title: MR imaging perfusion mismatch: a technique to verify successful targeting of liver tumors during transcatheter arterial chemoembolization.
abstract: OBJECTIVE
  To evaluate the combined use of transcatheter intraarterial perfusion (TRIP) magnetic resonance (MR) imaging and dynamic contrast-enhanced MR imaging to determine complete tumor targeting during transcatheter arterial chemoembolization (TACE) when performed within an integrated MR imaging-interventional radiology (IR) angiography suite.
  
  
  METHODS
  Between October 2006 and March 2007, eight consecutive patients with unresectable hepatocellular carcinoma (HCC) successfully underwent TACE in a combined MR imaging-IR suite. All patients were male, with a mean age of 59 years (range, 41-71 years). Tumor enhancement on TRIP MR images before and after TACE were qualitatively compared with dynamic contrast-enhanced MR images obtained after TACE. The authors computed the prevalence of perfusion mismatch. The presence of a perfusion mismatch was judged in a binary fashion.
  
  
  RESULTS
  A perfusion match, confirming complete tumor targeting, occurred in six of the eight patients (75%). There was a perfusion mismatch in two patients (25%). Subsequent interrogation showed that the underlying cause of the mismatch was secondary to an unexpected collateral vessel in the first patient and watershed location of the tumor in the second patient.
  
  
  CONCLUSIONS
  Performing TACE in an MR imaging-IR suite can facilitate complete tumor targeting. By comparing perfusion images from TRIP and contrast-enhanced MR sequences, the operator gains confidence and can potentially obtain more selective catheter placement during TACE.
authors.affiliation: Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Ste 800, Chicago, IL 60611, USA. r-lewandowski@northwestern.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Joshua
authors.initials: J
authors.lastname: Tepper
authors.forename: Dingxin
authors.initials: D
authors.lastname: Wang
authors.forename: Saad
authors.initials: S
authors.lastname: Ibrahim
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Mary
authors.initials: M
authors.lastname: Mulcahy
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent
authors.initials: K
authors.lastname: Sato
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Larson
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; 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; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000628:therapy*; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D016685:Mitomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; D019786:Gadolinium DTPA; D002945:Cisplatin