Snoeijink Tess J, van den Brekel Anne, van der Hoek Jan L, Greve Jaap G M, Remco Liefers H, Boswinkel Milou, Ruiter Simon J S, Roosen Joey, Jebbink Erik Groot, Nijsen J Frank W
Radboud University Medical Centre, Department of Medical Imaging, Nijmegen, The Netherlands.
University of Twente, TechMed Centre, Multi-Modality Medical Imaging Group, Enschede, The Netherlands.
Eur Radiol Exp. 2025 Aug 6;9(1):69. doi: 10.1186/s41747-025-00609-7.
Transarterial radioembolisation (TARE) is a treatment for liver malignancies, involving the injection of radioactive microspheres in the hepatic artery (HA). Tumour-to-nontumour uptake varies among patients, possibly influenced by patient-specific blood flow profiles. To examine the impact of HA blood flow rate and high microsphere dosages on microsphere distribution in normal liver parenchyma, ex vivo magnetic resonance imaging (MRI)-guided machine perfusion experiments were conducted in porcine livers.
Porcine livers were subjected to oxygenated normothermic machine perfusion at three HA flow rates (0.02, 0.15, and 0.22 mL/min/g liver tissue; n = 3 per condition). Five fractions of 250 mg nonradioactive Ho-loaded microspheres were administered to n = 9 livers, and four additional fractions of 1,000 mg to n = 6 livers. Dynamic contrast-enhanced and Ho-sensitive T2*-weighed MR scans were acquired to extract perfusion rates, fictive dose maps, and homogeneity indices (HI).
Microsphere distribution correlated moderately with perfusion rate at low HA flow rate (r = 0.611), and very strongly at higher HA flow rates (r = 0.977 and 0.951 for 0.15 and 0.22 mL/min/g, respectively). Homogeneity increased with increasing flow rates, with HIs ranging from 3.68-4.72 at low, to 2.01-2.66 at medium, and 1.60-2.36 at high HA flow rate. HI decreased with higher microsphere concentrations, though distribution patterns remained unchanged.
In our ex vivo model, higher HA flow rates resulted in more homogeneous microsphere distributions. The impact on tumourous tissue needs further investigation to determine whether pre-TARE HA blood flow measurements could improve microsphere distribution predictions.
Mapping of the hepatic arterial blood flow rate before transarterial radioembolisation and adjusting the treatment accordingly may help to improve outcomes for patients with liver cancer.
Parameters influencing microsphere distribution were studied in MRI-perfused healthy porcine livers. Higher hepatic arterial blood flow rates led to more homogeneous microsphere distributions. Administering large numbers of microspheres did not alter microsphere distribution patterns. Impact on tumour tissue should be further investigated.
经动脉放射性栓塞术（TARE）是一种治疗肝脏恶性肿瘤的方法，包括在肝动脉（HA）中注射放射性微球。患者之间肿瘤与非肿瘤的摄取情况各不相同，可能受到患者特异性血流情况的影响。为了研究肝动脉血流速率和高微球剂量对正常肝实质中微球分布的影响，在猪肝脏中进行了体外磁共振成像（MRI）引导的机器灌注实验。
对猪肝脏以三种肝动脉血流速率（0.02、0.15和0.22 mL/min/g肝组织；每种情况n = 3）进行含氧常温机器灌注。向n = 9个肝脏注射五剂250 mg载钬非放射性微球，向n = 6个肝脏额外注射四剂1000 mg。采集动态对比增强和钬敏感T2*加权磁共振扫描，以提取灌注速率、虚拟剂量图和均匀性指数（HI）。
在低肝动脉血流速率下，微球分布与灌注速率中度相关（r = 0.611），在较高肝动脉血流速率下相关性非常强（0.15和0.22 mL/min/g时r分别为0.977和0.951）。均匀性随血流速率增加而增加，低血流速率下HI范围为3.68 - 4.72，中等血流速率下为2.01 - 2.66，高肝动脉血流速率下为1.60 - 2.36。HI随微球浓度升高而降低，不过分布模式保持不变。
在我们的体外模型中，较高的肝动脉血流速率导致微球分布更均匀。对肿瘤组织的影响需要进一步研究，以确定TARE前肝动脉血流测量是否能改善微球分布预测。
经动脉放射性栓塞术前绘制肝动脉血流速率图并相应调整治疗，可能有助于改善肝癌患者的治疗效果。
在MRI灌注的健康猪肝脏中研究了影响微球分布的参数。较高的肝动脉血流速率导致微球分布更均匀。大量注射微球并未改变微球分布模式。对肿瘤组织的影响应进一步研究。
