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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 3/2013

01-06-2013 | Clinical Investigation

Dense Accumulation of Lipiodol Emulsion in Hepatocellular Carcinoma Nodule during Selective Balloon-occluded Transarterial Chemoembolization: Measurement of Balloon-occluded Arterial Stump Pressure

Authors: Toshiyuki Irie, Masashi Kuramochi, Nobuyuki Takahashi

Published in: CardioVascular and Interventional Radiology | Issue 3/2013

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Abstract

Purpose

To reveal the mechanism of dense accumulation of lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) during selective balloon-occluded transarterial chemoembolization (B-TACE).

Methods

Balloon-occluded arterial stump pressure (BOASP) at the embolization portion was measured during selective B-TACE for 43 nodules in 42 patients. Fluoroscopy and digital subtraction angiography were prospectively observed during selective B-TACE to note whether dense LE accumulation in HCC occurred. The LE concentration ratio of HCC to embolized liver parenchyma (LECHL ratio) was also calculated for each treatment on the basis of the computed tomographic scan obtained immediately after selective B-TACE. The relationships between degree of LE accumulation and the BOASP, as well as the LECHL ratio, were analyzed.

Results

Arterial flow beyond the catheter tip was maintained even after balloon inflation. In 39 of 43 treatments, LE inflow into the nontumorous liver parenchyma ceased immediately after LE droplets were filled in arteries of the nontumorous liver parenchyma while LE inflow into the HCC nodule continued (group 1). More dense LE accumulation in HCC nodule was obtained in these 39 treatments. In four treatments, LE inflow both into the nontumorous liver parenchyma and into the HCC nodule continued, and no dense LE accumulation in HCC nodule was observed (group 2). In these four treatments, thick anastomotic vessels with collateral artery were noted. The BOASP in group 1 was (mean ± SD) 33.8 ± 12.8 mmHg (range 13–64 mmHg) and that in group 2 was 92.3 ± 7.4 mmHg (range 83–100 mmHg). There was a statistically significant difference in BOASP between groups (p = 0.00004, Welch’s t test). The LECHL ratio in group 1 was 18.3 ± 13.9 (range 2.9–54.2) and that in group 2 was 2.6 ± 1.1 (range 1.7–4.2). There was a statistically significant difference in the LECHL ratio between the groups (p = 0.000034, Welch’s t test).

Conclusion

Selective B-TACE induced dense LE accumulation in HCC nodules in 39 (91 %) of 43 treatments in which BOASP was 64 mmHg or less.
Appendix
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Metadata
Title
Dense Accumulation of Lipiodol Emulsion in Hepatocellular Carcinoma Nodule during Selective Balloon-occluded Transarterial Chemoembolization: Measurement of Balloon-occluded Arterial Stump Pressure
Authors
Toshiyuki Irie
Masashi Kuramochi
Nobuyuki Takahashi
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
CardioVascular and Interventional Radiology / Issue 3/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-012-0476-z

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