Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
Basic Research Laboratory Department of Surgery, St. Mary's Hospital Herne, Ruhr University Bochum, Bochum, Germany.
Surg Endosc. 2018 Jan;32(1):166-174. doi: 10.1007/s00464-017-5652-4. Epub 2017 Jun 22.
Although recent data are contradictory, it is still claimed that Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) would deliver an aerosol which distributes homogeneously throughout the entire abdominal cavity.
Tc-Pertechnetat was administered in four postmortem swine using either PIPAC or liquid intra-peritoneal chemotherapy (IPC). The animals were examined by planar scintigraphy and SPECT/CT. Planar distribution images were divided into four regions of interest (ROIs: right/left upper and lower abdominal quadrant). SPECT/CT slices were scanned for areas of intense nuclide accumulation ("hot spots"). The percentage of relative distribution for planar scintigraphy was calculated by dividing the summed individual counts of each ROI by total counts measured in the entire abdominal cavity. The relative distribution of the "hot spots" was analyzed by dividing the counts of the local volume of interest (VOI) by the summed volume counts measured in the entire abdominal cavity.
In all four animals, planar scintigraphy showed inhomogeneous nuclide distribution. After PIPAC only 8-10% of the delivered nuclide was detected in one ROI with a mean deviation of 40% and 74% from a uniform nuclide distribution pattern. In all animals, SPECT/CT revealed "hot spots" beneath the PIPAC Micropump, catheter tip, and in the cul-de-sac region which comprise about 25% of the total amount of delivered nuclide in 2.5% of the volume of the entire abdominal cavity.
Our present data indicate that the intra-abdominal aerosol distribution pattern of PIPAC therapy is non-homogeneous and that the currently applied technology has still not overcome the problem of inhomogeneous drug distribution of IPC.
尽管最近的数据存在矛盾，但仍有人声称，腹腔内加压气溶胶化疗（PIPAC）会输送一种气溶胶，使其均匀分布在整个腹腔内。
在四只死后的猪中，通过 PIPAC 或液体腹腔内化疗（IPC）分别给予 Tc-过锝酸盐。使用平面闪烁显像和 SPECT/CT 对动物进行检查。将平面分布图像分为四个感兴趣区（ROI：右上、左上、右下和左下腹部象限）。扫描 SPECT/CT 切片以寻找放射性核素积聚的热点。通过将每个 ROI 的个体计数总和除以整个腹腔测量的总计数，计算平面闪烁显像的相对分布百分比。通过将局部感兴趣区（VOI）的计数除以整个腹腔测量的总和体积计数，分析“热点”的相对分布。
在所有四只动物中，平面闪烁显像显示放射性核素分布不均匀。在 PIPAC 后，只有 8-10%的放射性核素被一个 ROI 检测到，平均偏差为 40%和 74%，与均匀放射性核素分布模式不同。在所有动物中，SPECT/CT 均在 PIPAC 微泵、导管尖端和子宫直肠陷凹区域下方显示“热点”，这些区域占整个腹腔总放射性核素量的 25%，占整个腹腔体积的 2.5%。
我们目前的数据表明，PIPAC 治疗的腹腔内气溶胶分布模式不均匀，并且目前应用的技术尚未克服 IPC 药物分布不均匀的问题。
