To determine if there are differences in hepatic distribution of embolic particles following infusion with a standard end-hole catheter versus an antireflux microcatheter.
Materials and Methods
This prospective study included nine patients (age, 48–86 y) enrolled for treatment of hepatocellular carcinoma (n ¼ 6), liver-dominant metastatic disease (n ¼ 2), or intrahepatic cholangiocarcinoma (n ¼ 1) with resin yttrium-90 ( 90Y) microspheres. Before 90Y treatment, each patient received two same-day sequential lobar infusions of technetium 99m ( 99mTc) macroaggregated albumin (MAA) via a conventional end-hole catheter and an antireflux microcatheter positioned at the same location. Differences in technetium 99m–MAA distribution within tumor and nontarget sites were evaluated by singlephoton emission computed tomography (SPECT) on a qualitative and semiquantitative basis. The antireflux microcatheter was used for the ensuing 90Y treatment, with posttreatment 90Y positron emission tomography/computed tomography to assess distribution of 90Y microspheres.
Decreases in hepatic nontarget embolization were found in all patients when the antireflux catheter was used. These decreases ranged from a factor of 0.11 to a factor of 0.76 (mean, 0.42; σ ¼ 0.19), representing a 24%–89% reduction. Increased tumor deposition was also noted in all patients, ranging from a factor of 1.33 to a factor of 1.90 (mean, 1.68; σ ¼ 0.20), representing a relative increase of 33%–90%. Both findings were statistically significant (P o .05).
Although this pilot study identified differences in the downstream distribution of embolic particles when the antireflux catheter was used, further investigation is needed to determine if these findings are reproducible in a larger patient cohort and, if so, whether they are associated with any clinical impact.
Pasciak AS, McElmurray JH, Bourgeois AC, Heidel RE, Bradley YC. The impact of an antireflux catheter on target volume particulate distribution in liver-directed embolotherapy: a pilot study. J Vasc Interv Radiol. 2015 May;26(5):660-9
Pubmed Abstract Link
J Vasc Interv Radiol. 2015 May;26(5):660-9
(a) Distribution of 99mTc MAA on axial SPECT following infusion with an end-hole catheter in a 73-year-old man with HCC (patient 9; Table 1). (b) Axial SPECT demonstrates the distribution of MAA following infusion with an antireflux catheter. (c) Pretreatment axial hepatic-protocol CT demonstrates a right-lobe hepatic mass. Example spherical 2-cm-diameter ROIs were used to measure changes in distal tumor and normal liver MAA uptake. Quantitative analysis showed changes in MAA deposition by a factor of 1.77 (77% increase) in distal tumor and a factor of 0.40 (60% decrease) in normal liver with the antireflux catheter.