Transcatheter intraarterial perfusion: MR monitoring of chemoembolization for hepatocellular carcinoma--feasibility of initial clinical translation.
OBJECTIVE
To prospectively test the hypothesis that intraprocedural transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging can be used to successfully measure reductions in perfusion to the targeted hepatocellular carcinoma (HCC) and the adjacent surrounding liver tissue during MR-interventional radiology (IR)-monitored transcatheter arterial chemoembolization (TACE).


METHODS
This HIPAA-compliant prospective study was approved by the institutional review board. An MR-IR unit was used to perform TACE in 10 patients with HCC (seven male, three female; eight younger than 69 years, two older than 69 years). Intraprocedural reductions in tumor perfusion before and after TACE were monitored with TRIP MR imaging. Time-signal intensity curves were derived, and semiquantitative spatially resolved area under the time-signal intensity curve maps of tumor perfusion before and after TACE were produced. Mean perfusion values before and after TACE for liver tumors and adjacent liver tissue were compared by using a mixed-model analysis, with alpha = .05.


RESULTS
Perfusion reductions were measured successfully with TRIP MR imaging in 18 separate tumors during 13 treatment sessions. Perfusion maps showed significant perfusion reductions for tumors (P < .013) but not for adjacent nontumorous liver tissue (P = .21). For tumors, the mean perfusion value was 193 arbitrary units (AU) +/- 223 (standard deviation) before TACE and 45.3 AU +/- 91.9 after TACE, with a mean reduction in baseline perfusion of 74.6% +/- 24.8. For adjacent liver tissue, the mean perfusion value was 124 AU +/- 93.5 before TACE and 93.2 AU +/- 72.3 after TACE, with a mean reduction in baseline perfusion of 24.2% +/- 14.5.


CONCLUSIONS
TRIP MR imaging can be used to detect intraprocedural changes in perfusion to HCC and surrounding liver parenchyma during MR-IR-monitored TACE.
Larson
Andrew C
AC
Department of Radiology, Feinberg School of Medicine, Northwestern University, 448 E Ontario St, Suite 700, Chicago, IL 60611, USA.
Wang
Dingxin
D
Atassi
Bassel
B
Sato
Kent T
KT
Ryu
Robert K
RK
Lewandowski
Robert J
RJ
Nemcek
Albert A
AA
Mulcahy
Mary F
MF
Kulik
Laura M
LM
Miller
Frank H
FH
Salem
Riad
R
Omary
Reed A
RA
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007472:Iohexol / Q000008:administration & dosage; D008102:Liver Circulation; D008113:Liver Neoplasms / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D015641:Radiography, Interventional; D016896:Treatment Outcome
D003287:Contrast Media; D007472:Iohexol; D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D002945:Cisplatin