title: Effect of gravity on drug distribution after port-catheter implantation for hepatic arterial infusion chemotherapy: evaluation of the relationship between the injection posture and intrahepatic perfusion on fused images acquired with a combined SPECT/CT system.
abstract: OBJECTIVE
  We evaluated the effect of gravity on intrahepatic perfusion (IHP) in patients with a port-catheter system (PCS) implanted for hepatic arterial infusion chemotherapy (HAIC). Using fused single photon-emission computed tomographic (SPECT)/computed tomographic (CT) images, we compared IHP after the injection of technetium-99m-labeled macroaggregated albumin (Tc-99m-MAA) via a PCS with the patient in the upright and decubitus positions.
  
  
  METHODS
  We enrolled 27 patients with metastatic carcinoma of the liver who bore an implantable PCS for HAIC. SPECT/CT images were obtained on the third and seventh postimplantation day; 99mTc-MAA (185 MBq) was delivered with the patient in the upright and decubitus positions. We selected four regions of interest (ROIs) on SPECT images of the superior, inferior, anterior, and posterior regions. The anteroposterior and the superoinferior perfusion ratio (AP ratio, SI ratio) were derived from the mean counts in each ROI. Using an unpaired t-test, we compared these ratios after drug delivery in the upright and decubitus injection positions. We also visually compared IHP and classified the distribution of drugs delivered in the upright and decubitus positions on fused images. Moreover, using World Health Organization criteria, we evaluated the therapeutic response by comparing the tumor size on contrast-enhanced CT images obtained before and 3 months after treatment.
  
  
  RESULTS
  The SI ratios in the upright and decubitus injection positions were 1.14 and 0.92, respectively; the corresponding AP ratios were 1.47 and 1.73, respectively, indicating that there was no significant difference in these parameters irrespective of the injection position (SI ratio: P = .27, AP ratio: P = .35). However, in 14 of the 27 patients (52%), the visual appearance of IHP was different in the upright and decubitus positions. A change in the location of the catheter side hole when the decubitus was changed to the upright position produced a difference in IHP. Of 13 patients with identical drug distribution in both injection positions, six (46%) manifested a partial response (PR), five (38%) experienced no change (NC), and two (15%) experienced progressive disease (PD). Among the 14 patients with different drug distribution in the two injection positions, four (28%) achieved PR, five (36%) manifested NC, and the other five (36%) had PD.
  
  
  CONCLUSIONS
  Although the patient posture affected IHP by changing the position of the infusion catheter side hole in the liver, gravity had no significant effect on IHP in patients bearing an implantable PCS for the delivery of HAIC.
authors.affiliation: Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences 1-1-1, Honjo Kumamoto 860-8505, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tamura
authors.forename: Osama
authors.initials: O
authors.lastname: Ikeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakasone
authors.forename: Shinya
authors.initials: S
authors.lastname: Shiraishi
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: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D006112:Gravitation; D006801:Humans; D007261:Infusions, Intra-Arterial; D007267:Injections; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical; D011187:Posture; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents