Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany.
Cardiovasc Intervent Radiol. 2019 Oct;42(10):1441-1448. doi: 10.1007/s00270-019-02243-4. Epub 2019 May 14.
To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for detecting leakage of the double-balloon catheter used for chemosaturation percutaneous hepatic perfusion (CS-PHP).
Overall, 112 CS-PHP (09/2015-09/2018) in 52 patients were retrospectively screened for leakage alongside the double-balloon catheter on standard venograms. Finally, 18 procedures with visually detected leakage were included. Fifteen consecutive procedures without leakage served as control. To evaluate 2D-PA for leakage detection, the acquired digital subtraction venograms were post-processed. For each balloon, two different target ROIs were evaluated to assess a possible impact of localization and shape of the ROIs. Time to peak (TTP), peak density (PD), area under the curve (AUC), and ratios of target ROI/reference ROIs (PD/PD; AUC/AUC; and TTP/TTP) were calculated.
Leakages were located as follows: 15/18 cranial and 3/18 caudal. At the cranial balloon both ROIs showed a significant decrease in PD/PD and AUC/AUC (ROI1: p < 0.0001; p < 0.0001; ROI2: p < 0.0001; p < 0.0001) and a significant increase in TTP/TTP (ROI1: p = 0.0009; ROI2: p = 0.0003) after double-balloon correction. Following balloon adjustment, the 2D-PA ratios (PD and AUC) of the tested ROIs differed significantly (p < 0.05). The inter-individual comparison of the 2D-PA parameters of the group with leakage before balloon correction and the non-leakage group showed significantly different 2D-PA values for the cranial balloon in both ROIs (p < 0.05). No significant differences were found for the caudal balloon.
2D-PA provides a feasible tool for detecting leakages alongside the cranial portion of the double-balloon catheter used in CS-PHP. The shape and position of the ROIs used to assess perfusion and flow have an impact on the measurements.
评估 2 维灌注血管造影（2D-PA）检测化学饱和经皮肝灌注（CS-PHP）中双球囊导管渗漏的可行性。
回顾性筛选 2015 年 9 月至 2018 年 9 月期间 52 例患者共 112 例 CS-PHP 手术中标准静脉造影时双球囊导管周围的渗漏情况。最终纳入 18 例术中肉眼观察到渗漏的患者，将 15 例连续无渗漏患者作为对照。为评估 2D-PA 检测渗漏，对采集的数字减影静脉造影进行后处理。对于每个球囊，评估两个不同的靶 ROI，以评估 ROI 位置和形状对测量结果的影响。计算达峰时间（TTP）、峰值密度（PD）、曲线下面积（AUC）和靶 ROI/参考 ROI 的比值（PD/PD；AUC/AUC；和 TTP/TTP）。
渗漏位于 18 例中的 15 例颅侧和 3 例尾侧。在颅侧球囊，两个 ROI 的 PD/PD 和 AUC/AUC 均显著降低（ROI1：p<0.0001；p<0.0001；ROI2：p<0.0001；p<0.0001），TTP/TTP 显著增加（ROI1：p=0.0009；ROI2：p=0.0003）。在双球囊校正后，测试 ROI 的 2D-PA 比值（PD 和 AUC）差异有统计学意义（p<0.05）。对球囊校正前有渗漏组和无渗漏组的个体间比较显示，颅侧球囊两个 ROI 的 2D-PA 参数差异有统计学意义（p<0.05）。尾侧球囊无明显差异。
2D-PA 为检测 CS-PHP 中双球囊导管颅侧段的渗漏提供了一种可行的工具。用于评估灌注和血流的 ROI 的形状和位置对测量结果有影响。
