title: Pressure wire assessment of hemodynamic alterations after chemoembolization of hepatocellular carcinoma.
abstract: OBJECTIVE
  The end point of chemoembolization for hepatocellular carcinoma is qualitative. We intended to determine the feasibility of measuring intra-arterial pressure changes after chemoembolization and hypothesized that pressures would increase in the distal hepatic artery after the procedure.
  
  
  METHODS
  Before and after chemoembolization, systemic (S) systolic and mean pressures were measured along with celiac (C), lobar (L), and distal (D) hepatic artery pressures with a pressure wire. Corrected pressures were defined as a ratio with S as the denominator to account for intraprocedural S changes. Changes in the systolic and mean corrected pressures at each location (C/S, L/S, and D/S) were evaluated using paired t tests. Pressure changes in patients with and without tumor response using the Modified Response Evaluation Criteria in Solid Tumors were also compared.
  
  
  RESULTS
  Sixteen tumors were treated in 15 patients. One patient had bilobar tumors with separate supplying arteries. The only significant pressure change was systolic D/S (P = .02), while mean D/S approached significance (P = .08). C/S and L/S did not change significantly after chemoembolization. Eleven of 16 patients had a complete response, whereas the other five had a partial response after chemoembolization. When comparing complete to partial responders, no changes in systolic or mean C/S, L/S, or D/S reached statistical significance (all P > .05).
  
  
  CONCLUSIONS
  Measuring change in hepatic artery pressures is feasible. Distal intra-arterial corrected pressures increase significantly after chemoembolization. Further study to determine the ability to predict tumor necrosis at follow-up imaging is warranted.
authors.affiliation: The Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University, 132 South 10th Street, Suite 766 Main Building, Philadelphia, PA 19107, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Borowski
authors.forename: Andrea
authors.initials: A
authors.lastname: Frangos
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: McCann
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000295:instrumentation*; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014160:Transducers, Pressure; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; arterial pressure measurement; chemoembolization; endpoint determination