Quantification of perfusion reduction by using 2D-perfusion angiography following transarterial chemoembolization with drug-eluting beads
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To analyze the feasibility of 2D-perfusion angiography (2D-PA) for the quantification of perfusion reduction following transarterial chemoembolization with drug-eluting beads (DEB-TACE).
Overall, 24 DEB-TACE procedures in 19 patients were included. To quantify changes in tumor perfusion following DEB-TACE using 2D-PA, the acquired digital subtraction angiography (DSA) series were post-processed. A reference region-of-interest (ROI) in a main hepatic artery and two, distal target ROIs in embolized tumor tissue and in non-target liver parenchyma were placed in corresponding areas on DSA pre- and post-DEB-TACE. The time to peak (TTP), peak density (PD), and the area under the curve (AUC) were assessed and the ratios reference ROI/target ROIs were calculated.
In the embolized tumor, the 2D-PA ratios changed significantly (p < 0.05) after DEB-TACE, whereas no significant change was observed for non-target liver parenchyma (p > 0.05). PDtumor/PDinflow differed significantly to PDparenchyma/PDinflow pre-DEB-TACE (p < 0.0001), likewise AUCtumor/AUCinflow to AUCparenchyma/AUCinflow (p < 0.0001) with higher values in tumor tissue. The post-DEB-TACE ratios of AUC decreased significantly in the tumor tissue compared to the non-target liver parenchyma (p < 0.05).
2D-PA offers an objective approach to quantify the immediate perfusion reduction of embolized tumor tissue following DEB-TACE and may therefore be used to monitor peri-interventional stasis and to quantify technical success.
Keywords2D-perfusion angiography Transarterial chemoembolization Hepatocellular carcinoma Drug-eluting beads transarterial chemoembolization Drug-eluting beads Digital subtraction angiography
Area under the curve
Balloon pulmonary angioplasty
C-Arm computed tomography
Common hepatic artery
Chronic thromboembolic pulmonary hypertension
Conventional transarterial chemoembolization with Lipiodol
Digital subtraction angiography
Drug-eluting beads transarterial chemoembolization
Magnetic resonance imaging
Subjective angiographic chemoembolization endpoint scale
Time to peak
All authors substantially contributed to the conception and design, acquisition of data or analysis and interpretation of data for this work. All authors drafted the article or substantially revised it due to the important intellectual content. All authors gave final approval of this version of the manuscript to be published.
Compliance with ethical standards
The study was funded in parts by personal grants from the “Junge Akademie”.
Conflict of interest statement
Jan Hinrichs, Sabine Maschke, Thomas Rodt, Julius Renne, Roman Klöckner, Thomas Werncke, Matha Kirstein, Arndt Vogel: No conflict of interest. Frank Wacker: Grants from Siemens Healthcare, grants from DFG, Rebirth-Cluster of Excellence, grants from BMBF, German Centre for Lung Research (DZL), grants from Promedicus Ltd., outside the submitted work. Bernhard Meyer: Grants from Siemens Healthcare, during the conduct of the study; grants from Promedicus Ltd., outside the submitted work.
Statement of informed consent and human rights
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 (does not apply to this article).
Statement of human rights and animal rights
The study follows the ethical standards of the Declaration of Helsinki. Animal studies are not part of this article (does not apply to this article).
- 5.Coldwell DM, Stokes KR, Yakes WF. (1994) Embolotherapy: agents, clinical applications, and techniques. Radiographics 14: 623–43– quiz 645–6. doi: 10.1148/radiographics.14.3.8066276
- 7.Geschwind J-FH, Ramsey DE, Cleffken B, et al. (2003) Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency. Cardiovasc Interv Radiol 26:111–117. doi: 10.1007/s00270-002-2524-6 CrossRefGoogle Scholar
- 13.Hinrichs JB, Murray T, Akin M, et al. (2017) Evaluation of a novel 2D perfusion angiography technique independent of pump injections for assessment of interventional treatment of peripheral vascular disease. Int J Cardiovasc Imaging. 33:295–301. doi: 10.1007/s10554-016-1008-8 CrossRefPubMedGoogle Scholar
- 15.Lin Y-Y, Lee R-C, Guo W-Y, et al. (2016) Quantitative real-time fluoroscopy analysis on measurement of the hepatic arterial flow during transcatheter arterial chemoembolization of hepatocellular carcinoma: comparison with quantitative digital subtraction angiography analysis. Cardiovasc Interv Radiol 39:1557–1563. doi: 10.1007/s00270-016-1421-3 CrossRefGoogle Scholar
- 19.Schoenfeld C, Cebotari S, Hinrichs J, et al. (2016) MR Imaging-derived regional pulmonary parenchymal perfusion and cardiac function for monitoring patients with chronic thromboembolic pulmonary hypertension before and after pulmonary endarterectomy. Radiology. 279:925–934. doi: 10.1148/radiol.2015150765 CrossRefPubMedGoogle Scholar