Miyuki Sone MD, Presenter: Nothing to Disclose

Kenichi Kato MD, Abstract Co-Author: Nothing to Disclose

Atsuo Hirose MD, Abstract Co-Author: Nothing to Disclose

Tatsuhiko Nakasato MD, Abstract Co-Author: Nothing to Disclose

Shigeru Ehara MD, Abstract Co-Author: Nothing to Disclose

Takao Hanari, Abstract Co-Author: Nothing to Disclose

Yasuhiko Kikuchi, Abstract Co-Author: Nothing to Disclose

Masayoshi Kamata, Abstract Co-Author: Nothing to Disclose

Tadayuki Yamamoto, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Hepatic arterial infusion chemotherapy (HAIC) is an established treatment for unresectable malignant liver tumors. For implantation of catheter and port system, percutaneous approach is now widely used instead of surgical approach. Percutaneous implantation consists of several elements including unification of multiple hepatic arteries, embolization of gastrointestinal branches arising from hepatic artery, and implantation of catheter and port system for appropriate drug delivery. Vascular mapping is essential for treatment planning. The purpose of this study is to assess the impact of MSCTA on treatment planning for implantation of catheter and port system.

This is a prospective study including twenty-nine consecutive patients (16 men, 13 women, mean age 62) with unresectable malignant liver tumors. MSCTA was performed with a MSCT scanner with 16 detectors before implantation of catheter and port system for HAIC. Non-ionic contrast material was injected into antecubital vein and arterial-phase images were obtained with a 0.5mm-thickeness and a helical pitch of 15. 3-D reconstruction was obtained on a workstation. Twenty-eight patients underwent intraarterial digital subtraction angiography (DSA). Four radiologists evaluated MSCTA or DSA images to assess arterial anatomy and abnormalities. Visualization of each arterial segment was scored as 1, 2, and 3.

Mean visualization scores were all 3 in celiac axis, common and proper hepatic artery, right hepatic artery (RHA), left hepatic artery (LHA), gastroduodenal artery, and superior mesenteric artery (SMA) with both MSCTA and DSA. Scores of MSCTA and DSA were 2.5 and 2.3 in right gastric artery and 2.9 and 2.6 in left gastric artery, respectively. Replaced RHAs were depicted in 7 patients and replaced LHAs in 6 with both MSCTA and DSA. Stenosis of celiac axis was demonstrated in 3 patients. In one patient, MSCTA showed severe celiac and SMA stenoses, which precluded catheter implantation.

MSCTA is accurate in detection of abdominal arterial anatomy, variation, and abnormalities. MSCTA is suited for non-invasive planning of the implantation of catheter and port system for HAIC.

Sone, M, Kato, K, Hirose, A, Nakasato, T, Ehara, S, Hanari, T, Kikuchi, Y, Kamata, M, Yamamoto, T, et al, , Impact of Mutislice CT Angiography (MSCTA) on Treatment Planning for Percutaneous Implantation of Catheter and Port System in Patients with Malignant Liver Tumors.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4402956.html