title: Comparison of fusion imaging using a combined SPECT/CT system and intra-arterial CT: assessment of drug distribution by an implantable port system in patients undergoing hepatic arterial infusion chemotherapy.
abstract: Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinoma of the liver. We compared the perfusion patterns of HAI chemotherapy on intra-arterial port-catheter computed tomography (iapc-CT) and fused images obtained with a combined single-photon emission computed tomography/computed tomography (SPECT/CT) system. We studied 28 patients with primary or metastatic carcinoma of the liver who bore an implantable HAI port system. All underwent abdominal SPECT using Tc-99m-MAA (185 Mbq); the injection rate was 1 mL/min, identical to the chemotherapy infusion rate, and 0.5 mL/sec for iapc-CT. Delivery was through an implantable port. We compared the intrahepatic perfusion (IHP) and extrahepatic perfusion (EHP) patterns of HAI chemotherapy on iapc-CT images and fused images obtained with a combined SPECT/CT system. In 23 of 28 patients (82%), IHP patterns on iapc-CT images and fused images were identical. In 5 of the 28 patients (18%), IHP on fusion images was different from IHP on iapc-CT images. EHP was seen on fused images in 12 of the 28 patients (43%) and on iapc-CT images in 8 patients (29%). In 17 patients (61%), upper gastrointestinal endoscopy revealed gastroduodenal mucosal lesions. EHP was revealed on fused images in 10 of these patients; 9 of them manifested gastroduodenal toxicity at the time of subsequent HAI chemotherapy. Fusion imaging using the combined SPECT/CT system reflects the actual distribution of the infused anticancer agent. This information is valuable not only for monitoring adequate drug distribution but also for avoiding potential extrahepatic complications.
authors.affiliation: Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Honjo Kumamoto, Japan. osamu-3643ik@do9.enjoy.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Shinichiroh
authors.initials: S
authors.lastname: Kusunoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakaura
authors.forename: Shinya
authors.initials: S
authors.lastname: Shiraishi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Kawanaka
authors.forename: Seiji
authors.initials: S
authors.lastname: Tomiguchi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kanemitsu
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics*; D002408:Catheters, Indwelling; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013272:Stomach Diseases / Q000139:chemically induced; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin