Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter
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To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for detecting leakage of the double-balloon catheter used for chemosaturation percutaneous hepatic perfusion (CS-PHP).
Materials and Methods
Overall, 112 CS-PHP (09/2015-09/2018) in 52 patients were retrospectively screened for leakage alongside the double-balloon catheter on standard venograms. Finally, 18 procedures with visually detected leakage were included. Fifteen consecutive procedures without leakage served as control. To evaluate 2D-PA for leakage detection, the acquired digital subtraction venograms were post-processed. For each balloon, two different target ROIs were evaluated to assess a possible impact of localization and shape of the ROIs. Time to peak (TTP), peak density (PD), area under the curve (AUC), and ratios of target ROI/reference ROIs (PDtROI/PDREF; AUCtROI/AUCREF; and TTPtROI/TTPREF) were calculated.
Leakages were located as follows: 15/18 cranial and 3/18 caudal. At the cranial balloon both ROIs showed a significant decrease in PDtROI/PDREF and AUCtROI/AUCREF (ROI1: p < 0.0001; p < 0.0001; ROI2: p < 0.0001; p < 0.0001) and a significant increase in TTPtROI/TTPREF (ROI1: p = 0.0009; ROI2: p = 0.0003) after double-balloon correction. Following balloon adjustment, the 2D-PA ratios (PD and AUC) of the tested ROIs differed significantly (p < 0.05). The inter-individual comparison of the 2D-PA parameters of the group with leakage before balloon correction and the non-leakage group showed significantly different 2D-PA values for the cranial balloon in both ROIs (p < 0.05). No significant differences were found for the caudal balloon.
2D-PA provides a feasible tool for detecting leakages alongside the cranial portion of the double-balloon catheter used in CS-PHP. The shape and position of the ROIs used to assess perfusion and flow have an impact on the measurements.
Keywords2D-perfusion angiography Chemosaturation Percutaneous hepatic perfusion Double-balloon catheter Leakage
Activated clotting time
Area under the curve
Ratio of the target ROI to the reference ROI for AUC
Chemosaturation percutaneous hepatic perfusion
Digital subtraction angiography
Inferior vena cava
Ratio of the target ROI to the reference ROI for PD
Region of interest
Reference region of interest
Transjugular intrahepatic portosystemic shunt
Target region of interest
Time to peak
Ratio of the target ROI to the reference ROI for TTP
All authors significantly contributed to the design and composition, data analysis, and data interpretation for this study. Furthermore, all of the authors drafted the article or substantially revised it due to the important intellectual content. All of the authors gave their final consent for this version of the manuscript to be published.
Compliance with Ethical Standards
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Siemens Healthcare and ProMedicus (Bernhard Meyer and Frank Wacker, outside the submitted work). The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Our local ethics committee approved our protocol, and written informed consent was obtained from each study patient. The study follows the ethical standards of the Declaration of Helsinki. The article includes no identifying information.
Human and Animal Rights
This study follows the ethical standards of the Declaration of Helsinki. Animal studies are not part of this article (does not apply to this article).
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