Temporal variations in stump pressure and assessment of images obtained from cone-beam computed tomography during balloon-occluded transarterial chemoembolization.
OBJECTIVE
Balloon-occluded transcatheter arterial chemoembolization (B-TACE) was used to show the optimized duration of balloon occlusion to start injection of lipiodol in order to maximize lipiodol deposition in the nodule, and to reveal the endpoint of lipiodol injection.


METHODS
Of 29 consecutive patients who underwent balloon-occluded TACE between November 2013 and February 2014, we were able to measure stump pressure for 219 nodules in 27 patients. Tumors were counted, measured and could be visually assessed in 20 of these patients at 26 sites. Tumors with multiple feeders were found in eight patients. Arterial blood pressure was measured before, immediately after and 5 min after balloon occlusion prior to intra-arterial injection, as well as before and after balloon deflation after intra-arterial injection. Images were assessed qualitatively by two radiologists as well as quantitatively by calculating the contrast-to-noise ratio.


RESULTS
We found no significant difference in pressure between immediately after and 5 min after balloon occlusion. Mean stump pressure before balloon deflation after intra-arterial injection was 70.4 mmHg. We observed a significant increase in qualitative scores after balloon occlusion (P < 0.001), and the mean score in the third-order branch was significantly higher than that in the first-order branch (P = 0.048).


CONCLUSIONS
Our results indicate that intra-arterial injection can be started at any time after balloon occlusion and that 70 mmHg may be considered as a possible indicator of the end-point for arterial injection.
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Akihisa
A
Kakuta
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Koichi
K
Shibutani
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Shuichi
S
Ono
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Hiroyuki
H
Miura
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Fumiyasu
F
Tsushima
Department of Radiology, Aomori Prefectural Central Hospital, Hirosaki, Japan.
Shinya
S
Kakehata
Department of Radiology, Aomori Prefectural Central Hospital, Hirosaki, Japan.
Kiyoshi
K
Basaki
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Hiromasa
H
Fujita
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Hiroko
H
Seino
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Tamaki
T
Fujita
Department of Radiology and Radiation Oncology, Hirosaki University School of Medicine.
Yoshihiro
Y
Takai
balloon-occluded transcatheter arterial chemoembolization; cone-beam computed tomography; hepatocellular carcinoma; stump pressure