title: Evaluation of extrahepatic perfusion of anticancer drugs in the right gastric arterial region on fused images using combined CT/SPECT: is extrahepatic perfusion predictive of gastric toxicity?
abstract: BACKGROUND
  Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinomas of the liver. Since hepatic arteries also supply the stomach and duodenum, HAI may result in unwanted infusion into the upper gastrointestinal tract and consequent gastric toxicity. Using fused images obtained with a combined SPECT/CT system, we assessed extrahepatic perfusion (EHP) and its correlation with gastrointestinal toxicity in patients receiving HAI.
  
  
  METHODS
  We studied 41 patients with primary or metastatic carcinoma of the liver who received HAI chemotherapy consisting of 5-fluorouracil and cisplatin. All underwent abdominal SPECT using a (99m)Tc-MAA (185 MBq) instrument and an injection rate of 0.1 ml/min, identical to the chemotherapy infusion rate. Delivery was through an implantable port. We analyzed the distribution of the anticancer agent on fused images and the relationship between EHP of the right gastric arterial region and gastric toxicity. All patients underwent esophagogastroduodenoscopy (EGDS).
  
  
  RESULTS
  Of the 41 patients, 11 (27%) manifested enhancement of the duodenal and gastric pyloric region on fused images. EGDS at the time of reservoir placement detected gastric ulcers in 10 of these patients.
  
  
  CONCLUSIONS
  Fusion imaging with combined SPECT/CT reflects the actual distribution of the infused anticancer agents. The detection of EHP on fused images is predictive of the direct gastric toxicity from anticancer agents in patients undergoing HAI.
authors.affiliation: Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo, Kumamoto 860-8505, Japan. osamu-3643ik@do9.enjoy.ne.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakasone
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: Shouji
authors.initials: S
authors.lastname: Morishita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Keiichirou
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000188:drug therapy; D002408:Catheters, Indwelling; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004386:Duodenum / Q000098:blood supply; D016145:Endoscopy, Digestive System; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000098:blood supply* / Q000187:drug effects*; D013276:Stomach Ulcer / Q000139:chemically induced / Q000175:diagnosis; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D002945:Cisplatin; D005472:Fluorouracil