Science and Research

Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter

PURPOSE: 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. RESULTS: 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. CONCLUSION: 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.
  • Dewald, C. L. A.
  • Meine, T. C.
  • Winther, H. M. B.
  • Kloeckner, R.
  • Maschke, S. K.
  • Kirstein, M. M.
  • Vogel, A.
  • Wacker, F. K.
  • Meyer, B. C.
  • Renne, J.
  • Hinrichs, J. B.

Keywords

  • Angiography, Digital Subtraction/*methods
  • Antineoplastic Agents, Alkylating/administration & dosage/*therapeutic use
  • Catheterization/*instrumentation/methods
  • Chemotherapy, Cancer, Regional Perfusion/*methods
  • Equipment Design
  • Feasibility Studies
  • Female
  • Humans
  • Liver Neoplasms/*drug therapy
  • Male
  • Melphalan/administration & dosage/*therapeutic use
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • 2D-perfusion angiography
  • Chemosaturation
  • Double-balloon catheter
  • Leakage
  • Percutaneous hepatic perfusion
Publication details
DOI: 10.1007/s00270-019-02243-4
Journal: Cardiovasc Intervent Radiol
Pages: 1441-1448 
Number: 10
Work Type: Original
Location: BREATH
Disease Area: General Lung and Other
Partner / Member: MHH
Access-Number: 31089781
See publication on PubMed

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