RSS-Feed abonnieren
DOI: 10.1055/s-0029-1245192
© Georg Thieme Verlag KG Stuttgart · New York
Angiography-Based C-Arm CT for the Assessment of Extrahepatic Shunting before Radioembolization
Stellenwert der Rotationsangiographie für die Detektion extrahepatischer Shunts vor RadioembolisationPublikationsverlauf
received: 24.9.2009
accepted: 12.1.2010
Publikationsdatum:
24. Februar 2010 (online)
![](https://www.thieme-connect.de/media/roefo/201007/lookinside/thumbnails/10.1055-s-0029-1245192-1.jpg)
Zusammenfassung
Ziel: Beurteilung der Genauigkeit der Rotationsangiografie für die Detektion extrahepatischer Shunts vor Radioembolisation. Material und Methoden: 30 Patienten (Durchschnittsalter 64 ± 12 Jahre) mit hypervaskularisierten Lebertumoren wurden angiografiert; es wurden alle arteriellen gastrointestinalen Kollateralen des hepatischen Gefäßsystems coilembolisiert und die Mikrokatheterpositionen für die spätere SIRT festgelegt. Aus diesen 48 Positionen wurde eine Angiografie und Rotationsangiografie (XperCT®, Philips Healthcare) durchgeführt. Danach erhielten alle Patienten eine 99mTc-MAA-SPECT/CT. Die SPECT/CT diente als Referenzstandard zur Ermittlung der Genauigkeit der hepatischen Angiografie und der Rotationsangiografie für die Detektion extrahepatischer Shunts. Ergebnisse: Die SPECT/CT wies bei 5 Patienten extrahepatische Shunts nach (17 %). Bzgl. der Detektion extrahepatischer Shunts war die hepatische Angiografie bei 22 (73 %) Patienten richtig negativ, bei 5 (17 %) falsch negativ und bei 3 Patienten (10 %) unklar. Die Rotationsangiografie war richtig positiv bei 3 (10 %), richtig negativ bei 24 (80 %), falsch positiv bei 1 (3 %) und falsch negativ bei 2 Patienten (7 %). Die Spezifität und der NPV der Angiografie betrug 88 % bzw. 81 % die Sensitivität, Spezifität, der PPV, der NPV und die Genauigkeit der Rotationsangiografie betrugen 60 %, 96 %, 75 %, 92 % und 90 %. Schlussfolgerung: Die Rotationsangiografie bietet zusätzliche Informationen zur Angiografie bei der Detektion extrahepatischer Shunts vor SIRT. Aufgrund der genaueren Detektion extrahepatischer Shunts kann der Einsatz der Rotationsangiografie den Arbeitsablauf vor einer SIRT durch die Vermeidung unnötiger Reangiografien optimieren.
Abstract
Purpose: To retrospectively assess the accuracy of angiography-based C-arm CT for the detection of extrahepatic shunting before SIRT. Materials and Methods: 30 patients (mean age: 64 ± 12 years) with hypervascularized hepatic tumors underwent hepatic angiography, coil embolization of gastrointestinal collaterals and 99mTc-macroaggregated albumin (MAA) SPECT/CT before SIRT. Before MAA injection via a microcatheter from the intended treatment position, an angiography and angiography-based C-arm CT (XperCT™, Philips Healthcare) were acquired. Angiographies and XperCT™ were performed from 48 microcatheter positions followed by MAA injections and MAA-SPECT/CT. MAA-SPECT/CT served as the reference standard for determining the accuracy of hepatic arteriography and C-arm CT for the detection of extrahepatic shunting. Results: MAA-SPECT/CT revealed extrahepatic shunting in 5 patients (17 %). Hepatic arteriography yielded a true negative in 22 (73 %), a false negative in 5 (17 %), and an unclear result in 3 patients (10 %). C-arm CT yielded a true positive in 3 (10 %), true negative in 24 (80 %), false positive in 1 (3 %), and false negative in 2 patients (7 %). The specificity and the NPV of hepatic arteriography for the detection of extrahepatic shunting were 88 % and 81 %, respectively. For C-arm CT the sensitivity, specificity, PPV, NPV, and accuracy for the detection of extrahepatic shunting were 60 %, 96 %, 75 %, 92 %, and 90 %, respectively. Conclusion: C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies.
Key words
C - arm CT - SIRT - HCC - radioembolization
Reference
- 1 Hilgard P, Muller S, Hamami M. et al . Selektive interne Radiotherapie (Radioembolisation) und Strahlentherapie beim HCC-Stand und Perspektiven. Z Gastroenterol. 2009; 47 37-54
- 2 Jakobs T F, Hoffmann R T, Tatsch K. et al . Therapieresponse von Lebertumoren nach selektiver interner Radiotherapie. Radiologe. 2008; 48 839-849
- 3 Covey A M, Brody L A, Maluccio M A. et al . Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 2002; 224 542-547
- 4 Lewandowski R J, Sato K T, Atassi B. et al . Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol. 2007; 30 571-592
- 5 Salem R, Lewandowski R J, Sato K T. et al . Technical aspects of radioembolization with 90Y microspheres. Tech Vasc Interv Radiol. 2007; 10 12-29
- 6 Yarze J C, Hoffman M M. Another case of severe, chronically symptomatic, nonhealing gastroduodenal injury after radioembolization of hepatic tumor. Am J Gastroenterol. 2007; 102 2863
- 7 Carretero C, Munoz-Navas M, Betes M. et al . Gastroduodenal injury after radioembolization of hepatic tumors. Am J Gastroenterol. 2007; 102 1216-1220
- 8 Ogawa F, Mino-Kenudson M, Shimizu M. et al . Gastroduodenitis associated with yttrium 90-microsphere selective internal radiation: an iatrogenic complication in need of recognition. Arch Pathol Lab Med. 2008; 132 1734-1738
- 9 Leong Q M, Lai H K, Lo R G. et al . Radiation Dermatitis following Radioembolization for Hepatocellular Carcinoma: A Case for Prophylactic Embolization of a Patent Falciform Artery. J Vasc Interv Radiol. 2009; 20 833-836
- 10 Kluba T, Ruhle T, Schulze-Bovingloh A. et al . Reproduzierbarkeit der Befundung von lumbalen Pedikelschraubenpositionen mit ISO C 3D und CT. Fortschr Röntgenstr. 2009; 181 477-482
- 11 Dorfler A, Struffert T, Engelhorn T. et al . Flachdetektor-CT in der diagnostischen und interventionellen Neuroradiologie. Fortschr Röntgenstr. 2008; 180 891-898
- 12 Rabitsch E, Celedin S, Kau T. et al . Flachdetektor-CT als ergänzende Untersuchung bei der endoluminalen Behandlung von thorakalen und abdominellen Aortenaneurysmen – Erste klinische Erfahrungen. Fortschr Röntgenstr. 2008; 180 127-33
- 13 Hamami M E, Poeppel T D, Muller S. et al . SPECT/CT with 99mTc-MAA in Radioembolization with 90Y Microspheres in Patients with Hepatocellular Cancer. J Nucl Med. 2009; 50 688-692
- 14 Virmani S, Ryu R K, Sato K T. et al . Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. J Vasc Interv Radiol. 2007; 18 1305-1309
- 15 Jemal A, Murray T, Ward E. et al . Cancer statistics, 2005. CA Cancer J Clin. 2005; 55 10-30
- 16 Kulik L M, Mulcahy M F, Omary R A. et al . Emerging approaches in hepatocellular carcinoma. J Clin Gastroenterol. 2007; 41 839-854
- 17 Ibrahim S M, Lewandowski R J, Sato K T. et al . Radioembolization for the treatment of unresectable hepatocellular carcinoma: a clinical review. World J Gastroenterol. 2008; 14 1664-1669
- 18 Kennedy A S, Dezarn W A, McNeillie P. et al . Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol. 2008; 31 271-279
- 19 Vente M A, Wondergem M, Tweel van der I. et al . Yttrium-90 microsphere radioembolization for the treatment of liver malignancies: a structured meta-analysis. Eur Radiol. 2009; 19 951-959
- 20 Gates V L, Atassi B, Lewandowski R J. et al . Radioembolization with Yttrium-90 microspheres: review of an emerging treatment for liver tumors. Future Oncol. 2007; 3 73-81
- 21 Salem R, Thurston K G. Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3: comprehensive literature review and future direction. J Vasc Interv Radiol. 2006; 17 1571-1593
- 22 Salem R, Thurston K G. Radioembolization with 90yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 2: special topics. J Vasc Interv Radiol. 2006; 17 1425-1439
- 23 Salem R, Thurston K G. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: Technical and methodologic considerations. J Vasc Interv Radiol. 2006; 17 1251-1278
- 24 South C D, Meyer M M, Meis G. et al . Yttrium-90 microsphere induced gastrointestinal tract ulceration. World J Surg Oncol. 2008; 6 93
- 25 Yip D, Allen R, Ashton C. et al . Radiation-induced ulceration of the stomach secondary to hepatic embolization with radioactive yttrium microspheres in the treatment of metastatic colon cancer. J Gastroenterol Hepatol. 2004; 19 347-349
- 26 Thamboo T P, Wai C T, Lim L G. et al . Late gastric ulceration and cytomegalovirus infection following selective internal radiation therapy (SIRT) of the liver. Pathology. 2008; 40 303-305
- 27 Murthy R, Brown D B, Salem R. et al . Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy. J Vasc Interv Radiol. 2007; 18 553-61, quiz 562
- 28 Housseini A M, Bozlar U, Schmitt T M. et al . Comparison of three-dimensional rotational angiography and digital subtraction angiography for the evaluation of the liver transplants. Clin Imaging. 2009; 33 102-109
- 29 Kakeda S, Korogi Y, Ohnari N. et al . Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization. J Vasc Interv Radiol. 2007; 18 1508-1516
- 30 Takao H, Doi I, Watanabe T. Superselective transcatheter arterial chemoembolisation of an unresectable hepatocellular carcinoma using three-dimensional rotational angiography. Br J Radiol. 2007; 80 e85-7
- 31 Meyer B C, Frericks B B, Voges M. et al . Visualization of hypervascular liver lesions During TACE: comparison of angiographic C-arm CT and MDCT. Am J Roentgenol. 2008; 190 W263-W269
- 32 Liapi E, Hong K, Georgiades C S. et al . Three-dimensional rotational angiography: introduction of an adjunctive tool for successful transarterial chemoembolization. J Vasc Interv Radiol. 2005; 16 1241-1245
- 33 Tanigawa N, Komemushi A, Kojima H. et al . Three-dimensional angiography using rotational digital subtraction angiography: usefulness in transarterial embolization of hepatic tumors. Acta Radiol. 2004; 45 602-607
- 34 Wallace M J, Murthy R, Kamat P P. et al . Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. J Vasc Interv Radiol. 2007; 18 1500-1507
- 35 Kakeda S, Korogi Y, Hatakeyama Y. et al . The usefulness of three-dimensional angiography with a flat panel detector of direct conversion type in a transcatheter arterial chemoembolization procedure for hepatocellular carcinoma: initial experience. Cardiovasc Intervent Radiol. 2008; 31 281-288
- 36 Denecke T, Ruhl R, Hildebrandt B. et al . Planning transarterial radioembolization of colorectal liver metastases with Yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques. Eur Radiol. 2008; 18 892-902
- 37 Song S Y, Chung J W, Lim H G. et al . Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients. J Vasc Interv Radiol. 2006; 17 461-469
Dr. Till Alexander Heusner
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinik Essen
Hufelandstrasse 55
45147 Essen
Telefon: ++ 49/2 01/72 38 45 13
Fax: ++ 49/2 01/7 23 15 48
eMail: till.heusner@uni-due.de