Rafael Duran MD, Abstract Co-Author: Nothing to Disclose

Julius Chapiro MD, Abstract Co-Author: Nothing to Disclose

Ahmet Bas MD, Abstract Co-Author: Nothing to Disclose

MingDe Lin PhD, Abstract Co-Author: Employee, Koninklijke Philips NV

Ruediger Egbert Schernthaner MD, Abstract Co-Author: Nothing to Disclose

Jae Ho Sohn MS, Presenter: Nothing to Disclose

Gayane Yenokyan PhD, Abstract Co-Author: Nothing to Disclose

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, BTG International Ltd Consultant, Bayer AG Consultant, Guerbet SA Consultant, Nordion, Inc Grant, BTG International Ltd Grant, F. Hoffmann-La Roche Ltd Grant, Bayer AG Grant, Koninklijke Philips NV Grant, Nordion, Inc Grant, ContextVision AB Grant, CeloNova BioSciences, Inc Founder, PreScience Labs, LLC CEO, PreScience Labs, LLC

Theoretically intra-arterial therapies (IATs) are mainly targeting tumor tissue. However, part of the payload is inevitably delivered to non-tumoral liver tissue, thus potentially causing damage over time which in return may influence the portal venous pressure (PVP). The aim of this study was to investigate potential effects of IATs on PVP using non-invasive surrogate markers of portal hypertension.

This retrospective analysis included 107 patients (57 in hepatocellular carcinoma (HCC) group and 50 in metastatic group) who underwent IATs and had longitudinal pre-/post- therapy contrast-enhanced (ce)MRI as well as blood work follow-up. Porto-systemic shunts, ascites, and vascular invasion were evaluated on MRI. In addition, splenic volumes were measured on portal-venous-phase ceMRI. Platelet count (PC; in 109/L) and liver function were evaluated. Generalized linear mixed effects models with random intercept for patient and random slope for time trajectory were used to assess associations between IAT and the outcomes adjusting for potential confounders and accounting for the longitudinal nature of the data.

A total of 291 IAT procedures (230 cTACE, 47 DEB-TACE and 14 Y90 radioembolization) were performed. Spleen volume showed a linear increase with additional IAT sessions by on average of 17cm3/session (95%CI:7-27, p< .0001) after controlling for IAT method, diagnosis, spleen volume and ascites status at baseline. Patients treated with cTACE or DEB-TACE showed an association with a higher PC as compared to Y90 radioembolization, with values of 51 (P=.02) and 75 (p=.005) units above radioembolization, respectively. There was no statistically significant difference in PC between cTACE and DEB-TACE. PC showed a decrease with each additional IAT session by 12 units (95%CI:3-20, p=.008) after controlling for IAT method, diagnosis and PC at baseline.

Preliminary results indicate that those IATs with larger embolic effects (cTACE/DEB-TACE) lead to a larger increase of PVP and higher PC over time as compared to procedures with less embolic effect (Y90).

IATs seemed to increase PVP over time however with low complications-rate related to increased portal hypertension. 

Duran, R, Chapiro, J, Bas, A, Lin, M, Schernthaner, R, Sohn, J, Yenokyan, G, Geschwind, J, Effect of Intra-Arterial Therapies to Treat Liver Cancer on Portal Hypertension: Non-Invasive Assessment of Surrogate Markers of Portal Venous Pressure.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016179.html