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB (Italy); Sironi, Sandro [School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB (Italy); Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB (Italy)

    2014-09-15

    Highlights: • We examine perfusion values in two different categories of treated HCC patients. • Perfusion parameters are not influenced by TACE or RFA treatments. • CT-p represents a non-invasive diagnostic technique able to assess treatment response. - Abstract: Purpose: To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. Materials and methods: Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50 mL of non ionic contrast agent (350 mg I/mL) at a flow rate of 6 mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). Results: A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2 ± 6.3; AP 10.4 ± 7; BV 4.05 ± 4.8; TTP 38.9 ± 4.2; HPI 9.9 ± 9.2, whereas in partially treated lesions were: HP 43.2 ± 15.1 mL/s/100 g; AP 38.7 ± 8.8 mL/min; BV 20.7 ± 9.5 mL/100 mg; TTP 24 ± 3.7 s; HPI 61.7 ± 7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2 ± 4; AP 12.3 ± 3.4; BV 11.8 ± 2.8; TTP 43.9 ± 2.9; and HPI 17.1 ± 9.8. A significant difference (P < 0.001) was found for all parameters between residual viable tumor tissue (P < 0.001) compared to successfully treated lesion due to the presence of residual arterial vascular

  5. The occurrence of a pseudoaneurysm of the hepatic artery within the thrombosed portal vein of a patient with chronic pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Soo; Jang, Kyung Mi; Kim, Min Jeong; Yoon, Hoi Soo; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [College of Medicine, Hallym University, Anyang (Korea, Republic of)

    2008-04-15

    A pseudoaneurysm is an uncommon but important life threatening complication of chronic pancreatitis. The arteries most commonly affected by a pseudoaneurysm are (in decreasing percent occurrence), the splenic (40%), gastroduodenal (30%), pancreaticoduodenal (20%), gastric (5%), hepatic (2%), and others (superior mesenteric, jejunal, ileocecal, and aorta) (1-3%). Thrombosis of the splenic or portal vein is another important complication of chronic pancreatitis. In this case report, we present a rare complication in the form of a right hepatic artery pseudoaneurysm which developed within the thrombosed right portal vein of a 35-year-old woman afflicted with chronic pancreatitis.

  6. Hepatitis

    Science.gov (United States)

    ... inflammation of the liver.” This inflammation can be caused by a wide variety of toxins, drugs, and metabolic diseases, as well as infection. There are at least 5 hepatitis viruses. Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has ...

  7. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970349 Primary structure and variability of partialsequences in nonstructural gene 5 region of hepatitis Gvirus, CHANG Jinhong(常锦红), et al. Hepatol Instis,People’s Hosp, Beijing Med Univ, Beijing, 100044. NatlMed J China 1997; 77(3): 178-182. Objective: To sequence partial genome of hepatitis G

  8. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009209 Effects of chronic hepatitis B virus infection on human hepatic cytochrome P450 2C9.ZHO Fuping(周福平),et al.Dept Infect Dis,Shanghai Changzheng Hosp,Shanghai 200003.Chin J Infect Dis,2009;27(2):94-98.

  9. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920691 The determination of serum hepa-titis B virus DNA by polymerase chain rea-ction in hepatitis B patients treated withalpha-interferon. XU. Jianye(徐建业), et al.Centr Lab, Chongqing Cancer Instit, 630030.Chin J Intern Med, 1992; 31(5): 278-280. To clarify the status of HBV in serum of

  10. Imatinib mesylate induces responses in patients with liver metastases from gastrointestinal stromal tumor failing intra-arterial hepatic chemotherapy

    Directory of Open Access Journals (Sweden)

    Fiorentini Giammaria

    2006-01-01

    Full Text Available Background: Imatinib mesylate represents a real major paradigm shift in cancer therapy, targeting the specific molecular abnormalities, crucial in the etiology of tumor. Intra-arterial hepatic chemotherapy (IAHC followed by embolization, has been considered an interesting palliative option for patients with liver metastases from gastrointestinal stromal tumor (GIST, due to the typically hypervascular pattern of the tumor. Aims: We report our experience with IAHC followed by Imatinib mesylate, in order to show the superiority of the specific molecular approach in liver metastases from GIST. Materials and Methods: Three patients (pts with pretreated massive liver metastases from GIST, received IAHC with Epirubicin 50 mg/mq, every 3 weeks for 6 cycles. At the evidence of progression, they received Imatinib mesylate. Results: We observed progressive diseases in all cases. In 1998, one patient underwent Thalidomide at 150 mg orally, every day for 4 months, with evidence of stable disease and clinical improvement. In 2001, two patients received Imatinib mesylate at 400 mg orally, every day, with evidence of partial response lasting 18+ months and 16 months. One of them had grade 3 neutropenia, with suspension of therapy for 3 weeks. Conclusion: No patient treated with IAHC, reported objective responses, but two of them obtained partial response after the assumption of Imatinib mesylate and one showed temporary stabilization with thalidomide. Imatinib mesylate represents a new opportunity in GIST therapy, targeting the specific molecular alteration. It seems to be superior to conventional intra arterial hepatic chemotherapy.

  11. Physiological outflow boundary conditions methodology for small arteries with multiple outlets: a patient-specific hepatic artery haemodynamics case study.

    Science.gov (United States)

    Aramburu, Jorge; Antón, Raúl; Bernal, Nebai; Rivas, Alejandro; Ramos, Juan Carlos; Sangro, Bruno; Bilbao, José Ignacio

    2015-04-01

    Physiological outflow boundary conditions are necessary to carry out computational fluid dynamics simulations that reliably represent the blood flow through arteries. When dealing with complex three-dimensional trees of small arteries, and therefore with multiple outlets, the robustness and speed of convergence are also important. This study derives physiological outflow boundary conditions for cases in which the physiological values at those outlets are not known (neither in vivo measurements nor literature-based values are available) and in which the tree exhibits symmetry to some extent. The inputs of the methodology are the three-dimensional domain and the flow rate waveform and the systolic and diastolic pressures at the inlet. The derived physiological outflow boundary conditions, which are a physiological pressure waveform for each outlet, are based on the results of a zero-dimensional model simulation. The methodology assumes symmetrical branching and is able to tackle the flow distribution problem when the domain outlets are at branches with a different number of upstream bifurcations. The methodology is applied to a group of patient-specific arteries in the liver. The methodology is considered to be valid because the pulsatile computational fluid dynamics simulation with the inflow flow rate waveform (input of the methodology) and the derived outflow boundary conditions lead to physiological results, that is, the resulting systolic and diastolic pressures at the inlet match the inputs of the methodology, and the flow split is also physiological.

  12. Interrelationship of oxygen supply by hepatic artery and portal vein: rapid analysis of ischemia-reflow-induced changes in hepatic oxygenation in experimental and clinical subjects by tissue near-infrared spectroscopy.

    Science.gov (United States)

    Tokuka, A; Tanaka, A; Kitai, T; Yanabu, N; Mori, S; Sato, B; Tanaka, K; Yamaoka, Y; Hirao, K

    1994-01-01

    The rapid changes in extracellular oxygenation and intracellular oxidation during ischemia and reflow were measured in deep liver tissue by a novel method combining tissue near-infrared spectroscopy with multicomponent curve-fitting analysis. This method enabled us to make real-time measurements of oxygen saturation (SO2) and amount (THB) of hemoglobin in the liver sinusoid as parameters of extracellular oxygenation state and of redox transition of cytochrome aa3 as intracellular oxidation state. Clamping of the hepatic artery in rabbit decreased the THB with a transient fall of SO2. Clamping of the portal vein decreased both SO2 and THB. The decreases of SO2 and THB caused by Pringle's maneuver were larger than the sum of decreases by hepatic artery and portal vein. These changes in SO2 were correlated with intramitochondrial oxidation state as measured by cytochrome aa3. These results indicate the presence of an interrelationship of oxygen supply by hepatic artery and portal vein. This method was clinically applied during and after clamping of hepatic artery and portal vein in 19 cases of hepatic resection with or without chronic hepatic diseases. The decrease in SO2 values before and after clamping (SO2D) and the slope of SO2 recovery (SO2R) after release were calculated. SO2D and SO2R values of the portal vein in cirrhotics were significantly higher and lower, respectively, than those in the normal liver. These data indicate that the present method provides a rapid and reliable method of quantifying hepatic oxygenation during liver surgery and its perioperative management.

  13. Factors Predicting Survival after Transarterial Chemoembolization of Unresectable Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Farina M. Hanif

    2014-10-01

    Full Text Available Background: Transarterial chemoembolization is the preferred treatment for unresectable, intermediate-stage hepatocellular carcinoma. Survival after transarterial chemoembolization can be highly variable. The purpose of this study is to identify the factors that predict overall survival of patients with unresectable hepatocellular carcinoma who undergo transarterial chemoembolization as the initial therapy. Methods:We included patients who underwent transarterial chemoembolization from 2007 to 2012 in this study. Patient’s age, gender, cause of cirrhosis, Child-Turcotte-Pugh score, model of end-stage liver disease score, Cancer of the Liver Italian Program score, Okuda stage, alpha- fetoprotein level, site, size and number of tumors were recorded. Radiological response to transarterial chemoembolization was assessed by computerized tomography scan at 1 and 3 months after the procedure. Repeat sessions of transarterial chemoembolization were performed according to the response. We performed survival assessment and all patients were assessed for survival at the last follow-up. Results: Included in this study were 71 patients of whom there were 57 (80.3 % males, with a mean age of 51.9±12.1 years (range: 18-76 years. The mean follow-up period was 12.5±10.7 months. A total of 31 (43.7% patients had only one session of transarterial chemoembolization, 17 (23.9% underwent 2 and 11 (15.5% had 3 or more sessions. On univariate analysis, significant factors that predicted survival included serum bilirubin (P=0.02, esophageal varices (P=0.002, Cancer of the Liver Italian Program score (P=0.003, tumor size (P=0.005, >3 sessions of transarterial chemoembolization (P=0.006 and patient's age (P=0.001. Cox regression analysis showed that tumor size of 1 transarterial chemoembolization session (P=0.004 were associated with better survival. Conclusion: Our study demonstrates that survival after transarterial chemoem- bolization is predicted by tumor size

  14. INFLUENCE OF PERI-ARTERIAL HEPATIC DENERVATION ON THE GLYCEMIC RESPONSE TO EXERCISE IN RATS

    NARCIS (Netherlands)

    LINDFELDT, J; BALKAN, B; VANDIJK, G; SCHEURINK, A; AHREN, B; STEFFENS, AB

    1993-01-01

    Exercise is known to increase hepatic glucose production. Previous studies have suggested that the sympathetic nerves only marginally contribute to this process. This study examined whether increased catecholamine response or increased adrenoceptor sensitivity might have affected previous results sh

  15. Transarterial RAdioembolization versus ChemoEmbolization for the treatment of hepatocellular carcinoma (TRACE: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Seinstra Beatrijs A

    2012-08-01

    Full Text Available Abstract Background Hepatocellular carcinoma is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10 to 15% of hepatocellular carcinoma patients are suitable candidates for treatment with curative intent, such as hepatic resection and liver transplantation. A majority of patients have locally advanced, liver restricted disease (Barcelona Clinic Liver Cancer (BCLC staging system intermediate stage. Transarterial loco regional treatment modalities offer palliative treatment options for these patients; transarterial chemoembolization (TACE is the current standard treatment. During TACE, a catheter is advanced into the branches of the hepatic artery supplying the tumor, and a combination of embolic material and chemotherapeutics is delivered through the catheter directly into the tumor. Yttrium-90 radioembolization (90Y-RE involves the transarterial administration of minimally embolic microspheres loaded with Yttrium-90, a β-emitting isotope, delivering selective internal radiation to the tumor. 90Y-RE is increasingly used in clinical practice for treatment of intermediate stage hepatocellular carcinoma, but its efficacy has never been prospectively compared to that of the standard treatment (TACE. In this study, we describe the protocol of a multicenter randomized controlled trial aimed at comparing the effectiveness of TACE and 90Y-RE for treatment of patients with unresectable (BCLC intermediate stage hepatocellular carcinoma. Methods/design In this pragmatic randomized controlled trial, 140 patients with unresectable (BCLC intermediate stage hepatocellular carcinoma, with Eastern Cooperative Oncology Group performance status 0 to 1 and Child-Pugh A to B will be randomly assigned to either 90Y-RE or TACE with drug eluting beads. Patients assigned to 90Y-RE will first receive a diagnostic angiography, followed by the actual transarterial treatment, which can be divided into two sessions in case

  16. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005226 Characteristics of peripheral blood T lymphocyte subsets in hepatitis B patients. FAN Zhen-ping(范振平),et al. Center Bio Ther, Instit Infect Dis, 302 Hosp Chin PLA, Beijing 100039. World Chin J Digestol, 2005;13(2): 194-197. Objective: To characterize the T-lymphocyte subsets in peripheral blood of patients with acute and chronic hepatitis B, and to explore their relations with the disease state. Methods: Peripheral blood

  17. Microscope-assisted hepatic artery reconstruction in adult living donor liver transplantation-A review of 325 consecutive cases in a single center.

    Science.gov (United States)

    Lee, Chen-Fang; Lu, Johnny Chuieng-Yi; Zidan, Ahmed; Lee, Ching-Song; Wu, Tsung-Han; Chan, Kun-Ming; Lee, Wei-Chen

    2017-02-01

    Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature. Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed. Under microscope assistance, all hepatic artery anastomosis were performed in a risk-free and back-wall first manner. We collected donors' and recipients' demographics, operative procedures, and outcome. A total of 325 adult LDLTs were enrolled in the study. Of these, 297(91.4%) were right liver graft. The mean diameter of the hepatic arteries of the graft was 1.9 ± 0.3 mm. A single HA anastomosis was performed in 310 patients (95.4%). The 1-, 3-, and 5-year overall patient survival rates were 84.8%, 76.8%, and 75.2%, respectively. Only one (0.3%) episode of HAT was encountered in our series. The patient was treated successfully with nonsurgical management. Our study showed that the occurrence of HAT is avoidable. Identifying risk factors associated with HAT, meticulous surgical techniques, and careful routine flow monitoring are mandatory to avoid disastrous complications. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Transcatheter arterial chemoembolization combined with radiofrequency ablation for the treatment of hepatocellular carcinoma: a meta- analysis of long- term efficacy%经肝动脉化疗栓塞联合射频消融治疗原发性肝癌远期疗效的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    含笑; 吕维富

    2013-01-01

    Objective To compare the therapeutic effect of transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with that of simple TACE for hepatocellular carcinoma (HCC). Methods The data bases, including CBM, CNKI, PubMed, EMBASE, Elsevier Sciencedirect, Williams & Wilkins, Lippincott and Springer, were searched. All data related to patients with HCC receiving TACE + RFA or simple TACE in randomized-controlled clinical trials (RCT) were collected. Articles that met the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis. Results A total of 8 articles were enrolled in this study. The subgroup analysis showed that the 1 -year, 2-year and 3-year survival rates in TACE+RFA group were statistically higher than those in simple TACE group [1-year survival rate: OR = 0.49, 95% CI (0.33,0.75), P = 0.001; 2-year survival rate: OR = 0.40, 95% CI (0.23,0.70), P = 0.001; 3 - year survival rate: OR = 0.50, 95% CI (0.36,0.69), P = 0.000]. Conclusion Compared with simple TACE, TACE plus RFA can significantly improve the long-term survival rate in patients with HCC.%目的 探讨经肝动脉化疗栓塞(TACE)联合射频消融(RFA)与单独行TACE治疗原发性肝癌的远期疗效的区别.方法 检索CBM、CNKI、PubMed、EMBASE、ElsevierSciencedirect、Lippincott,Williams & Wilkins、Springer数据库,收集所有TACE联合RFA治疗原发性肝癌与单独性TACE治疗的临床随机对照试验(RCT)文献.按照纳入标准选择文献,提取相关数据,应用STATA11.0软件进行统计学处理.结果 共纳入中外文献8篇,分别行亚组分析显示,TACE联合RFA治疗组的1、2、3年生存率均明显优于TACE单独治疗组[1年生存率:OR = 0.49,95%CI(0.33,0.75),P = 0.001;2年生存率:OR = 0.40,95%CI(0.23,0.70),P = 0.001;3年生存率:OR = 0.50,95%CI(0.36,0.69),P = 0.000].结论 与单独行TACE治疗相比,TACE联合RFA治疗方案能明显提高原发

  19. Use of Caval Subtraction 2D Phase-Contrast MR Imaging to Measure Total Liver and Hepatic Arterial Blood Flow: Preclinical Validation and Initial Clinical Translation.

    Science.gov (United States)

    Chouhan, Manil D; Mookerjee, Rajeshwar P; Bainbridge, Alan; Walker-Samuel, Simon; Davies, Nathan; Halligan, Steve; Lythgoe, Mark F; Taylor, Stuart A

    2016-09-01

    Purpose To validate caval subtraction two-dimensional (2D) phase-contrast magnetic resonance (MR) imaging measurements of total liver blood flow (TLBF) and hepatic arterial fraction in an animal model and evaluate consistency and reproducibility in humans. Materials and Methods Approval from the institutional ethical committee for animal care and research ethics was obtained. Fifteen Sprague-Dawley rats underwent 2D phase-contrast MR imaging of the portal vein (PV) and infrahepatic and suprahepatic inferior vena cava (IVC). TLBF and hepatic arterial flow were estimated by subtracting infrahepatic from suprahepatic IVC flow and PV flow from estimated TLBF, respectively. Direct PV transit-time ultrasonography (US) and fluorescent microsphere measurements of hepatic arterial fraction were the standards of reference. Thereafter, consistency of caval subtraction phase-contrast MR imaging-derived TLBF and hepatic arterial flow was assessed in 13 volunteers (mean age, 28.3 years ± 1.4) against directly measured phase-contrast MR imaging PV and proper hepatic arterial inflow; reproducibility was measured after 7 days. Bland-Altman analysis of agreement and coefficient of variation comparisons were undertaken. Results There was good agreement between PV flow measured with phase-contrast MR imaging and that measured with transit-time US (mean difference, -3.5 mL/min/100 g; 95% limits of agreement [LOA], ±61.3 mL/min/100 g). Hepatic arterial fraction obtained with caval subtraction agreed well with those with fluorescent microspheres (mean difference, 4.2%; 95% LOA, ±20.5%). Good consistency was demonstrated between TLBF in humans measured with caval subtraction and direct inflow phase-contrast MR imaging (mean difference, -1.3 mL/min/100 g; 95% LOA, ±23.1 mL/min/100 g). TLBF reproducibility at 7 days was similar between the two methods (95% LOA, ±31.6 mL/min/100 g vs ±29.6 mL/min/100 g). Conclusion Caval subtraction phase-contrast MR imaging is a simple and clinically

  20. Transpulmonary chemoembolization (TPCE) as a treatment for unresectable lung metastases

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J.; Lehnert, Thomas; Zangos, Stephan; Eichler, Katrin; Hammerstingl, Renate; Korkusuz, Huedayi; Lindemayr, Sebastian [Johann Wolfgang Goethe-University Clinic, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany)

    2008-11-15

    To evaluate tumor response after treating unresectable lung metastases with transpulmonary chemoembolization (TPCE) in palliative intention. From 2001 to 2005, 52 patients (mean: 59.8 years; 32 males/20 females) suffering from 106 unresectable lung metastases (mean:6 metastases/patient; range,1-21) were treated with 2-10 TPCE-sessions (mean: 3.3 sessions/patient). Metastases originated from primaries, including colorectal carcinoma (n = 20), breast cancer (n = 6), renal cellular carcinoma (n = 5), thyroid cancer (n = 4), cholangiocellular carcinoma (n = 2), leiomyosarcoma (n = 2), and others (n = 13). Tumor-feeding pulmonary arteries were selectively probed after puncturing the femoral vein, and administering 10 ml lipiodol, mitomycin C, and microspheres (Spherex) each via balloon catheter over pulmonary approach. During therapy, follow-up was accomplished at 4-week intervals using unenhanced and contrast-enhanced CT. After sequential therapy, follow-up was performed every 3 months for a period of 6 months up to 2.25 years. All patients tolerated the treatments well without major side effects or complications. In 24% (n = 13) moderate to high lipiodol uptake was found, while 75% (n = 39) of the tumors showed a low uptake. According to the RECIST criteria, ''partial response'' was achieved in 16 cases, ''stable disease'' in 11 cases, and ''progressive disease'' in 25 cases [mean survival: 17 months/median: 21.1 months (Kaplan-Meyer)]. According to these findings, TPCE is a well-tolerated procedure for palliative treatment of unresectable lung metastases. (orig.)

  1. Intra-Arterial Treatment of Primary and Metastatic Liver Tumors

    NARCIS (Netherlands)

    Buijs, M.A.M.; Vossen, J.A.

    2009-01-01

    The aims of this thesis were, first, to investigate the toxicities associated with trans-arterial chemoembolization (TACE) of liver tumors and to evaluate the use of MR imaging in characterizing tumor response after this locoregional therapy, second, to further develop intra-arterial therapy of live

  2. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  3. Assessment of liver circulation by quantitative scintiangiography: Evaluation of the relative contribution of the hepatic arterial and portal venous blood flows to liver perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Molino, G.; Squadrone, E.; Baccegal, M.; Magnani, C.

    1989-04-01

    Quantitative hepatic scintiangiography was previously used for evaluating the relative contribution of hepatic arterial and portal venous blood flows to the hepatic circulation. The present study compares 3 different procedures (automatic and manual integration, and slope fitting methods) for analyzing the hepatic time activity curves obtained after bolus i.v. injection of 370 MBq /sup 99m/Tc-diethylentriaminopentacetic acid. Twenty five subjects were studied: Five controls, ten cirrhotics, and ten portal hypertensive patients previously submitted to side to side portacaval anastomosis. The correspondence between results given by the different methods was satisfactory only in shunted patients, and the reproducibility of computed parameters was quite poor for all procedures. Accordingly, none of the methods can be considered as supporting reliable quantitative pathophysiological evaluations. However, the hepatic arterial/portal venous flow ratio was found to be increased in liver cirrhosis and in shunted patients and therefore, in spite of the limitations underlined before and of the absence of data on the reproducibility of consecutive injections, hepatic scintiangiography may be of some clinical utility.

  4. 肝移植术中采用受者脾动脉重建肝动脉的临床效果%Clinical effects of using the receptor splenic artery to reconstruct hepatic artery in liver transplantation

    Institute of Scientific and Technical Information of China (English)

    田庆; 张建军; 邓永林; 郑虹; 潘澄; 蒋文涛; 张雅敏; 高伟; 杨涛

    2013-01-01

    目的 探讨肝移植术中采用受者脾动脉重建供肝动脉的临床效果.方法 回顾性分析1998年1月至2012年12月间3912例次肝移植的临床资料.因受者肝动脉不适宜吻合,有68例采用受者脾动脉重建移植肝动脉.结果 68例受者肝移植术中利用脾动脉重建肝动脉的耗时为50~100 min.68例受者中,术后早期(1个月内)发生动脉并发症4例,发生率为5.8%,其中肝动脉血栓1例,肝动脉狭窄3例,其余受者肝动脉血液供应良好,未发生动脉狭窄、闭塞,亦未发生脾梗死.术后院外随访2~60个月,随访期间未发生肝动脉相关并发症,9例受者死于肿瘤复发,4例死于消化道出血,5例死于多器官功能衰竭,5例死于心血管并发症;术后1、3、5年存活率分别为88.2%、72.0)%和63.2%.结论 当肝移植术中受者肝总动脉不可用时,采用受者脾动脉重建移植肝动脉的方法安全、简单、有效,并不增加术后动脉并发症的发生率.%Objective To study the clinical effect of using the receptor splenic artery to reconstruct the hepatic artery in liver transplantation.Method The clinical data of 3912 cases subject to liver transplantation between January 1998 and December 2012 were retrospectively analyzed.When the recipient's hepatic artery is not suitable to reconstruct hepatic artery,the recipient's splenic artery was used to reconstruct the hepatic artery in 68 cases subject to liver transplantation.Results The reconstruction of the hepatic artery by utilizing recipient's splenic artery took 50~ 100 min in 68 cases subject to liver transplantation.In these patients,arterial complications occurred in 4 cases (5.8%) in the early postoperative period (within 1 month),including 1 case of the hepatic arterial thrombosis (HAT) and 3 cases of hepatic arterial stenosis (HAS).The remaining recipients had good blood supply in hepatic artery,and no artery complications and the splenic infarction occurred.During a

  5. MicroRNA Expression in a Readily Accessible Common Hepatic Artery Lymph Node Predicts Time to Pancreatic Cancer Recurrence Postresection.

    Science.gov (United States)

    Nguyen, Hai V; Gore, Jesse; Zhong, Xin; Savant, Sudha S; Deitz-McElyea, Samantha; Schmidt, C Max; House, Michael G; Korc, Murray

    2016-10-01

    Lymph node involvement in pancreatic adenocarcinoma (PAC) predicts postresection survival, but early lymph node metastasis detection is not easily accomplished. We assessed a panel of microRNAs (miRNAs) in a common hepatic artery lymph node (station 8) that is readily accessible during pancreatoduodenectomy (PD) to determine if increased miRNA levels correlate with postresection recurrence. Station 8 lymph nodes overlying the common hepatic artery collected during PD were assayed for miRNA-10b, miRNA-30c, miRNA-21, and miRNA-155 and cytokeratin-19 (CK19), an epithelial cell marker, using quantitative PCR. Expression was correlated with disease recurrence, recurrence-free survival (RFS), and overall survival (OS). Station 8 lymph nodes from 37 patients (30 periampullary carcinomas (PCs), 2 chronic pancreatitis, 5 other cancers) exhibited increased miRNA-10b levels in 14/30 PCs, and in 10 of these 14 patients, cancer recurred during the study period (2012-2015). High miRNA-10b was also associated with shorter RFS (42.5 vs. 92.4 weeks, p < 0.05) but not OS, whereas miRNA-30c, miRNA-21, and miRNA-155 levels and CK19 mRNA levels in station 8 nodes were variable and did not correlate with RFS or OS. We conclude that elevated miRNA-10b levels in station 8 lymph nodes could be utilized to assess risk for early disease progression in patients with periampullary tumors.

  6. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008312 Impact of hepatitis B virus infection on the activity of hematopoietic stem cell.SHI Yanmei(石雁梅),et al.Dept Infect Dis,1st Clin Coll,Harbin Med Univ,Harbin 150001.Chin J Infect Dis 2008;26(4):197-201.Objective To study the impact of hepatitis B virus (HBV)infection on the activity of cord hematopoieticstem cells.Methods CD34+cells were isolated from healthy human cord blood by mini MACS.Cells were

  7. Mass-forming intrahepatic cholangiocarcinoma: Enhancement patterns in the arterial phase of dynamic hepatic CT - Correlation with clinicopathological findings

    Energy Technology Data Exchange (ETDEWEB)

    Fujita, Nobuhiro; Asayama, Yoshiki; Nishie, Akihiro; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Moirta, Koichiro; Honda, Hiroshi [Kyushu University, Department of Clinical Radiology, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Takayama, Yukihisa [Kyushu University, Department of Radiology Informatics and Network, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Shirabe, Ken [Kyushu University, Department of Surgery and Science, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan); Aishima, Shinichi [Saga University Hospital, Department of Pathology and Microbiology, Faculty of Medicine, Saga City, Saga (Japan); Wang, Huanlin; Oda, Yoshinao [Kyushu University, Department of Anatomic Pathology, Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2017-02-15

    To evaluate the relationship between the enhancement pattern of intrahepatic cholangiocarcinomas (ICCs) in the hepatic arterial phase (HAP) of dynamic hepatic CT and the clinicopathological findings with special reference to the perihilar type and the peripheral type. Forty-seven patients with pathologically proven ICCs were enrolled. Based on the enhancement pattern in the HAP, the lesions were classified into three groups: a hypovascular group (n=13), rim-enhancement group (n=18), and hypervascular group (n=16). The clinicopathological findings were compared among the three groups. Perihilar-type ICCs were significantly more frequently observed in the hypovascular group than in the rim-enhancement and hypervascular groups (p=0.006 and p <0.001, respectively). Lymphatic invasion, perineural invasion, and biliary invasion were significantly more frequent in the hypovascular group than the rim- enhancement group (p=0.001, p=0.025 and p=0.029, respectively) or hypervascular group (p <0.001, p <0.001 and p=0.025, respectively). Patients with hypovascular lesions showed significantly poorer disease-free survival than patients with rim-enhancing or hypervascular lesions (p=0.001 and p=0.001, respectively). Hypovascularity was an independent preoperative prognostic factor for disease-free survival (p<0.001). Hypovascular ICCs in the HAP tend to be of perihilar type and to have more malignant potential than other ICCs. (orig.)

  8. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008449 A cross-sectional survey of occult hepatitis B virus infection in HIV-infected patients. MA Jianxin(马建新), et al.Dept Infect Dis, Shanghai Public Health Clin Center, Shanghai 201508. Chin J Intern Med 2008;47(7):574-577. Objective To assess the prevalence of occult HBV infection in HIV-infected patients.

  9. Clinical Outcome of Autologous Hematopoietic Stem Cell Infusion via Hepatic Artery or Portal Vein in Patients with End-stage Liver Diseases

    Institute of Scientific and Technical Information of China (English)

    Xiao-lun Huang; Tian Zhang; Ping Xie; Mao-zhu Yang; Shao-ping Deng; Le Luo; Lan-yun Luo; Hua Xue; Ling-ling Wei; Yu-tong Yao; Hai-bo Zou; Xiao-bing Huang; Yi-fan Zhu

    2014-01-01

    Objective To investigate the efficacy of hematopoietic stem cell (HSC) transplantation via the hepatic artery vs. the portal vein for end-stage liver disease (ESLD). Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy results were analyzed using the Knodell score. Results Eighty patients (58 males and 22 females) were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation (P Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients. The administration route of HSC has no significant impact on the efficacy of transplantation.

  10. 微波消融术联合肝动脉介入栓塞术治疗肝细胞癌的临床研究%Clinical research of microwave ablation plus transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    马玫丽; 盛立军; 任国华; 宋鹏远

    2014-01-01

    目的:比较微波消融术( microwave ablation,MWA)联合或者不联合经肝动脉化疗栓塞术( transcathe-ter arterial chemoembolization,TACE)治疗肝细胞癌( HCC)的临床疗效以及不良反应。方法:选择89例2006年10月至2009年7月入我院治疗的肿瘤直径≤5cm的原发性肝细胞癌患者,采用随机数字法分为MWA联合TACE组(n=44)或者单独MWA组(n=45)进行随机对照研究,观察两组患者的总生存率(OS)、无复发生存率( RFS)以及不良反应。结果:所有患者均治疗成功,随访时间为7-62个月,随访结束时联合组患者死亡15人,微波组死亡23人。联合组、微波组分别有16人、25人出现疾病进展。1年、2年、3年OS分别为86.4%,74.4%,61.8%和77.4%,63.6%,50.0%。对应的RFS为72.4%,61.6%,45.8%和61.7%,52.2%,39.8%。联合组的OS以及RFS高于单纯微波组(风险比率HR为0.323,95%CI为0.295-0.351,P=0.002;风险比率HR为0.258,95%CI为0.230-0.286,P=0.02)。研究过程中无治疗相关性死亡。对相关因素进行Logistic回归分析,治疗分配、肿瘤大小、肿瘤数目是OS相关预后因素,治疗分配、肿瘤大小是RFS相关预后因子。结论:MWA联合TACE术治疗病灶≤5cm的HCC患者疗效优于单独的MWA治疗疗效。%Objective:To compare microwave ablation( MWA)with or without transcatheter arterial chemoemboli-zation( TACE)in the treatment of hepatocellular carcinoma( HCC). Methods:The research was conducted on 89 pa-tients with HCC less than 5cm received treatment in our hospital between October 2006 and July 2009. They were ran-domly assigned to recesive MWA combined with TACE(n=44)or MWA alone(n=45). The end point were overall survival( OS)、recurrence-free( RFS)and adverseeffects. Results:Technical success was achieved in all patients,at a follow-up of 7 to 62 months,15 patients in the MWA-TACE group and 23 patients in the MWA group had died. 16

  11. Hepatic artery reconstruction in orthotopic liver transplantation%原位肝移植肝动脉重建临床分析

    Institute of Scientific and Technical Information of China (English)

    吴刚; 刘永锋; 刘树荣; 张佳林; 李桂臣; 陈旭春

    2008-01-01

    目的 总结分析原位肝移植肝动脉重建经验,提高肝移植疗效和受体存活率.方法 总结1995年5月至2006年12月实施的183例肝移植临床资料,常规动脉重建163例,供者腹腔动脉干Carrell's袖片或肝总动脉-脾动脉汇合部与受者肝左-右动脉汇合部吻合25例,胃十二指肠-肝固有动脉汇合部吻合134例,腹腔动脉干吻合4例.采用髂动脉.腹主动脉搭桥20例.术后根据凝血酶原时间(PT),应用普通肝素或低分子肝素抗凝.术中、术后应用多普勒超声监测肝动脉血供.结果 183例肝移植患者中有6例发生肝动脉并发症,发生率为3.28%(6/183),其中肝动脉血栓形成(hepatic artery thrombosis,HAT)5例,肝动脉狭窄(hepatic artery stenosis,HAS)1例.常规通路动脉重建组动脉并发症发生率1.84%(3/163),髂动脉-腹主动脉搭桥组为15.0%(3/20),两者比较差异有统计学意义(X2=9.73,P<0.01).6例并发症患者中有1例HAT于术后19 d死于多器官功能衰竭,另5例通过介入治疗治愈,死亡率16.7%.结论 正确地选择肝动脉重建吻合的部位和术后有效的抗凝治疗减少HAT和HAS的发生,多普勒超声的早期发现和放射介入的及时治疗可以挽救移植物,避免再移植.%Objective To summarize experience for hepatic artery reconstruction in orthotopic liver transplantation(OLT).Method A retrospective analysis was made for 183 cases of orthotopic liver transplantation performed in our institute from May 1995 to december 2006.All the arterial reconstructions were performed with 6-0 polypropylene sutures in an interrupted fashion under a 3.5 magnification surgical loupe.Donor hepatic arteries were anastomosed at the origin of the celiac artery with a Carrel's patch or at the level of splenic artery confluence.Extra-anatomic arterial reconstruction was based on recipient aorta using donor iliac artery graft.OLT with routine anatomic arterial construction served as control.Heparin or low

  12. Hepatitis

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008079 Relationship of HBV genotype and bcp and pc mutations with HBV DNA rebound after lamivudine therapy. SU Minghua(苏明华), et al. Dept Infect Dis Clin Hosp, Guangxi Med Univ, Nanning 530027. World Chin J Digestol 2007;15(33):3507-3513. Objective To investigate the relationship of HBV gene mutations with HBV DNA rebound after lamivudine therapy. Methods Twenty-seven hepatitis B patients with HBV DNA rebound after

  13. 抗癌剂复方莪术油肝动脉栓塞治疗肝癌的疗效及临床评价%Curative Effect and Clinical Evaluation of the Anticancer of Compound Ze-doary Turmeric Oil Hepatic Artery Embolism in Treatment of Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    王国庆

    2016-01-01

    目的:探讨抗癌剂复方莪术油肝动脉栓塞治疗肝癌的疗效。方法整群选取2012年3月-2013年4月间该院收治的肝癌患者120例,随机分成两组各60例,对照组给予单纯肝动脉化疗栓塞术,研究组则采取抗癌剂复方莪术油肝动脉栓塞治疗。结果研究组治疗近期有效率为91.67%,明显高于对照组66.67%的近期有效率,研究组3例出现不良反应,对照组10例出现不良反应,不良反应率显著低于对照组,对照组1、3、5年生存率分别为60%、31.67%和18.33%,研究组分别为81.67%、55%和41.67%,明显高于对照组,差异具有统计学意义,P<0.05。结论抗癌剂复方莪术油肝动脉栓塞治疗肝癌疗效显著,安全可靠。%Objective To discuss the curative effect of the anticancer of compound zedoary turmeric oil hepatic artery em-bolism in treatment of liver cancer. Methods 120 cases of patients with liver cancer treated in our hospital from March 2012 to April 2013 were selected and randomly divided into two groups with 60 cases in each, the control group were treated with the pure transcatheter arterial chemoembolization, the research group were treated with the anticancer of com-pound zedoary turmeric oil hepatic artery embolism. Results The treatment effective rate in short term in the research group was obviously higher than that in the control group (91.67%vs 66.67%), the adverse reaction rate in the research group was obviously lower than that in the control group ( 3 cases vs 10 cases), The 1-year, 3-year and 5-year survival rate in the re-search group were obviously higher than those in the control group (60%, 31.67% and 18.33% vs 81.67%,55% and 41.67%), and the differences were statistically significant P<0.05. Conclusion The anticancer of compound zedoary turmeric oil hepatic artery embolism in treatment of liver cancer has an obvious curative effect and it is safe and reliable.

  14. Transarterial administration of integrin inhibitor loaded nanoparticles combined with transarterial chemoembolization for treating hepatocellular carcinoma in a rat model

    Science.gov (United States)

    Qian, Jun; Oppermann, Elsie; Tran, Andreas; Imlau, Ulli; Qian, Kun; Vogl, Thomas Josef

    2016-01-01

    AIM: To compare the effect of transarterial chemoembolization (TACE) plus GRGDSP (Gly-Arg-Gly-Asp-Ser-Pro, integrin-inhibitor) loaded nanoparticles with TACE alone or TACE + GRGDSP in a rat model of liver tumor. METHODS: Morris hepatoma 3924A tumors were implanted in the livers of 30 ACI rats. The ACI rats were divided randomly into three groups (10 animals each). Tumor volume before treatment (V1) was examined by magnetic resonance imaging (MRI), and then, after laparotomy and placement of a PE-10 catheter into the hepatic artery, the following interventional protocols were performed: TACE (mitomycin C + lipiodol + degradable starch microspheres) + GRGDSP loaded nanoparticles for group A; TACE + GRGDSP for group B (control group 1); TACE alone for group C (control group 2). Tumor volume (V2) was assessed by MRI and the mean ratio of the post-treatment to pretreatment tumor volumes (V2/V1) was calculated. Immunohistochemical analysis was performed to assess the quantification of matrix metalloprotein 9 (MMP-9) and vascular endothelial growth factor (VEGF) positive tumor cells in each treatment group. RESULTS: The mean tumor growth ratios (V2/V1) were 1.3649 ± 0.1194 in group A, 2.0770 ± 0.1595 in group B, and 3.2148 ± 0.1075 in group C. Compared with groups B and C, group A showed a significant reduction in tumor volume. Lower expression of MMP-9 and VEGF in hepatocellular carcinoma was observed in group A than in groups B and C. The angiogenesis of tumor was evaluated using anti-VEGF antibodies, and the metastasis of tumor was assessed using anti-MMP-9 antibody. MMP-9 and VEGF were expressed in all specimens. The immunoexpression of these proteins was confirmed by the presence of red cytoplasmic staining in tumor cells. Lower expression of MMP-9 and VEGF in hepatocellular carcinoma was observed in group A than in groups B and C. CONCLUSION: Transarterial administration of integrin inhibitor loaded nanoparticles combined with TACE evidently retards tumor growth

  15. {sup 31}P MR spectroscopy to evaluate the efficacy of hepatic artery embolizatio in the treatment of neuroendocrine liver metastases

    Energy Technology Data Exchange (ETDEWEB)

    Ljungberg, Maria; Vikhoff-Baaz, Barbro; Starck, Goeran; Forssell-Aronsson, Eva [Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg (Sweden); Department of Medical Physics and Biomedical Engineering, MR Centre, Sahlgrenska University Hospital, Gothenburg (Sweden)], E-mail: Maria.Ljungberg@vgregion.se; Westberg, Gunnel; Waengberg, Bo; Ahlman, Haakan [Department of Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg (Sweden); Ekholm, Sven [Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden (Sweden)

    2012-12-15

    Background. It is common to treat patients with metastatic disease from gastrointestinal neuroendocrine (NE) tumors with surgical reduction to prolong survival. This can be combined with hepatic arterial embolization (HAE) and medical treatment to reduce hormonal symptoms. Today there are no rapid and reliable methods to evaluate the efficacy of HAE in the treatment of neuroendocrine liver metastasis. Purpose. To investigate metabolic changes in hepatic metastases of NE tumors following HAE, and to establish if there are any early spectral patterns that might indicate therapeutic efficacy based on in vivo {sup 31}P MRS data. Material and Methods. Volume selective {sup 31}P MRS was used to study 11 patients with disseminated NE tumors with regional lymph nodes and bilobar liver metastases. Measurements were performed before and 1 and 3 days after HAE. Results. Non-responders had significantly higher PME/Pi and {alpha}NTP/{Sigma}NTP ratios than the responders before HAE (P < 0.05). Three days after HAE, non-responders still had significantly higher {alpha}NTP/{Sigma}NTP than the responders did (P < 0.05). We also observed trends for increased PME ratios 3 days after HAE, decreased ATP-levels, and liberated Pi in responders. Conclusion. This {sup 31}P-MRS study showed significant differences in PME/Pi and {alpha}NTP/{Sigma}P ratios between responders and non-responders on the day before HAE, which is an interesting finding that may reflect intrinsic properties of the tumor tissue. We also observed trends for cell membrane renewal and increased energy consumption in responders after HAE. These results demonstrate potentials for {sup 31}P-MRS to predict individual responsiveness prior to HAE.

  16. An analysis of clinical factors in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization complicated with diabetes%经肝动脉化疗栓塞肝细胞癌诱发肝源性糖尿病的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    范文哲; 张应强; 王于; 姚学华; 杨建勇; 李家平

    2014-01-01

    Objective To investigate related clinical factors of hepatocellular carcinoma (HCC) patients received transcatheter arterial chemoembolization (TACE) complicated with hepatogenous diabetes (HD).Methods Forty eight cases of HCC line after TACE combined HD patients as the case group,and another forty eight cases of HCC line after TACE without HD patients as control group.A case-control study was retrospectively analyzed among two groups.A logistic regression modelwas established.Results Multivariates analysis showed that family history of diabetes (OR =3.464,95% CI 1.100-10.909,P =0.034),HBV DNA > 1 × 105 IU/ml (OR =5.420,95% CI 1.235-23.792,P =0.025),liver function Child-Pugh C (OR =7.653,95% CI 1.385-42.301,P =0.020),major larger tumors > 10 em (OR =5.347,95% CI 1.499-19.067,P =0.010),the initial embolism area > 70% (OR =9.031,95% CI 1.782-48.537,P =0.008),TACE > 3 times (OR =3.726,95% CI 1.151-12.065,P =0.028) were independent risk factors of HD in patients with HCC after TACE.Conclusion Family history of diabetes,HBV DNA > 1 × 105 IU/ml,Child-Pugh C,major tumors size > 10 cm,the initial embolism area > 70%,TACE > 3 times were independent risk factors of HD in HCC patients after TACE.As for factors to these patients,the blood glucose was monitored promptly in order to early diagnosis and treatment.%目的 探讨经肝动脉化疗栓塞(TACE)治疗肝细胞癌(HCC)诱发患者肝源性糖尿病(HD)的临床危险因素.方法 收集2005年11月至2011年12月中山大学附属第一医院48例HCC行TACE后出现HD的患者作为研究组,同期48例HCC行TACE后而无HD的患者为对照组.采用病例-对照研究的方法,对各个研究因素采用逐步引入剔除法,建立logistic回归模型进行各因素系统分析.结果 多因素logistic回归分析显示,HCC患者TACE后发生HD的独立危险因素包括糖尿病家族史(OR=3.464,95% CI1.100~110.909,P=0.034)、HBV DNA>1×105 IU/ml(OR=5.420,95% CI1.235~23

  17. Target hepatic artery regional chemotherapy and bevacizumab perfusion in liver metastatic colorectal cancer after failure of first-line or second-line systemic chemotherapy.

    Science.gov (United States)

    Chen, Hui; Zhang, Ji; Cao, Guang; Liu, Peng; Xu, Haifeng; Wang, Xiaodong; Zhu, Xu; Gao, Song; Guo, Jianhai; Zhu, Linzhong; Zhang, Pengjun

    2016-02-01

    Colorectal cancer liver metastasis (CRLM) is a refractory disease after failure of first-line or second-line chemotherapy. Bevacizumab is recommended as first-line therapy for advanced colorectal cancer, but is unproven in CRLM through the hepatic artery. We report favorable outcomes with targeted vessel regional chemotherapy (TVRC) for liver metastatic gastric cancer. TVRC with FOLFOX and bevacizumab perfusion through the hepatic artery was attempted for CRLM for efficacy and safety evaluation. In a single-institution retrospective observational study, 246 patients with CRLM after at least first-line or second-line failure of systemic chemotherapy received TVRC with FOLFOX (i.e. oxaliplatin, leucovorin, and 5-fluorouracil). Of 246 patients, 63 were enrolled into two groups: group 1 (n=30) received bevacizumab and TVRC following tumor progression during previous TVRC treatments; group 2 (n=33) received TVRC plus bevacizumab for CRLM on initiating TVRC. There were no significant differences in the median survival time (14.7 vs. 13.2 months, P=0.367), although the median time to progression was significant (3.3 vs. 5.5 months, P=0.026) between groups. No severe adverse events related to TVRC plus bevacizumab perfusion occurred. Target vessel regional chemotherapy with FOLFOX plus bevacizumab perfusion through the hepatic artery was effective and safe in CRLM. The optimal combination of TVRC and bevacizumab needs further confirmation in future phase II-III clinical trials.

  18. Transarterial chemoembolization (TACE) with mitomycin C and gemcitabine for liver metastases in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J.; Naguib, Nagy N.N.; Nour-Eldin, Nour-Eldin A.; Eichler, Katrin; Zangos, Stefan; Gruber-Rouh, Tatjana [Johann Wolfgang Goethe-University Frankfurt, Institute for Diagnostic and Interventional Radiology, Frankfurt am Main (Germany)

    2010-01-15

    The purpose of this study was to evaluate the efficacy of transarterial chemoembolization (TACE) using different drug combinations in the treatment of breast cancer liver metastases in terms of local tumor control and survival rate. A total of 208 patients (mean age 56.4 years, range 29-81) with unresectable hepatic metastases of breast cancer were repeatedly treated with TACE at 4-week intervals. In total, 1,068 chemoembolizations were performed (mean 5.1 sessions/patient, range 3-25). The chemotherapy protocol consisted of mitomycin-C only (8 mg/m{sup 2}; n=76), mitomycin-C with gemcitabine (n=111), and gemcitabine only (1,000 mg/m{sup 2}; n=21). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated by MRI according to RECIST criteria. Survival rates were calculated using Kaplan-Meier method. For all protocols, local tumor control was partial response 13% (27/208), stable disease 50.5% (105/208), and progressive disease 36.5% (76/208). The 1-, 2-, and 3-year survival rates after TACE were 69, 40, and 33%. Median and mean survival times from the start of TACE were 18.5 and 30.7 months. Treatment with mitomycin-C only showed median and mean survival times of 13.3 and 24 months, with gemcitabine only they were 11 and 22.3 months, and with a combination of mitomycin-C and gemcitabine 24.8 and 35.5 months. TACE is an optional therapy for treatment of liver metastases in breast cancer patients with better results from the combined chemotherapy protocol. (orig.)

  19. 平阳霉素混合碘油经动脉化疗栓塞抑制兔VX2肝癌生长的实验研究%Effects of transcatheter arterial chemoembolization with pingyangmycin-lipiodol emulsion on VX2 liver tumors in rabbits

    Institute of Scientific and Technical Information of China (English)

    刘曦; 罗小平; 曹闻挺; 邓昊

    2012-01-01

    栓塞治疗更加有效.%Objective To evaluate the changes induced in tumor tissue,the feeding artery,and neovascularization upon pingyangmycin-lipiodol emulsion treatment via transcatheter arterial chemoembolization (TACE) using the rabbit VX2 liver cancer model.Methods The VX2 liver tumor model was established in 28 rabbits,and baseline tumor volume (V1,in mm3) was measured by spiral scan computed tomography (CT).Then,the rabbits were randomly divided into four groups (n =7 each) and administered intraarterial therapies of:ultrafluid lipoidol embolization (group A); pingyangmycin (group B);pingyangmycin-lipiodol emulsion (group C); or saline (group D).All rabbits were sacrificed seven days later,and the response to therapy was determined by measuring the tumor volume (V2,in mm3),calculating the tumor growth rate,detecting expression of the vascular endothelial growth factor (VEGF) tumor biomarker,and performing histological analysis of the microvessel density (MVD) in the liver.Results Prior to therapy,the average V1 of the groups was statistically similar (A:389.8± 167.3,B:404.1 ± 184.9,C:355.1±158.3,D:378.1 ± 189.0; (F=0.257,P> 0.05).In contrast,after therapy the average V2 of the groups was significantly different (A:922.6±32.9,B:665.9±99.9,C:349.5± 177.8,D:1403.5±411.2; F=26.23,P<0.05),as was the tumor growth ratio (A:1.4,B:0.6,C:-0.02,D:2.7) and the mean positive ratio of VEGF (A:57.1%,B:42.9%,C:28.6%,D:100%;F=8.407,P<0.05).MVD was highest in group D and lowest in group C (all,P<0.05).Bivariate correlation analysis revealed a positive correlation between VEGF expression and MVD (r=0.743,P<0.01).Conclusion Pingyangmyein exerts anti-tumor effects in the rabbit VX2 liver cancer model but is more effective when adminis tered as the combination therapy ofpingyangmycin-lipiodol emulsion with TACE.

  20. Computationally efficient particle release map determination for direct tumor-targeting in a representative hepatic artery system.

    Science.gov (United States)

    Childress, E M; Kleinstreuer, C

    2014-01-01

    Implementation of a novel direct tumor-targeting technique requires a computer modeling stage to generate particle release maps (PRMs) which allow for optimal catheter positioning and selection of best injection intervals for drug-particles. This simulation task for a patient-specific PRM may require excessive computational resources and a relatively long turn-around time for a fully transient analysis. Hence, steady-state conditions were sought which generates PRMs equivalent to the pulsatile arterial flow environment. Fluid-particle transport in a representative hepatic artery system was simulated under fully transient and steady-state flow conditions and their corresponding PRMs were analyzed and compared. Comparisons of the transient PRMs from ten equal intervals of the cardiac pulse revealed that the diastolic phase produced relatively constant PRMs due to its semisteady flow conditions. Furthermore, steady-state PRMs, which best matched the transient particle release maps, were found for each interval and over the entire cardiac pulse. From these comparisons, the flow rate and outlet pressure differences proved to be important parameters for estimating the PRMs. The computational times of the fully transient and steady simulations differed greatly, i.e., about 10 days versus 0.5 to 1 h, respectively. The time-averaged scenario may provide the best steady conditions for estimating the transient particle release maps. However, given the considerable changes in the PRMs due to the accelerating and decelerating phases of the cardiac cycle, it may be better to model several steady scenarios, which encompass the wide range of flows and pressures experienced by the arterial system in order to observe how the PRMs may change throughout the pulse. While adding more computation time, this method is still significantly faster than running the full transient case. Finally, while the best steady PRMs provide a qualitative guide for best catheter placement, the final

  1. Comparison of hepatic arterial infusion chemotherapy and sorafenib in elderly patients with advanced hepatocellular carcinoma: A case series

    Science.gov (United States)

    NEMOTO, TOMOYUKI; MATSUDA, HIDETAKA; NOSAKA, TAKUTO; SAITO, YASUSHI; OZAKI, YOSHIHIKO; HAYAMA, RYOKO; NAITO, TATSUSHI; TAKAHASHI, KAZUTO; OFUJI, KAZUYA; OHTANI, MASAHIRO; HIRAMATSU, KATSUSHI; SUTO, HIROYUKI; NAKAMOTO, YASUNARI

    2014-01-01

    Sorafenib and hepatic arterial infusion chemotherapy (HAIC) are both indicated for unresectable hepatocellular carcinoma (HCC). In this study, we compared the efficacy and safety of HAIC to that of sorafenib in elderly patients with HCC. Eligible patients included those aged ≥70 years, with histologically or clinically confirmed advanced HCC. A total of 12 patients received sorafenib (800 mg per day) and 8 patients received HAIC with 5-fluorouracil (300 mg/m2 on days 1–5 and 8–12) with or without cisplatin (20 mg/m2 on days 1 and 8), with interferon-α (3 times per week for 4 weeks). The response rate was significantly higher in patients treated with HAIC (37.5%) compared to that in patients treated with sorafenib (no response). The median overall survival (18.6 and 11.7 months) and progression-free survival (4.0 and 5.0 months) were similar between the sorafenib and HAIC groups, respectively. In the sorafenib group, 58.3% of the patients discontinued treatment compared to none in the HAIC group. The most frequent adverse event leading to discontinuation of sorafenib was anorexia. Similar to sorafenib, HAIC appears to be a feasible treatment and may also have the advantage of an adequate safety profile for elderly patients with advanced HCC. Further study of HAIC in a larger population of elderly patients is required to assess its potential as an alternative to sorafenib for HCC. PMID:25279193

  2. Role of interventional therapy in hepatic artery stenosis and non-anastomosis bile duct stricture after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Da-Bing Zhao; Jie-Sheng Qian; Hong Shan; Zai-Bo Jiang; Ming-Sheng Huang; Kang-Shun Zhu; Gui-Hua Chen; Xiao-Chun Meng; Shou-Hai Guan; Zheng-Ran Li

    2007-01-01

    AIM: To analyze the clinical manifestations and the effectiveness of therapy in patients with orthotopic liver transplantation (OLT)-associated hepatic artery stenosis (HAS) and non-anastomosis bile duct stricture.METHODS: Nine cases were diagnosed as HAS and non-anastomosis bile duct stricture. Percutaneous transluminal angioplasty (PTA) was performed in four HAS cases, and expectant treatment in other five HAS cases; percutaneous transhepatic bile drainage, balloon dilation, stent placement were performed in all nine cases.RESULTS: Diffuse intra- and extra-bile duct stricture was observed in nine cases, which was associated with bile mud siltation and biliary infection. Obstruction of the bile duct was improved obviously or removed. Life span/ follow-up period was 13-30 mo after PTA of four HAS cases, 6-23 mo without PTA of other five cases.CONCLUSION: Progressive, non-anastomosis, and diffuse bile duct stricture are the characteristic manifestations of HAS and non-anastomosis bile duct stricture after OLT. These are often associated with bile mud siltation, biliary infection, and ultimate liver failure. Interventional therapy is significantly beneficial.

  3. Effect of recombinant human endostatin combined with hepatic artery interventional therapy on progression-free survival of patients with advanced hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    HAO Mingzhi

    2016-01-01

    Full Text Available ObjectiveTo investigate the effect of recombinant human endostatin (Endostar combined with hepatic artery interventional therapy on the progression-free survival (PFS of patients with advanced hepatocellular carcinoma (HCC. MethodsA total of 86 patients with advanced HCC who were admitted to Fujian Provincial Tumor Hospital from March 2011 to May 2015 were selected and divided into treatment group and control group according to a matched pair design. The treatment group (43 patients was given Endostar combined with hepatic artery interventional therapy, and the control group (43 patients was given hepatic artery interventional therapy combined with oral administration of Ganfule. The chi-square test was applied for comparison of categorical data between the two groups, and the t-test was applied for comparison of continuous data between the two groups. The Kaplan-Meier method was applied for survival analysis, the Log-rank test was applied for univariate analysis, and Cox proportional hazards model was applied for multivariate analysis. ResultsThe median PFS in the treatment group and the control group was 154 d [95% confidence interval (CI: 94-214 d] and 70 d (95%CI: 39-101 d, respectively, with a significant difference between the two groups (χ2=10.741, P=0001. Univariate analysis showed that the severity of liver cirrhosis, number of tumors, and main portal vein tumor thrombus/inferior vena cava tumor thrombus were the prognostic factors for patients with advanced HCC (χ2=8.182, 9.150, and 6.565, P=0.004, 0.027, and 0.038; multivariate analysis showed that the severity of liver cirrhosis and main portal vein tumor thrombus/inferior vena cava tumor thrombus were the independent prognostic factors for PFS in patients with advanced HCC who were treated with Endostar combined with hepatic artery interventional therapy (P=0.028 and 0.013. ConclusionEndostar can effectively prolong the PFS of patients with advanced HCC after hepatic artery

  4. THE CHANGES OF PERIPHERAL BLOOD T LYMPHOCYTE SUBSETS IN PATIENTS WITH PRIMARY HEPATIC CARCINOMA BOTH PRE-TACE AND POST-TACE

    Institute of Scientific and Technical Information of China (English)

    南克俊; 李春丽; 魏永长; 隋晨光; 刘亚民; 陈葳

    2002-01-01

    Objective To observe the variations of the cellular immunological function in patients with primary hepatic carcinoma both pre-TACE (transcatheter arterial chemoembolization, TACE). Methods T lymphocyte subset CD4, CD8 and CD4/CD7 ratio in 45 patients with primary hepatic carcinoma both pre-TACE and post-TACE were measured by flow Cytometer, and compared with the result of T lymphocyte subset in 19 healthy people as normal control samples. Results The CD4 and CD4/CD8 ratio in patients with primary hepatic carcinoma were significantly lower than those in normal control (P<0.05), while CD8 higher (P<0.05); The CD4 and CD4/CD8 ratio in patients with primary hepatic carcinoma were much more lower after TACE than those before TACE (P<0.05), while CD8 was higher but had no significant difference (P>0.05). Conclusion The cellular immunological function in patients with primary hepatic carcinoma decreased and is much more lower after TACE.

  5. The selection of monochromatic images in the post process of hepatic arterial CT angiology before TACE%肝癌化疗栓塞术前肝动脉能谱CT成像中最佳单能量的选择

    Institute of Scientific and Technical Information of China (English)

    孙奕波; 李铭; 毛定彪; 白爱国; 齐琳; 任庆国; 高丰; 杨艳丽; 陆芳

    2013-01-01

    Objective To investigate the value of using optimal contrast noise ratio to select one optimal keV monochromatic images to improve image quality of hepatic arterial CT angiology before transcatheter arterial chemoembolization.Methods 96 patients with hepatic malignant tumors were underwent spectral CT examination from October 2011 to October 2012.There were 52 males and 44 females with ages ranging from 51 to 62 years(mean age of 57.61 years).Using GE ADW 4.4 and GSI view software to post process the images and measure optimal CNR in transverse image to select an optimal keV monochromatic images.Measure contrast and noise of proper hepatic artery and the right hepatic artery in QC images,predefine keV monochromatic images selected by system and monochromatic images select by using optimal contrast noise ratio.Two radiologists major in abdominal and vascular radiology evaluate those images using score 1-5.Statistical analysis was carried out using the Stata version 10.0 software.P < 0.05 was defined as statistical significance.Results The score,contrast and noise of monochromatic images select by using optimal contrast noise ratio was significantly higher than other two methods,and those of monochromatic images selected by system was significantly higher than QC images(P <0.05).Conclusions Using optimal contrast noise ratio to select one keV monochromatic images set will enhance contrast between hepatic arteries and surrounding tissue,make arteries more visible and improve image quality of hepatic arterial CT angiology.%目的 探讨选择最佳对比信噪比(CNR)获得最理想keV单能量图像质量以指导肝癌肝动脉化疗栓塞术的价值.方法 收集我院2011年10月至2012年10月临床诊断无手术切除指征的肝细胞癌患者96例(其中男52例,女44例),采用GE Discovaery 750 HDCT扫描,范围从膈顶至双肾下极.图像后处理采用ADW 4.4工作站和GSI-view软件,在单能量轴位图像上测量最佳CNR,并从101个单能

  6. Structure remodeling of swine hepatic artery in portal hypertension%门静脉高压症猪肝动脉的结构重建

    Institute of Scientific and Technical Information of China (English)

    贺细菊; 于明华; 李文春; 张兴华; 黄铁柱

    2011-01-01

    Objective To establish a reliable swine portal hypertension model and explore the morphological properties of hepatic arteries. Methods Liver cirrhosis and portal hypertension were induced by carbon tetrachlorideand fenobarbital ( n = 8), 4 pigs served as the control, the hepatic arteries were collected and serially sectioned. The tissue structure, elastic fiber, collagen fiber and smooth muscle were stained by HE, Weigert, Aniline blue and Orange G respectively. The morphological data of hepatic arteries were obtained by the computer image analysis system. Results The portal vein pressure of experimental group was (4. 17 ± 1.03 ) kPa, that of the control group was ( 1.51 ± 0. 79 ) kPa. The intima and media thickness of hepatic artery was obviously larger than that of the control ( P <0. 05 ). The wall thickness and the diameter of hepatic artery were obviously larger than that of the control ( P < 0. 0l ), the relative percentage of collagen fibers(C) was significantly larger than that of the control (P < 0. 0l ), the relative percentage of elastic fibers ( E ) decreased significantly ( P < 0. 05 ), the ratio of C and E increased significanfiy. Conclusion The hepatic artery has suffered extensive morphological remodeling while portal hypertension, and in return affected the hepatic artery buffer response.%目的 建立猪门静脉高压症模型,探讨门静脉高压症时肝动脉的结构重建.方法猪以四氯化碳、苯巴比妥、乙醇配合高脂、低蛋白、低胆碱饮食进行混合饲养.通过脾静脉插管测压,取肝动脉常规石蜡包埋、切片,用HE 法、Weigert 法、Aniline blue法,Organge G法分别染组织结构、弹性纤维、胶原纤维和平滑肌,用计算机图像分析系统定量分析肝动脉的几何形态及显微成分.结果实验组门静脉压为(4.17±1.03)kPa,明显大于对照组(1.51±0.79)kPa;实验组肝动脉的内膜与中膜增厚,管壁增厚,管径增粗,胶原纤维的百分含量显著增

  7. Pulmonary Lipiodol Accumulation after Transarterial Chemoembolization: CT Findings and Its Radiologic Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Youn, In Young; Chong, Se Min; Kwak, Byung Kook; Shin, Hyung Jin; Seo, Gi Young; Seo, Jae Seung; Kim, Jae Kyun [Dept. of Radiology, Chung Ang University Medical Center, Chung Ang University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    To evaluate CT findings and radiologic outcomes of pulmonary lipiodol accumulation (PLA) after transarterial chemoembolization (TACE). This retrospective study involved 488 TACEs for hepatocellular carcinoma (HCC) (n = 160) and hepatic metastasis for non-hepatic malignancies (n = 7) in 167 patients. We reviewed the patient clinicoradiologic findings before and after TACE and calculated the incidence of PLA and PLA resolution time after initial CT and after TACE. Lipiodol accumulation in the lungs was seen under CT after TACE in seven patients (M : F = 6 : 1, mean age 61 years). The incidence of PLA at CT was 4.1% (7/167 patients). In five patients, associated intrathoracic abnormalities including pleural effusion with (n 3) or without consolidation (n = 2) were revealed at CT scans. The CT resolution time and PLA recovery time were 56 {+-} 54 days and 66 {+-} 52 days, respectively. The recovery time for lipiodol accumulation was 66 days. It is believed that the clinical and radiologic outcome of PLA without respiratory failure is promising, and conservative treatment will suffice when lipiodol accumulation in the lungs is seen in CT images after TACE.

  8. Repetitive transarterial chemoembolization (TACE) of liver metastases from renal cell carcinoma: Local control and survival results

    Energy Technology Data Exchange (ETDEWEB)

    Nabil, Mohamed [Johann Wolfgang Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Klinikum der Johann Wolfgang Goethe-Universitaet, Institut fuer Diagnostische und Interventionelle Radiologie, Frankfurt am Main (Germany); Gruber, Tatjana; Zangos, Stephan; Vogl, Thomas J. [Johann Wolfgang Goethe University, Institute of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Yakoub, Danny [Imperial College London, St Mary' s Hospital, Department of Biosurgery and Surgical Technology, London (United Kingdom); Ackermann, Hanns [Johann Wolfgang Goethe University, Department of Biostatistics and Medical Information, Frankfurt am Main (Germany)

    2008-07-15

    The purpose was to evaluate the effectiveness of transarterial chemoembolization (TACE) in local tumor control and survival in patients with hepatic metastases from renal cell carcinoma (RCC). Prospective evaluation of TACE treatment outcome in 22 patients recruited from 1999 and 2005 was performed. The chemotherapeutic agent used was mitomycin only in 45% of the patients and mitomycin together with gemcitabine in the other 55%. The embolizing materials used in all of the patients were iodized oil (lipiodol) and degradable starch microspheres. Local response was evaluated by MRI and judged according to Response Evaluation Criteria in Solid Tumors (RECIST). Mean and median survival and survival probability after diagnosis and treatment were both calculated by Kaplan-Meier method. Partial response was achieved in 13.7%, stable disease in 59% and progressive disease in 27.3% of patients. Survival time from the diagnosis of metastases ranged from 18 to 307 months and from 2.2 to 35 months from the start of TACE treatment. The median and mean survival times from the date of diagnosis were 68.6 and 102.9 months, respectively. The median and mean survival times from the start of TACE were 8.2 and 11.7 months, respectively. Survival probability from the start of treatment was 31% after 1 year and 6% after 2 years. TACE can result in a favorable local tumor response in patients with hepatic metastases from RCC, but survival results are still limited. (orig.)

  9. The Analysis of the Causes of Prolonged Hospitalization after Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma

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    Chang, Nam Kyu; Jeong, Yong Yeon [Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Park, Seo Yeon; Kim, Jae Kyu [Chonnam National University Medical School, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-01-15

    We wanted to analyze the causes of prolonged hospitalization (over 7 days) after transarterial chemoembolization (TACE) in patients with unresectable Hepatocellular Carcinoma and its related factors. We analyzed the total hospital days after patients with unresectable Hepatocellular Carcinoma received transarterial chemoembolization, and these patients were treated during the recent 6 month at our hospital. Two hundred twenty three sessions showed a short term hospital stay (less than 7 days) and 57 sessions showed a prolonged hospital stay (more than 7 days), so a total of 280 sessions were analyzed. The hospital stay less than seven days was set for the control group and this was correlated with the patient's age, gender, the level of bilirubin and albumin, the platelet counts, the AST/ALT ratio, the a-FT, the presence of portal vein thrombosis and ascites, several scoring systems (Child-Pugh, CLIP, and OKUDA score) and the need for additional embolization at the time of the procedure. Compared with that of the control group, ascites (p=0.004), portal vein thrombosis (p=0.000), a platelet count below the hundred thousand (p=0.012), a Child-Pugh score more than B (p=0.023), a CLIP score more than 2 (p=0.000) and a OKUDA score more than II (p=0.000) showed significant differences. The evaluation of patients' factors would be useful to predict extended post-procedural hospitalization after hepatic chemoembolisation

  10. Influence of Diabetes on the Prognosis of Patients With Barcelona Clinic Liver Cancer Stage B HCC After Transcatheter Arterial Chemoembolization%糖尿病对巴塞罗那临床肝癌分期B期原发性肝细胞癌患者经肝动脉化疗栓塞术后预后的影响研究

    Institute of Scientific and Technical Information of China (English)

    黄高峰; 庞志刚; 贾华磊

    2016-01-01

    Objective To analyze the effects of diabetes mellitus on the prognosis of patients with primary Barcelona clinic liver cancer(BCLC)stage B hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE). Methods From January 2012 to June 2015,we enrolled 151 HCC patients who underwent TACE in the Second Affiliated Hospital of Zhengzhou University and accorded with inclusion and exclusion criteria. Among them,17 HCC patients combined with DM were enrolled as case group,and 134 HCC patients without DM were enrolled as control group. General data and prognosis of the two groups were analyzed,and Cox proportional hazards regression model was used to analyze the influencing factors for the prognosis of BCLC stage B HCC patients after TACE. Results The two groups were not significantly different in gender,age,ALT,Child-Pugh grading,AFP,the sum of tumor diameter,the incidence of portal hypertension,antiviral therapy and times of treatment(P > 0. 05);case group was higher than control group in FPG level(P < 0. 05). With gender, age,having DM or not,ALT,Child-Pugh grading,AFP,the sum of tumor diameter,having portal hypertension or not, receiving antiviral therapy or not and times of treatment as independent variables and prognosis after TACE as dependent variables,univariate Cox proportional hazards regression model analysis showed that the prognosis after TACE of HCC patients had relation with the having DM or not, ALT, Child-Pugh grading, AFP, the sum of tumor diameter, having portal hypertension or not,receiving antiviral therapy or not and times of treatment(P < 0. 05). Multivariate Cox proportional hazards regression model analysis showed that having DM or not,Child-Pugh grading,the sum of tumor diameter,receiving antiviral therapy or not and times of treatment were influencing factors for the prognosis after TACE of HCC patients(P < 0. 05). The 1 -year survival rate,2 - year survival rate and median survival time of control group were 67% ,20% and

  11. Interventiona1 diagnosis and treatment of hepatic artery complications after liver transplantation%肝移植术后肝动脉并发症的介入诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    陈尘; 高健; 胡立宝

    2015-01-01

    目的 评价介入技术在肝移植术后肝动脉并发症的诊断与治疗中的价值.方法 回顾性分析2005年5月至2015年4月北京大学人民医院8例肝移植术后肝动脉并发症患者介入诊断和治疗及随访资料.结果 肝动脉血栓形成6例,其中4例动脉溶栓后,发现伴肝动脉狭窄,2例重度狭窄者行肝动脉支架成形术,1例轻中度狭窄者仅予溶栓治疗,1例狭窄血管伴严重扭曲者溶栓治疗效果不佳,行开腹肝动脉切开取栓及吻合术;1例可见侧支循环建立,未予治疗;1例溶栓后血管通畅,未见狭窄.移植后脾动脉盗血综合征4例,行脾动脉栓塞术.肝动脉假性动脉瘤1例,行支架辅助动脉瘤栓塞术.随访1例肝动脉狭窄行动脉支架成形术患者术后5d因肝细胞广泛坏死行2次肝移植;余7例随访23 ~108个月肝功能均未见异常.结论 介入技术能有效地诊断和治疗肝移植术后肝动脉并发症.%Objective To evaluate the value of intervention technique in diagnosing and treating hepatic artery complications after liver transplantation.Methods Data of 8 patients with hepatic artery complications after liver transplantation from May 2005 to April 2015 were retrospectively analyzed.Results Totally 6 patients had hepatic artery thrombosis;among them,hepatic artery stenosis was found after intra-arterial thrombolysis in 4 cases.Among them,2 cases had severe stenosis and underwent hepatic artery stent angioplasty;1 case had mild-moderate stenosis and underwent thrombolytic therapy;1 case had ineffective thrombolysis due to severe artery distortion and underwent hepatic artery embolectomy and anastomosis.The collateral circulation was established in 1 case and no treatment was given;no hepatic artery stenosis was found after intra-arterial thrombolysis in 1 case;1 patient had splenic artery steal syndrome and underwent splenic artery embolization;1 patient had hepatic artery pseudoaneurysm formation and underwent stent

  12. Topografia da artéria hepática no fígado de capivara (Hydrochaerus hydrochaeris Arrangement of hepatic artery in capybara (Hydrochaerus hydrochaeris

    Directory of Open Access Journals (Sweden)

    Wilson Machado de Souza

    2007-02-01

    Full Text Available A distribuição dos ramos da artéria hepática, no fígado, foi estudada em 30 fígados de capivara (Hydrochaerus hydrochaeris mediante injeção arterial com látex natural corado, fixação em formol a 10%, dissecção pela face visceral e esquematização. A lobação do fígado, nestes animais, é semelhante à do suíno, permitindo identificar os lobos lateral direito, medial direito, quadrado, medial esquerdo, lateral esquerdo e caudado (processos caudado e papilar. A artéria hepática divide-se mais freqüentemente (73,3% nos ramos direito e esquerdo e, em menor número de preparações (26,6%, trifurca-se nos ramos direito, intermédio e esquerdo. Esses vasos alcançam, sob diferentes arranjos, os lobos do fígado.The distribution of the hepatic arterial branches in capybara's (Hydrochaerus hydrochaeris liver was studied in 30 animals. After arterial injection with stain natural latex, the organs were fixed in formaldehyde 10%, dissected and schematized. The lobation of the liver in these animals, is similar to the one of the swine, allowing to identify the following lobes: right lateral, right medial, quadrate, left medial, left lateral and caudate (processes caudate and papillary. The hepatic artery is divided more frequently (73.3% in the branches right and left and in lesser number of preparations (26.6%, the vessel gives three resulting in the branches right, intermediate and left. These vessels reach, under different arrangements the lobes of the liver, when appears coincident passages with the one of the biliferous ways and portal vein, allowing in this way establish an port-bilio-arterial division.

  13. Chemoembolization of unresectable hepatocellular carcinoma: Decreased toxicity with slow-release doxorubicin‑eluting beads compared with lipiodol.

    Science.gov (United States)

    Recchia, Francesco; Passalacqua, Giovanni; Filauri, Pietro; Doddi, Marco; Boscarato, Pietro; Candeloro, Giampiero; Necozione, Stefano; Desideri, Giovambattista; Rea, Silvio

    2012-05-01

    Chemoembolization with lipiodol (TACE) improves survival of selected patients with unresectable hepatocellular carcinoma (HCC), but results in substantial toxicity. To improve treatment tolerance, we conducted this phase II study using doxorubicin-loaded beads (DC Beads®) delivered by selective transcatheter arterial chemoembolization (DEB-TACE). We compared the results with those obtained with TACE in our historical controls. Thirty-five patients were recruited with diagnoses of HCC. Patients received DEB-TACE with doxorubicin loaded on DC Beads. Computed tomography of the upper abdomen was performed one month after DEB-TACE. Historical controls were a group of 70 patients with matched characteristics treated with TACE. After a median follow-up of 14.1 months (range, 6-36 months), 22 patients (63%) had an objective response. There was a statistically significant decrease in liver enzymes (p<0.001), lactate dehydrogenase, (p<0.001) in DEB-TACE-treated patients compared to TACE-treated patients. DEB-TACE with doxorubicin-loaded DC Beads, a safe and reliable treatment for HCC, leads to decreased toxicity compared to TACE.

  14. Clinical effects of transcatheter arterial chemoembolization combined with stereotactic body radiation therapy on patients with unresectable hepatocellular carcinoma%肝动脉栓塞化疗联合立体定向放射治疗原发性肝癌的疗效分析

    Institute of Scientific and Technical Information of China (English)

    张学成; 贺选; 王永锋; 赵晨年

    2016-01-01

    Objective:To analyse the therapeutic effects and side -effect of the transcatheter arterial chemoembo-lization(TACE)combined with stereotactic body radiation therapy (SBTR)for patients with unresectable hepatocel-lular carcinoma.Methods:All 96 cases of advanced hepatocellular carcinoma were divided into 2 groups,44 cases in therapy group treated with TACE and SBTR,52 cases in control group treated with TACE alone.For TACE,(30 ~50) mg epirubicin,(1 000 ~1 500)mg 5 -fluorouracil and /or (40 ~60)mg cisplatin were perfused into the hepatic arter-ies,(3 ~18)ml iodized oil was given to emobolized the hepatic arteries.For SBRT,LUNA -260 whole body -gamma knife radiosurgery was used,≥50% isodose curve included PTV,and the total treatment dose was 30 ~50Gy/5 ~12f,5 times per week.Average dose of liver <23Gy,V30 <30%.Results:For therapy group and control group,average TACE were 2.0(1 ~6)and 3.6(1 ~7)times.Medium survival time(MST)were 18.1 and 10.6 months respective-ly.The 2 year's local control rates were 42.5% and 32.8% respectively,and 3 year's local control rates were 35.8%, 22.5%(P =0.044,P =0.040).For therapy group,2 and 3 years survival rates were 40.5% and 32.2% respective-ly,and for control group,they were 29.2% and 20.3% respectively.All of them showed a statistically significant differences for 2 and 3 year's survival rates(P =0.048,P =0.032).There were 2 cases with radiation induced liver disease(RILD)in therapy group.Conclusion:The efficacy of TACE combined with SBRT is superior to that of TACE alone for advanced hepatocellular carcinoma.The side -effect is moderate and clinical acceptable.%目的:分析肝动脉栓塞化疗(TACE)联合立体定向放射治疗(SBRT)不能手术的原发性肝癌的疗效及毒副反应。方法:96例不能手术的原发性肝癌患者,TACE 联合 SBRT 治疗44例(研究组),单纯 TACE 治疗52例(对照组)。TACE 灌注化疗药物为:氟尿嘧啶(5-FU)(1000~1500)mg

  15. The complicated management of a patient following transarterial chemoembolization for metastatic carcinoid

    Directory of Open Access Journals (Sweden)

    Shah Manisha H

    2008-11-01

    Full Text Available Abstract Background Transarterial Chemoembolization (TACE has been recognized as a successful way of managing symptomatic and/or progressive hepatic carcinoid metastases not amenable to surgical resection. Although it is a fairly safe procedure, it is not without its complications. Case presentation This is a case of a 53 year-old woman with a patent foramen ovale (PFO and mild pulmonary hypertension who underwent TACE for progressive carcinoid liver metastases. She developed acute heart failure, due to a severe inflammatory response; this resulted in pneumatosis intestinalis due to non-occlusive mesenteric ischemia. We describe the successful non-operative management of her pneumatosis intestinalis and the role of a PFO in this patient's heart failure. Conclusion TACE remains an effective and safe treatment for metastatic carcinoid not amenable to resection, this case illustrates the complexity of complications that can arise. A multi-disciplinary approach including ready access to advanced critical care facilities is recommended in managing such complex patients.

  16. Iodized oil uptake assessment with cone-beam CT in chemoembolization of small hepatocellular carcinomas

    Institute of Scientific and Technical Information of China (English)

    Ung Bae Jeon; Jun Woo Lee; Ki Seok Choo; Chang Won Kim; Suk Kim; Tae Hong Lee; Yeon Joo Jeong; Dae Hwan Kang

    2009-01-01

    AIM: To evaluate the utility of assessing iodized oil uptake with cone-beam computed tomography (CT) in transarterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC). METHODS: Cone-beam CT provided by a biplane flatpanel detector angiography suite was performed on eighteen patients (sixteen men and two women; 41-76 years; mean age, 58.9 years) directly after TACE for small HCC (26 nodules under 30 mm; mean diameter, 11.9 mm; range, 5-28 mm). The pre-procedural locations of the tumors were evaluated using triphasic multi-detector row helical computed tomography (MDCT). The tumor locations on MDCT and the iodized oil uptake by the tumors were analyzed on cone-beam CT and on spot image directly after the procedures. RESULTS: All lesions on preprocedural MDCT were detected using iodized oil uptake in the lesions on conebeam CT (sensitivity 100%, 26/26). Spot image depicted iodized oil uptake in 22 of the lesions (sensitivity 85%). The degree of iodized oil uptake was overestimated (9%, 2/22) or underestimated (14%, 3/22) on spot image in five nodules compared with that of cone-beam CT. CONCLUSION: Cone-beam CT is a useful and convenient tool for assessing the iodized oil uptake of small hepatic tumors (< 3 cm) directly after TACE.

  17. Comparative Study of Compensatory Liver Regeneration in a Rat Model: Portal Vein Ligation Only versus Sequential Ligation of the Portal Vein and Hepatic Artery

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Soo Young [Dept. of Pathology, Dongnam Institute of Radiological and Medical Sciences, Busan (Korea, Republic of); Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Lee, Byung Mo [Dept. of Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2013-04-15

    To compare the volume change and the regenerative capacity between portal vein ligation (embolization) (PVL) and heterochronous PVL with hepatic artery ligation (HAL) in a rodent model. The animals were separated into three groups: group I, ligation of the left lateral and median portal vein branches; group II, completion of PVL, followed by ligation of the same branches of the hepatic artery after 48 h; control group, laparotomy without ligation was performed. Five rats from each group were sacrificed on 1, 3, 5, and 7 days after the operation. Volume change measurement, liver function tests and immunohistochemical analysis were performed. The volume of the nonligated lobe between groups I and II was not significantly different by day 5 and day 7. Mean alanine aminotransferase and total bilirubin levels were significantly higher in group II, while the albumin level was higher in group I. Both c-kit- and MIB-5-positive cells used in the activity detection of regeneration were more prevalent in group I on day 1, 3, and 5, with statistical significance. There was no operation related mortality. PVL alone is safe and effective in compensatory liver regeneration. Performing both PVL and HAL does not confer any additional benefits.

  18. Aortic and Hepatic Contrast Enhancement During Hepatic-Arterial and Portal Venous Phase Computed Tomography Scanning: Multivariate Linear Regression Analysis Using Age, Sex, Total Body Weight, Height, and Cardiac Output.

    Science.gov (United States)

    Masuda, Takanori; Nakaura, Takeshi; Funama, Yoshinori; Higaki, Toru; Kiguchi, Masao; Imada, Naoyuki; Sato, Tomoyasu; Awai, Kazuo

    We evaluated the effect of the age, sex, total body weight (TBW), height (HT) and cardiac output (CO) of patients on aortic and hepatic contrast enhancement during hepatic-arterial phase (HAP) and portal venous phase (PVP) computed tomography (CT) scanning. This prospective study received institutional review board approval; prior informed consent to participate was obtained from all 168 patients. All were examined using our routine protocol; the contrast material was 600 mg/kg iodine. Cardiac output was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. We calculated contrast enhancement (per gram of iodine: [INCREMENT]HU/gI) of the abdominal aorta during the HAP and of the liver parenchyma during the PVP. We performed univariate and multivariate linear regression analysis between all patient characteristics and the [INCREMENT]HU/gI of aortic- and liver parenchymal enhancement. Univariate linear regression analysis demonstrated statistically significant correlations between the [INCREMENT]HU/gI and the age, sex, TBW, HT, and CO (all P linear regression analysis showed that only the TBW and CO were of independent predictive value (P linear regression analysis only the TBW and CO were significantly correlated with aortic and liver parenchymal enhancement; the age, sex, and HT were not. The CO was the only independent factor affecting aortic and liver parenchymal enhancement at hepatic CT when the protocol was adjusted for the TBW.

  19. Metastasis-Associated Protein 1 Is Involved in Angiogenesis after Transarterial Chemoembolization Treatment

    Directory of Open Access Journals (Sweden)

    Tao Xue

    2017-01-01

    Full Text Available Background. Transarterial chemoembolization (TACE, a well-established treatment for unresectable hepatocellular carcinoma (HCC, blocks the arterial blood supply to the tumor, which can be short-lived as development of collateral neovessels, leading to the failure of treatment. Metastasis-associated protein 1 (MTA1 is involved in development of tumors and metastases. However, the role of MTA1 in angiogenesis is still obscure. Methods. We detected the expression of MTA1 and hypoxia-inducible factor-1α (HIF-1α and microvessel density (MVD value in liver tumor tissues and tumor periphery before and after TACE treatment. Hepatocellular carcinoma cell line HepG2, tube formation assay, and chorioallantoic membrane (CAM assay were applied to explore the mechanism of MTA1 in angiogenesis. Results. We found that expression of MTA1 increased after TACE treatment, especially in tumor periphery, which was accompanied by markedly elevated MVD value, indicating a significant correlation between MTA1 and MVD value. Moreover, MTA1 contributed to neovascularization of residual tumors. Cellular experiments further revealed that MTA1 increased the stability and the expression of HIF-1α, and overexpression of MTA1 enhanced tube formation and neovessels of chick embryos. Conclusions. MTA1 is an active angiogenic regulator; our results shed light on better understanding in neovascularization, which are helpful to predict prognosis of TACE, and provide evidences for intervention to improve therapeutic effects on HCC.

  20. Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease-A Case Report and Review of the Literature.

    Science.gov (United States)

    Barr, James; Kokotsakis, John; Tsipas, Pantelis; Papapavlou, Prodromos; Velissarios, Konstantinos; Kratimenos, Theodoros; Athanasiou, Thanos

    2017-02-01

    Chronic mesenteric ischemia (CMI) is a rare disorder caused by severe stenosis of the mesenteric arterial supply that results in postprandial pain and weight loss. Treatment options are surgical or endovascular. Surgical bypass can be performed in an antegrade fashion from the supraceliac abdominal aorta (AA) or the distal descending thoracic aorta or in a retrograde fashion from the infrarenal aorta or the common iliac artery. However, in some patients with disease of the descending thoracic aorta or the AA, another site for the proximal anastomosis needs to be found. In this article, we report the case of a 69-year-old man with a thoracoabdominal aortic aneurysm and CMI in whom we performed bypass grafts to the hepatic and superior mesenteric arteries using the ascending aorta as the site for the proximal anastomoses via a median sternolaparotomy. In addition, we performed a literature review of all similar cases and provide an analysis of this technique and an assessment of the success rates.

  1. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    2013-01-01

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability in

  2. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability

  3. Comparison of arterial pressure and plethysmographic waveform-based dynamic preload variables in assessing fluid responsiveness and dynamic arterial tone in patients undergoing major hepatic resection

    NARCIS (Netherlands)

    Vos, J. J.; Kalmar, A. F.; Struys, M. M. R. F.; Wietasch, J. K. G.; Hendriks, H. G. D.; Scheeren, T. W. L.

    2013-01-01

    Dynamic preload variables to predict fluid responsiveness are based either on the arterial pressure waveform (APW) or on the plethysmographic waveform (PW). We compared the ability of APW-based variations in stroke volume (SVV) and pulse pressure (PPV) and of PW-based plethysmographic variability in

  4. Combined transarterial chemoembolization and arterial administration of Bletilla striata in the interventional treatment of liver tumor in rats%白芨在经肝动脉化疗栓塞术治疗大鼠肝细胞癌实验中的应用

    Institute of Scientific and Technical Information of China (English)

    钱骏; 吴汉平; 郑传胜; 黎维勇; Vossoughi Daryusch; Oppermann Elsie; Vogl Thomas; 冯敢生

    2005-01-01

    目的评价白芨在经肝动脉化疗栓塞术(transarterial chemoembolization, TACE)治疗ACI大鼠肝细胞癌实验中的应用价值.方法在30只ACI大鼠肝包膜下植入Morris Hepatom 3924A肝癌瘤块(2 mm3),移植术后13 d进行MR检查,测量肿瘤体积(V1),第14 天时,经大鼠胃十二指肠动脉逆行插管至肝动脉,采取以下治疗方案:A组0.1 mg丝裂霉素+0.1 ml 碘油+1.0 mg白芨 (10只);B组0.1 mg 丝裂霉素+0.1 ml 碘油+1.0 mg 白芨+肝动脉结扎(10只);C组0.1 mg 丝裂霉素+0.1 ml 碘油(对照组,10只).13 d后再次进行MR检查以测量肿瘤体积(V2),比较肝肿瘤体积生长率(V2/V1).结果介入治疗后与治疗前肿瘤体积之比 (V2/V1) 分别为A组6.28,B组1.53,C组9.14. 与对照组C相比,采取A、B组的治疗方案均能抑制肝肿瘤的生长(P<0.05 和 P<0.01),A组与B组之间的肿瘤生长率差异亦有统计学意义(P<0.01).结论白芨作为肝动脉栓塞剂,结合局部化疗术和肝动脉结扎术能明显抑制大鼠肝细胞癌的生长.

  5. Hepatic arterial infusion chemotherapy using 5-fluorouracil and systemic interferon-α for advanced hepatocellular carcinoma in combination with or without three-dimensional conformal radiotherapy to venous tumor thrombosis in hepatic vein or inferior vena cava.

    Science.gov (United States)

    Murakami, Eisuke; Aikata, Hiroshi; Miyaki, Daisuke; Nagaoki, Yuko; Katamura, Yoshio; Kawaoka, Tomokazu; Takaki, Shintaro; Hiramatsu, Akira; Waki, Koji; Takahashi, Shoichi; Kimura, Tomoki; Kenjo, Masahiro; Nagata, Yasushi; Ishikawa, Masaki; Kakizawa, Hideaki; Awai, Kazuo; Chayama, Kazuaki

    2012-05-01

      We investigated the efficacy of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and systemic interferon (IFN)-α (HAIC-5-FU/IFN) for advanced hepatocellular carcinoma (HCC) with venous tumor thrombosis (VTT) in the hepatic vein trunk (Vv2) or inferior vena cava (Vv3).   Thirty-three patients with HCC/Vv2/3 underwent HAIC with 5-FU (500 mg/body weight/day, into hepatic artery on days 1-5 on the first and second weeks) and IFN-α (recombinant IFN-α-2b 3 000 000 U or natural IFN-α 5 000 000 U, intramuscularly on days 1, 3 and 5 of each week). Three-dimensional conformal radiotherapy (3D-CRT) was used in combination with HAIC-5-FU/IFN in 14 of 33 patients to reduce VTT.   The median survival time (MST) was 7.9 months, and 1- and 2-year survival rates were 30% and 20%, respectively. Evaluation of intrahepatic response after two cycles of HAIC-5-FU/IFN showed complete response (CR) in three (9%) and partial response (PR) in seven (21%), with an objective response rate of 30%. Multivariate analysis identified reduction of VTT (P = 0.0006), size of largest tumor (P = 0.013) and intrahepatic response CR/PR (P = 0.030) as determinants of survival. CR/PR correlated significantly with tumor liver occupying rate (P = 0.016) and hepatitis C virus Ab (P = 0.010). Reduction of VTT correlated significantly with radiotherapy (P = 0.021) and platelet count (P = 0.015). Radiotherapy-related reduction in VTT significantly improved survival of 16 patients with Vv3 and non-CR/PR response of HAIC-5-FU/IFN (P = 0.028).   As for advanced HCC with VTT of Vv2/3, HAIC-5-FU/IFN responsive patients could obtain favorable survival. Despite ineffective HAIC-5-FU/IFN, the combination with effective radiotherapy to VTT might improve patients' prognosis. © 2011 The Japan Society of Hepatology.

  6. Reconstrução arterial no transplante hepático: a melhor reconstrução para variação da artéria hepática direita Artery reconstruction in liver transplantation: the best reconstruction of right hepatic artery variation

    Directory of Open Access Journals (Sweden)

    Wellington Andraus

    2013-03-01

    Full Text Available INTRODUÇÃO: Variações na anatomia da artéria hepática são comuns, com incidência de 20-50%. No transplante hepático, reconstruções durante a operção de bandeja são frequentemente necessárias para proporcionar anastomoses arteriais adequadas. O uso de "patch" é frequente, visando reduzir a incidência de complicações. Entretanto, quando está presente a variação da artéria hepática direita, ramo da artéria mesentérica superior, a reconstrução ocasionalmente produz torções e problemas de fluxo. MÉTODOS: Descreve-se uma técnica cirúrgica alternativa para reconstrução da variação da artéria hepática direita usando um "patch de Carrel" da artéria mesentérica superior. O "patch" é anastomosado no coto da artéria esplênica permitindo orientação vertical e bom fluxo sanguíneo. RESULTADOS: Entre 120 transplantes hepáticos, quatro casos consecutivos de variação da artéria hepática direita foram reconstruídas utilizando essa técnica. Todos eles apresentaram patência e bom fluxo no pós-operatório. CONCLUSÃO: A técnica proposta mostra-se interessante método alternativo para reconstrução da variação da artéria hepática direita no transplante hepático.INTRODUCTION: Variations on the anatomy of the hepatic artery are common, with incidence of 20-50%. In liver transplantation, back-table reconstruction is often necessary for an easier and prompt arterial anastomosis and so, the use of arterial patches has been related to lower the incidence of complications. However, when a right hepatic artery variation from the superior mesenteric artery is present, the reconstruction occasionally produces twisting and flow problems. METHODS: Is described a surgical alternative for right hepatic artery variation reconstruction using a Carrel-patch from the superior mesenteric artery. The patch is anastomosed with the splenic artery stump to allow vertical orientation and improve blood flow. RESULTS: Among 120

  7. Sectional localization of a small hepatocellular carcinoma in the right hepatic lobe by computed tomography: Comparison between the conventional and portal vein tracing methods

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chun-Gao [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); The First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing (China); Chung, Jin Wook; Hur, Saebeom; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Yin, Yong-Hu; Kim, Young Il [Seoul National University Hospital, Department of Radiology, Jongro-gu, Seoul (Korea, Republic of); Ahn, Sang-bu [Dongnam Institution of Radiological and Medical Sciences, Department of Radiology, Busan (Korea, Republic of); Cho, Baik Hwan [Chonbuk National University Hospital, Department of Radiology, Jeonju (Korea, Republic of)

    2016-12-15

    To compare the accuracy of the conventional and portal vein tracing methods in the right hepatic lobe in multidetector computed tomography (MDCT). This retrospective study included patients with hepatocellular carcinoma (HCC) lesions in the right hepatic lobe who underwent multiphasic MDCT and C-arm CT hepatic arteriography (C-arm CTHA) for chemoembolization. The accuracies of the conventional and portal vein tracing methods were evaluated using C-arm CTHA as the gold standard. A total of 147 patients with 205 HCC nodules were included. The C-arm CTHA could identify all the tumour-feeding arteries and consequently demonstrated that 120 lesions were located in the anterior section, 78 in the posterior section, and 7 in the border zone. The accuracy rates of conventional vs. portal vein tracing methods were 71.7 % vs. 98.3 % for the anterior section lesions, 67.9 % vs. 96.2 % for the posterior section, and 28.6 % vs. 57.1 % for the border zone. The portal vein tracing method was more accurate than the conventional method (P<0.001). The portal vein tracing method should be used for sectional localization of HCCs in the right lobe, because it predicts the location more accurately than the conventional method. (orig.)

  8. Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: Implications for planning 90Y radioembolization?

    Energy Technology Data Exchange (ETDEWEB)

    Burgmans, M.C., E-mail: mburgmans@hotmail.com [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Too, C.W., E-mail: too.chow.wei@singhealth.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Kao, Y.H., E-mail: yung.h.kao@gmail.com [Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Goh, A.S.W., E-mail: anthony.goh.s.w@sgh.com.sg [Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Chow, P.K.H., E-mail: gsupc@singnet.com.sg [Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857 (Singapore); Department of Surgical Oncology, National Cancer Center Singapore, 11 Hospital Drive, Singapore 169610 (Singapore); Tan, B.S., E-mail: tan.bien.soo@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Tay, K.H., E-mail: tay.kiang.hiong@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore); Lo, R.H.G., E-mail: richard.lo.h.g@sgh.com.sg [Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608 (Singapore)

    2012-12-15

    Purpose: To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization. Material and methods: From August 2008 to November 2010, 79 patients (range 23–83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed. Results: A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p < 0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively. Conclusion: The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.

  9. Vascular complications (splenic and hepatic artery aneurysms) in the occipital horn syndrome: report of a patient and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Mentzel, H.-J. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)]|[Institute of Diagnostic and Interventional Radiology, Bachstrasse 18, D-07 740 Jena (Germany); Seidel, J.; Vogt, L. [Department of Paediatrics, University of Jena, Friedrich-Schiller-Universitaet Jena, Jena/Thueringen (Germany); Vogt, S.; Kaiser, W.A. [Institute of Diagnostic and Interventional Radiology, University of Jena (Germany)

    1999-01-01

    We report an 18-year-old boy with occipital horn syndrome who developed aneurysms of the splenic and hepatic arteries. Occipital horn syndrome, also called X-linked cutis laxa or Ehlers-Danlos syndrome (EDS) type IX, is characterised by a skeletal dysplasia which includes occipital horns, broad clavicles, deformed radii, ulnae and humeri, narrow rib cage, undercalcified long bones and coxa valga. Distinctive features common to all patients are unusual facial appearance, hypermobility of finger joints, limitation of extension of elbows, chronic diarrhoea and genitourinary abnormalities. In this case report we describe the difficulties encountered in the diagnostic management of patients with EDS-related vascular lesions. (orig.) With 5 figs., 2 tabs., 12 refs.

  10. Hepatitis B Virus Reactivation after Partial Hepatic Irradiation Alone: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Kyung [Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2010-11-15

    Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

  11. 氩氦刀冷冻消融联合TACE治疗巨大肝癌的临床观察∗%Clinical observation of argon-helium knife cryotherapy combined with transcatheter arterial chemoemboli-zation (TACE) on huge liver cancer

    Institute of Scientific and Technical Information of China (English)

    邱国钦; 许丽贞; 罗鹏飞; 陈玉强

    2015-01-01

    Objective To explore the efficacy and safety of argon⁃helium knife cryotherapy combined with transcatheter arte⁃rial chemoembolization ( TACE) on huge hepatocellular carcinoma. Methods Eighty⁃five patients with huge liver cancer from Septem⁃ber 2006 to August 2011 were analyzed retrospectively. Observation group ( n=44) received one to two TACE and one to three argon⁃helium knife cryotherapy after one month sequently, while the control group ( n=41) received TACE treatment only. Response to chemotherapy was assessed by RECIST criteria 1. 0 and follow⁃up data was investigated. Results The response rate of observation group was 70. 5%, higher than 46. 3% of the control group (P<0. 05). The 1⁃, 2⁃, 3⁃year survival rates of observation group were 77. 3%, 56. 8% and 36. 4%, and medium overall survival time was 19. 2 months, which were all higher than the 51. 2%, 36. 6%, 14. 6% and 11. 8 months of control group ( P<0. 05) . The adverse reaction of both groups were mild⁃to⁃moderate and tolerable. Con⁃clusion Argon⁃helium knife cryotherapy combined with TACE has synergism effect and minimally invasive, and provide a new regiem for comprehensive treatment on huge hepatocellular carcinoma.%目的:探讨氩氦刀冷冻消融联合经肝动脉化疗栓塞( TACE)治疗巨大肝癌的有效性和安全性。方法回顾性分析本院2006年9月至2011年8月收治的巨大肝癌患者85例,其中观察组44例先行1~2次TACE,1个月后序贯氩氦刀治疗1~3次,而对照组41例仅行单纯TACE治疗。按照实体瘤的疗效评价标准( RECIST)1.0版评价疗效并随访生存。结果观察组有效率( RR)为70.5%,高于对照组的46.3%( P<0.05);观察组1、2和3年生存率分别为77.3%、56.8%和36.4%,中位生存时间为19.2个月,均高于对照组的51.2%、36.6%、14.6%和11.8个月( P<0.05);两组患者的不良反应均为轻中度且可耐受。

  12. Unusual biliary scan appearance in a child with a transplanted liver with hepatic arterial thrombosis: a case report.

    Science.gov (United States)

    Porn, U; Howman-Giles, R; Shun, A; Dorney, S; Uren, R

    2000-02-01

    A 5-year-old girl with biliary atresia and a subsequent Kasai procedure is described. She had clinical symptoms suggestive of rejection after a recent orthotopic liver transplant A hepatobiliary scan showed partial hepatic infarction and a biloma in the infarcted area.

  13. Transcatheter intra-arterial infusion of doxorubicin loaded porous magnetic nano-clusters with iodinated oil for the treatment of liver cancer.

    Science.gov (United States)

    Jeon, Min Jeong; Gordon, Andrew C; Larson, Andrew C; Chung, Jin Wook; Kim, Young Il; Kim, Dong-Hyun

    2016-05-01

    A promising strategy for liver cancer treatment is to deliver chemotherapeutic agents with multifunctional carriers into the tumor tissue via intra-arterial (IA) transcatheter infusion. These carriers should release drugs within the target tissue for prolonged periods and permit intra-procedural multi-modal imaging of selective tumor delivery. This targeted transcatheter delivery approach is enabled via the arterial blood supply to liver tumors and utilized in current clinical practice which is called chemoembolization or radioembolization. During our study, we developed Doxorubicin (Dox) loaded porous magnetic nano-clusters (Dox-pMNCs). The porous structure and carboxylic groups on the MNCs achieved high-drug loading efficiency and sustained drug release, along with magnetic properties resulting in high MRI T2-weighted image contrast. Dox-pMNC within iodinated oil, Dox-pMNCs, and Dox within iodinated oil were infused via hepatic arteries to target liver tumors in a rabbit model. MRI and histological evaluations revealed that the long-term drug release and retention of Dox-pMNCs within iodinated oil induced significantly enhanced liver cancer cell death.

  14. Rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases following combined loco-regional therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei [Dept. of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore (Singapore)

    2013-08-15

    This manuscript describes an unusual case of rapid intra-hepatic dissemination of hepatocellular carcinoma with pulmonary metastases occurring 1 month after combined chemoembolization and radiofrequency ablation. Inferior vena cava and portal vein invasion tumor thrombus was also detected, possibly accounting for the mechanism of disease dissemination route of disease.

  15. Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

    Science.gov (United States)

    McCurdy, Heather M

    2013-01-01

    Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

  16. Intra-arterial embolotherapy for intrahepatic cholangiocarcinoma: update and future prospects

    Science.gov (United States)

    Savic, Lynn Jeanette; Chapiro, Julius

    2017-01-01

    Intrahepatic cholangiocarcinoma (ICC) is a rare disease and carries a poor prognosis with surgery remaining the only curative treatment option. However, due to the late presentation of symptoms and close proximity of the tumors to central hepatic structures, only about 30% of patients are classified eligible to resection. As for palliative approaches, ICC constitutes a possible indication for loco-regional therapies (LRT). As such, intra-arterial therapies (IAT) are reported to be feasible, safe and effective in inducing tumor response in unresectable ICC. The paradigm of IAT is premised on the selective delivery of embolic, chemotherapeutic agents to the tumor via its feeding arteries, thus allowing dose escalation within the carcinoma and reduction of systemic toxicity. Conventional transcatheter arterial chemoembolization (cTACE) so far remains the most commonly used IAT modality. However, drug-eluting beads (DEB)-TACE was initiated with the idea of more selective targeting of the tumor owing to the combined embolizing as well as drug-eluting properties of the microspheres used in this setting. Moreover, radioembolization is performed by intra-arterial administration of very small spheres containing β-emitting yttrium-90 (Y90-RE) to the site of the tumor. Clinical evidence exists in support of survival benefits for IAT in the palliative treatment of ICC compared to surgery and systemic chemotherapy. As for combination regimens, cTACE, DEB-TACE and Y90-RE are reported to achieve conversion of patients to surgery in a sequential treatment planning and simultaneous IAT combinations may provide a therapeutic option for treatment escalation. Regarding the current status of literature, controlled randomized prospective trials to compare different IAT techniques and combination therapies as well as treatment recommendations for different IAT modalities are needed. PMID:28261591

  17. Hepatic Arterial Phase on Gadoxetic Acid-Enhanced Liver MR Imaging: A Randomized Comparison of 0.5 mL/s and 1 mL/s Injection Rates

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Mo; Heo, Suk Hee; Kim, Jin Woong; Lim, Hyo Soon; Jeong, Yong Yeon; Kang, Heoung Keun [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Sang Soo [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2014-10-15

    To compare gadoxetic acid injection rates of 0.5 mL/s and 1 mL/s for hepatic arterial-phase magnetic resonance (MR) imaging. In this prospective study, 101 consecutive patients with suspected focal liver lesions were included and randomly divided into two groups. Each group underwent dynamic liver MR imaging using a 3.0-T scanner after an intravenous injection of gadoxetic acid at rates of either 0.5 mL/s (n = 50) or 1 mL/s (n = 51). Arterial phase images were analyzed after blinding the injection rates. The signal-to-noise ratios (SNRs) of the liver, aorta, portal vein, hepatic vein, spleen, and pancreas were measured. The contrast-to-noise ratios (CNRs) of the hepatocellular carcinomas (HCC) were calculated. Finally, two experienced radiologists were independently asked to identify, if any, HCCs in the liver on the images and score the image quality in terms of the presence of artifacts and the proper enhancement of the liver, aorta, portal vein, hepatic vein, hepatic artery, spleen, pancreas, and kidney. The SNRs were not significantly different between the groups (p = 0.233-0.965). The CNRs of the HCCs were not significantly different (p = 0.597). The sensitivity for HCC detection and the image quality scores were not significantly different between the two injection rates (p = 0.082-1.000). Image quality and sensitivity for hepatic HCCs of arterial-phase gadoxetic acid-enhanced MR were not significantly improved by reducing the contrast injection rate to 0.5 mL/s compared with 1 mL/s.

  18. Efficacy and safety of transarterial chemoembolization combined to conformal radiotherapy for uninodular hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Philippe Merle

    2014-12-01

    Full Text Available Purpose: A proportion of patients with uninodular hepatocellular carcinoma (HCC cannot benefit from potential curative therapies such as liver transplantation, surgical resection or radiofrequency ablation. Thus, they are prone to receive transarterial chemoembolization (TACE that is a palliative option with low probability of both complete response and prolonged local control. Herein, we assessed the combination of TACE and 3D-high dose conformal radiotherapy (3D-HDCRT for efficacy and safety in HCC. Methods: We retrospectively analyzed the outcome of 35 consecutive patients with uninodular HCC ≤ 100 mm, treated by one course of TACE combined to 3D-HDCRT. The follow-up consisted on clinics, biology, hepatic CT-scan or MRI at month-1 and -3, and thereafter every 3 months. Results: Complete response was obtained in 80% of patients following mRECIST criteria (95% in HCC ≤ 50 mm, and 60% in HCC > 50 mm with uncommon local recurrence (11%, overall survival rates of 79%, 59% and 44% at respectively 1, 2 and 3 years (median, 37.3 months, and 11.4% grade-3/4 toxicities. Pre-therapeutic α-fetoprotein level ≥ 200 ng/mL was found as a strong predictor of poorer outcome. Conclusion: We showed that TACE combined to 3D-HDCRT can be highly efficient to reach local control and interesting overall survival rates for uninodular HCC, with limited severe toxicities for Child-Pugh A patients. Subsequent prospective controlled trials are warranted for comparison with therapeutic standards.

  19. Arterio-portal shunts in the cirrhotic liver: perfusion computed tomography for distinction of arterialized pseudolesions from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Michael A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Karolinska Institutet, Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Marquez, Herman P.; Gordic, Sonja; Alkadhi, Hatem [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Leidner, Bertil; Aspelin, Peter; Brismar, Torkel B. [Karolinska Institutet, Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Klotz, Ernst [Computed Tomography and Radiation Oncology, Siemens Healthcare, Forchheim (Germany)

    2017-03-15

    To determine perfusion computed tomography (P-CT) findings for distinction of arterial pseudolesions (APL) from hepatocellular carcinoma (HCC) in the cirrhotic liver. 32 APL and 21 HCC in 20 cirrhotic patients (15 men; 65 ± 10 years), who underwent P-CT for evaluation of HCC pre- (N = 9) or post- (N = 11) transarterial chemoembolization, were retrospectively included using CT follow-up as the standard of reference. All 53 lesions were qualitatively (visual) and quantitatively (perfusion parameters) analysed according to their shape (wedge, irregular, nodular), location (not-/adjunct to a fistula), arterial liver perfusion (ALP), portal venous liver perfusion (PLP), hepatic perfusion index (HPI). Accuracy for diagnosis of HCC was determined using receiver operating characteristics. 18/32 (56 %) APL were wedge shaped, 10/32 (31 %) irregular and 4/32 (12 %) nodular, while 11/21 (52 %) HCC were nodular or 10/21 (48 %) irregular, but never wedge shaped. Significant difference between APL and HCC was seen for lesion shape in pretreated lesions (P < 0.001), and for PLP and HPI in both pre- and post-treated lesions (all, P < 0.001). Diagnostic accuracy for HCC was best for combined assessment of lesion configuration and PLP showing an area under the curve of 0.901. Combined assessment of lesion configuration and portal venous perfusion derived from P-CT allows best to discriminate APL from HCC with high diagnostic accuracy. (orig.)

  20. CT perfusion imaging in assessing the effect of primary hepatic carcinoma after intervention treatment%CT灌注成像对原发性肝癌介入术后疗效的评价

    Institute of Scientific and Technical Information of China (English)

    王宇超; 申宝忠; 张同; 王丹; 秦海燕

    2013-01-01

    Objective To discuss the value of CT perfusion imaging( CTPI )in determining the effet of primary hepatic carcinoma(PHC )after intervention treatment. Methods 33 patients with hepatocellular carcinoma who agreed to accept transcatheter arterial chemoembolization( TACE )were involved in this study. Lesions were solitary. CTPI, enhanced CT and digital subtraction angiography( DSA )were performed one week before and one month after treatment. Taking DSA as the "gold standard" ,the acquired blood perfusion colour - picture and the perfusion parameters were analyzed and compared to access the value of CTPI in determining the effect of PHC after TACE. Results Compared with preoperative tumor tissue,the values of the hepatic arterial perfusion ( HAP ),the hepatic perfusion index( HPI )and the total hepatic blood flow( THBF )of the postoperative one were decreased significantly( P 0. 05 ), and there was no blood supply in the lipiodol deposition or tumor necrosis area, the time density curve( TDC )of which showed a horizontal line, and compared with preoperative surrounding normal liver tissue. The CTPI value of the postoperative one had no significant change( P >0. 05 ). CTPI diagnosis accuracy was 93. 94% ; sensitivity was 100% ,and specificity was 77. 78% . CTPI on the detection of residual or recurrent hepatocellular carcinoma had a good agreement with DSA( kappa = 0. 836,P =0. 000 ). Conclusion CTPI can well reflect the blood supply of the local lesion and the surrounding normal hepatic tissue after TACE. It can partly replace DSA to evaluate the effect of PHC after TACE.%目的 探讨CT灌注成像(CT perfusion imaging,CTPI)在评价原发性肝癌(Primary hepatic carcinoma,PHC)行经导管动脉化疗栓塞术(Transcatheter arterial chemoembolization,TACE)后的疗效方面的价值.方法 收集患有PHC并行TACE术的患者33例,病灶均为单发,所有病例于TACE术前1周及术后1个月行64排CTPI、CT增强和血管造影(Digital subtraction angiography

  1. Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Wael E. A., E-mail: wspikes@yahoo.com; Dasgupta, Niloy; Lippert, Allison J.; Turba, Ulku C.; Davies, Mark G. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Kumer, Sean [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Gardenier, Jason C.; Sabri, Saher S.; Park, Auh-Whan [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Waldman, David L. [University of Rochester Medical Center, Department of Imaging Sciences (United States); Schmitt, Timothy [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Matsumoto, Alan H.; Angle, John F. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)

    2013-02-15

    To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated. Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were 'iatrogenic' (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively. Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.

  2. Added value of arterial enhancement fraction color maps for the characterization of small hepatic low-attenuating lesions in patients with colorectal cancer.

    Directory of Open Access Journals (Sweden)

    Mina Park

    Full Text Available To assess the added value of arterial enhancement fraction (AEF color maps for the differentiation of small metastases from hepatic benign lesions.We retrospectively analyzed 46 patients with colorectal cancer who underwent multiphasic liver CT imaging and had low-attenuating liver lesions smaller than 3 cm (123 total lesions; metastasis: benign = 32:91. AEF color maps of the liver were created from multiphasic liver CT images using dedicated software. Two radiologists independently reviewed multiphasic CT image sets alone and in combination with image sets with AEF color maps using a five-point scale. The additional diagnostic value of the color maps was assessed by means of receiver-operating characteristic (ROC analysis.The area under the ROC curve (Az increased when multiphasic CT images were combined with AEF color map analysis as compared with evaluation based only on multiphasic CT images (from 0.698 to 0.897 for reader 1, and from 0.825 to 0.945 for reader 2; P < 0.001 and 0.002, respectively. The increase Az was especially significant for lesions less than 1 cm (from 0.702 to 0.888 for reader 1, and from 0.768 to 0.958 for reader 2; P = 0.001 and P = 0.001, respectively. The mean AEF of tumor-adjacent parenchyma (35.07 ± 27.2 was significantly higher than that of tumor-free liver parenchyma (27.3 ± 20.6 (P = 0.04.AEF color mapping can improve the diagnostic performance for small hepatic metastases from colorectal cancer and may allow for the elimination of additional examinations.

  3. Liver and biliary damages following transarterial chemoembolization of hepatocellular carcinoma: comparison between drug-eluting beads and lipiodol emulsion

    Energy Technology Data Exchange (ETDEWEB)

    Monier, Arnaud; Duran, Rafael; Bize, Pierre; Dunet, Vincent; Denys, Alban [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Guiu, Boris [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Montpellier University Hospital, Department of Diagnostic and Interventional Radiology, Montpellier (France); Aho, Serge [University Hospital, Department of Epidemiology, Dijon (France); Deltenre, Pierre [Lausanne University Hospital, Department of Gastroenterology, Lausanne (Switzerland)

    2017-04-15

    To compare transarterial chemoembolization (TACE)-related hepatic toxicities of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) in patients with intermediate-stage hepatocellular carcinoma. In this retrospective study, 151 consecutive patients undergoing cTACE or DEB-TACE and MRI 3-6 weeks before and after therapy were included. Toxicity was assessed on imaging (global hepatic damages (GHD), overall biliary injuries, biliary cast, bile duct dilatation, intrahepatic biloma, portal thrombosis), and clinico-biological follow-ups. Tumour response, time to progression (TTP), and overall survival were assessed. Factors influencing complication rate were identified by generalized equation logistic regression model. Biliary injuries and intrahepatic biloma incidence were significantly higher following DEB-TACE (p < 0.001). DEB-TACE showed a significant increased risk of GHD (OR: 3.13 [1.74-5.63], p < 0.001) and biliary injuries (OR: 4.53 [2.37-8.67], p < 0.001). A significant relationship was found between baseline prothrombin value and GHD, biliary injuries and intrahepatic biloma (all p < 0.01), and between the dose of chemotherapy and intrahepatic biloma (p = 0.001). Only TTP was significantly shorter following DEB-TACE compared to cTACE (p = 0.025). DEB-TACE was associated with increased hepatic toxicities compared to cTACE. GHD, biliary injuries, and intrahepatic biloma were more frequently observed with high baseline prothrombin value, suggesting that cTACE might be more appropriate than DEB-TACE in patients with less advanced cirrhosis. (orig.)

  4. Efficacy comparison between hepatic arterial infusion chemotherapy plus systemic chemotherapy used as first-line and non-first-line treatments for the patients of colorectal cancers with unresectable hepatic metastases

    Institute of Scientific and Technical Information of China (English)

    Ping Chen; Bei Zhang; Guifang Guo; Liangping Xia; Huijuan Qiu

    2014-01-01

    Objective:The combination of hepatic arterial chemotherapy (HAIC) and systemic chemotherapy (SYC) has potential ef ect on colorectal cancer (CRC) patients with unresectable hepatic metastasis. The aim of this retrospective study was to investigate the ef icacy and safety of this combined therapeutic regimen on Chinese patients based on single institute experiences. Methods:Al 54 patients of this retrospective analysis were diagnosed with CRC with unresectable liver metas-tasis and received combined HAIC and SYC. Among the patients, 23 of them received HAIC plus SYC when they developed liver metastases as first-line treatment (Group 1), and 31 patients received HAIC plus SYC as non-first-line treatment (Group 2). The dif erent ef icacy in two groups was analyzed by SPSS 19.0. Results:The overal response rate (ORR) were 52.2%and 25.8%respectively in Groups 1 and 2 (P=0.047), and the disease control rate (DCR) were 65.2%and 35.5%respec-tively in Groups 1 and 2 (P=0.031). The median progression-free survival (PFS) were 6.8 and 3.3 months (P=0.002), the median hepatic progression-free survival (H-PFS) were 8.8 and 3.7 months (P=0.001), and the median overal survival (OS) were 18.8 and 13.7 months (P=0.121) in Groups 1 and 2, respectively. No fatal reaction was observed and no significant dif erence of adverse reaction was found in two groups. Grade 3/4 toxic ef ects included neutropenia (9.7%in Group 2 only), gastrointestinal reaction (8.7%in Group 1 and 6.5%in Group 2), stomatitis (6.5%in Group 2 only) and hyperbilirubinemia (4.3%in Group 1 only). Conclusion:HAIC combined with SYC showed promising ef icacy and safe profiles on CRC patients with unresectable liver metastases.

  5. Association between the Hepatic Lipase Promoter Region Polymorphism (-514 C/T and the Presence and Severity of Premature Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Hamidreza Goodarzynejad

    2017-06-01

    Full Text Available Background: Hepatic lipase (HL plays a crucial role in lipid metabolism, but there is debate about whether HL acts in a more pro- or more anti-atherogenic fashion. We aimed to examine the relationship between the -514 C/T polymorphism within the HL gene (LIPC and the risk of angiographically determined premature coronary artery disease (CAD.Methods: Four hundred seventy-one patients with newly diagnosed angiographically documented (≥ 50% luminal stenosis of any coronary vessel premature CAD were compared to 503 controls (subjects with no luminal stenosis in coronary arteries. A real-time polymerase chain reaction and high-resolution melting analysis was used to distinguish between the genotypes.Results: There was no significant difference in the distribution of -514 C/T genotypes between the 2 groups in the whole population or in the men, but the examined polymorphism was found to be associated with the presence of CAD in the women (p value = 0.029. After the application of a multiple logistic regression model, the minor T allele of the LIPC gene was not found to be independently associated with the presence of CAD either in the total population (adjusted OR = 0.97, 95% CI = 0.75-1.25; p value = 0.807 or in the women (adjusted OR = 0.91, 95% CI = 0.59-1.40; p value = 0.650 and in the men (adjusted OR = 1.15, 95% CI = 0.81-1.64; p value = 0.437 separately.Conclusion: Our findings suggest that there is no relationship between the LIPC -514 C/T and the risk of premature CAD or its severity in patients undergoing coronary angiography.

  6. Association of hepatic lipase -514T allele with coronary artery disease and ankle-brachial index, dependence on the lipoprotein phenotype: the GENES study.

    Directory of Open Access Journals (Sweden)

    Céline Verdier

    Full Text Available OBJECTIVES: Relationship between hepatic lipase (LIPC polymorphism and coronary artery disease (CAD has often led to contradictory results. We studied this relation by genotyping rs1800588 in the LIPC promoter in a case-control study on CAD (the GENES study. We also investigated the relationship between this polymorphism and the ankle-brachial index (ABI, which is predictive of atherosclerosis progression and complications in patients at high cardiovascular risk. METHODS: 557 men aged 45-74 with stable coronary artery disease and 560 paired controls were genotyped for rs1800588. Medical data, clinical examination including determination of ABI and biological measurements related to cardiovascular risk factors enabled multivariate analyses and multiple adjustments. RESULTS: CAD cases showed a higher T-allele frequency than controls (0.246 vs 0.192, p = 0.003. An interaction has been found between LIPC polymorphism and triglycerides (TG levels regarding risk of CAD: TT-homozigosity was associated with an Odds ratio (OR of 6.4 (CI: 1.8-22.3 when TG were below 1.5 g/L, but no association was found at higher TG levels (OR = 1.34, CI: 0.3-5.9. The distribution of LIPC genotypes was compared between CAD patients with normal or abnormal ABI and impact of LIPC polymorphism on ABI was determined. Following multiple adjustments, association of the T-allele with pejorative ABI (<0.90 was significant for heterozygotes and for all T-carriers (OR = 1.55, CI: 1.07-2.25. CONCLUSION: The -514T LIPC allele is associated with CAD under normotriglyceridemic conditions and constitutes an independent determinant of pejorative ABI in coronary patients.

  7. [A case report-advanced pancreas cancer with liver and lung metastases well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting].

    Science.gov (United States)

    Hasuike, Yasunori; Tanigawa, Takahiko; Yamada, Masaharu; Minami, Yukiko; Ezumi, Koji; Kashiwazaki, Masaki; Fujimoto, Takayoshi

    2008-11-01

    We report a case of advanced pancreatic cancer with liver and lung metastases that was well controlled over one year by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion in an outpatient setting. The patient was a 74-year-old woman. Chief complaints were back pain and anorexia. She was diagnosed with pancreas cancer with liver and lung metastases at the time of first visit. We started systemic chemotherapy with gemcitabine 1 g/body and 5-FU 1 g/body alternately every other week on an outpatient basis. At 1.5 months (M) after initiation of chemotherapy, we started radiation therapy to the main tumor at a total dose of 40 Gy. After radiation, chemotherapy was resumed. As a result, the size of the main tumor decreased but metastatic liver tumors got larger. Then we changed to combination therapy with systemic chemotherapy (gemcitabine and 5-FU) and hepatic arterial infusion (5-FU weekly). Liver metastases almost disappeared after 7.5 M. Despite all these treatments, however, the number of metastatic lung tumors increased. The patient was hospitalized for 15 M and died after 17 M. We focused on and succeeded in the prolongation of lifetime and maintenance of QOL by combination therapy with systemic chemotherapy, radiation and hepatic arterial infusion therapy.

  8. Cerebral blood flow measured by arterial-spin labeling MRI: A useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis

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    Zheng, Gang [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002 (China); College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016 (China); Zhang, Long Jiang, E-mail: kevinzhlj@163.com [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002 (China); Zhong, Jianhui [Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Box648, 601 Elmwood Avenue, Rochester, NY 14642-8648 (United States); Wang, Ze [Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3900 Chestnut St., Philadelphia, PA 19104 (United States); Qi, Rongfeng; Shi, Donghong [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002 (China); Lu, Guang Ming, E-mail: cjr.luguangming@vip.163.com [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002 (China)

    2013-11-01

    Purpose: To investigate the role of arterial-spin labeling (ASL) MRI to non-invasively characterize the patterns of cerebral blood flow (CBF) changes in cirrhotic patients and to assess the potential of ASL MRI to characterize minimal hepatic encephalopathy (MHE). Materials and methods: This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Thirty six cirrhosis patients without overt hepatic encephalopathy (16 MHE patients and 20 non hepatic encephalopathy (non-HE) patients) and 25 controls underwent ASL MRI, and CBF was measured for each subject. One-way ANOCOVA test with age and gender as covariences was used to compare CBF difference among three groups, and post hoc analysis was performed between each two groups. Region-based correlation analysis was applied between Child–Pugh score, venous blood ammonia level, neuropsychological tests and CBF values in cirrhosis patients. Receiver operator characteristic (ROC) analysis was used for assessing CBF measurements in ASL MRI to differentiate MHE from non-HE patients. Results: The gray matter CBF of MHE patients (71.09 ± 11.88 mL min{sup −1} 100 g{sup −1}) was significantly higher than that of non-HE patients (55.28 ± 12.30 mL min{sup −1} 100 g{sup −1}, P < 0.01) and controls (52.09 ± 9.27 mL min{sup −1} 100 g{sup −1}, P < 0.001). Voxel-wise ANOCOVA results showed that CBFs were significantly different among three groups in multiple gray matter areas (P < 0.05, Bonferroni corrected). Post hoc comparisons showed that CBF of these brain regions was increased in MHE patients compared with controls and non-HE patients (P < 0.05, Bonferroni corrected). CBF of the right putamen was of the highest sensitivity (93.8%) and moderate specificity (75.0%) for characterization of MHE when using the cutoff value of 50.57 mL min{sup −1} 100 g{sup −1}. CBFs in the bilateral median cingulate gyri, left supramarginal gyrus, right angular gyrus, right

  9. Primar y hepatic neuroendocrine carcinoma:clinical analysis of 11 cases

    Institute of Scientific and Technical Information of China (English)

    Yang-Qing Huang; Feng Xu; Jia-Mei Yang; Bin Huang

    2010-01-01

    BACKGROUND: Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare, and fewer than 300 cases have been reported in the English/Chinese-language literature, therefore it is dififcult to make a proper diagnosis and determine a therapeutic approach. METHODS: Eleven PHNEC patients were admitted to our hospital between January 1996 and May 2008. Laboratory examination, digestive endoscopy, B-ultrasonography, CT, MRI, or PET-CT were performed on the patients for preoperative diagnosis. All patients received liver resection. Some patients received transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection treatment (PEIT), or octreotide injection when a recurrence was found. The patients' clinical data were recorded and all patients were followed up. RESULTS: The patients were conifrmed pathologically as having PHNEC . Their median follow-up time was 33 months (12-107 months). All patients survived, and the longest post-operative survival time was 107 months, the longest disease-free survival time was 98 months, the 1-year survival rate was 100%, and the 1-year recurrence rate was 45.5%(5/11). CONCLUSIONS: Since PHNEC is easy to confuse with hepato-cellular carcinoma, careful screening of symptoms is needed to avoid misdiagnosis. Resection is the ifrst choice of treatment for PHNEC and provides the most favorable outcomes including long-term survival. Other treatment such as TACE and PEIT can be considered as well, especially when a tumor recurs.

  10. Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: a large cohort study.

    Science.gov (United States)

    Xue, Tongchun; Le, Fan; Chen, Rongxin; Xie, Xiaoying; Zhang, Lan; Ge, Ningling; Chen, Yi; Wang, Yanhong; Zhang, Boheng; Ye, Shenglong; Ren, Zhenggang

    2015-03-01

    Patients with huge hepatocellular carcinoma >10 cm in diameter represent a special subgroup for treatment. To date, there are few data and little consensus on treatment strategies for huge hepatocellular carcinoma. In this study, we summarized the effects and safety of transarterial chemoembolization for huge hepatocellular carcinoma. A retrospective study was performed based on a large cohort of patients (n = 511) with huge hepatocellular carcinoma who underwent serial transarterial chemoembolization between January 2008 to December 2011 and were followed up until March 2013. We found median survival time was 6.5 months. On multivariate analysis, Child-Pugh class (A versus B) (p huge hepatocellular carcinoma and is recommended as a component of combination therapy. In addition, patients with good liver function and low alpha-fetoprotein levels may acquire greater survival benefits from transarterial chemoembolization.

  11. 全肝CT灌注扫描对于介入术后肝肿瘤活性的观察%CT Perfusion imaging for whole liver: evaluating viable lesion after transarterial chemoembolization for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    陈广; 张宝丰; 肖国文

    2013-01-01

    目的 经动脉导管化疗栓塞术(transarterial chemoembolization,TACE)治疗后患者进行全肝灌注扫描,比较增强CT、全肝灌注扫描和DSA三种检查技术对TACE治疗后肝癌瘤灶活性的检出率.方法 17例经过穿刺病理或血清学证实的肝细胞癌患者曾经行TACE介入治疗:患者于介入术后4周行全肝脏CT灌注扫描.明确经过碘油栓塞治疗的病灶44个被列入观察中.肝脏灌注分数(hepatic arterial fracture,HAF)灌注图高参数信号作为判定术后瘤灶存有活性的标准.分别采用增强CT、全肝CT灌注成像和DSA判定介入治疗后肿瘤活性,最后对不同影像技术的肿瘤活性检出率进行比较.结果 DSA造影的肿瘤活性检出率最高,达86.36%,CTP的检出率84.09%,而增强CT扫描的检出率70.45%最低.并且与前两者相比有显著性差异(P=0.016和0.031).结论 作为无创性检查手段,CTP的肿瘤活性检出力明显强于增强CT,并且接近DSA造影.因此,全肝CT灌注扫描是一种有价值的观测肝癌介入治疗疗效的无创医疗技术.%Objective To compare the enhanced CT,DSA with CT-perfusion in detectability to viability of lesion after transarterial chemoembolization for hepatocellular.Methods 17 patients with histopathologically proven HCC underwent post-treatment CT perfusion examinations (4 weeks after TACE).In post-treatment CT-perfusion HAF image,The highlevel HAF was clue to viable lesion for hepatocellular carcinoma.McNemar Test was used to compare the differences in detectability to viability of lesion between enhanced CT,DSA with CT-perfusion.Results 44 lesions were involved in this study.The detectability to viability of lesion of DSA and CT-perfusion were superior to enhanced CT,and their differences were statistically significant between DSA,CT-perfusion and enhanced CT (P =0.016 and 0.031,respectively).Conclusion CT perfusion imaging for whole liver is a feasible technique for monitoring viability of lesion and

  12. Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization

    Energy Technology Data Exchange (ETDEWEB)

    Schernthaner, Ruediger Egbert [The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (United States); Lin, MingDe [Philips Research North America, Ultrasound and Interventions (United States); Duran, Rafael; Chapiro, Julius; Wang, Zhijun; Geschwind, Jean-François, E-mail: jfg@jhmi.edu [The Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology (United States)

    2015-08-15

    PurposeTo evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.MethodsThis retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI.ResultsOf 61 ICC lesions, only 45.9 % were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8 % and 93.4 %, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5 %) and 30 (90.9 %) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7 %) compared to EAP (31.1 %) and DSA (21.3 %) (p < 0.01).ConclusionDPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE.

  13. Hemobilia secondary to hepatic artery pseudoaneurysm:An unusual complication of bile leakage in a patient with a history of a resected Ⅲb Klatskin tumor

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Siablis; Zafiria G. Papathanassiou; Dimitrios Karnabatidis; Nikolaos Christeas; Constantine Vagianos

    2005-01-01

    we report a case of a 74-year-old woman with a 16-year history of a double bilo-enteric anastomosis due to resected hilar cholangiocarcinoma [Type Ⅲb Klatskin tumor]. The patient presented with cholangitis secondary to benign anastomotic stenosis which resulted in a large intrahepatic biloma. In order to restore the patency of the anastomosis and overcome cholangitis, several attempts took place,including endobiliary stenting, balloon-assisted biloplasty and transhepatic billiary drainage. Anastomotic patencywas achieved, complicated, however, by persistent upper gastro-intestinal bleeding, presented as hemobilia. A biloma-induced pseudoaneurysm of the left hepatic artery was diagnosed. This had ruptured into the biliary tract,and presented the actual cause of the hemobilia. Selective embolism of the pseudoaneurysm resulted in control of the hemorrhage, and was successfully combined with transhepatic dilatation of the anastomosis and percutaneous drainage of the biloma. The patient was ultimately cured and seems to be in excellent condition, 5 mo after treatment.

  14. Can the Splenic Artery Resistive Index Be an Ancillary Sign on Ultrasound for the Differentiation of Alcoholic Cirrhosis from Hepatitis B-virus Related Cirrhosis?

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    Byun, Joo Nam; Kim, Dong Hun [Chosun University Hospital, Gwangju (Korea, Republic of)

    2007-06-15

    We wanted to assess the usefulness of the splenic artery resistive index (RIS) for differentiating between alcoholic cirrhosis (AC) and hepatitis B-virus related cirrhosis (VC). A total of 109 subjects (28 normal healthy controls, 38 patients with VC and 43 patients with AC) were included in this study. The spleen sizes, Child-Pugh scores and RISs were compared between the two cirrhotic groups. The receiver op