Civelek A C, Sitzmann J V, Chin B B, Venbrux A, Wagner H N, Grochow L B
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287-9217.
AJR Am J Roentgenol. 1993 Apr;160(4):865-70. doi: 10.2214/ajr.160.4.8456683.
One purpose of this study was to determine if patients who have anatomic variations in their hepatic arteries are at increased risk for complications associated with the use of intrahepatic arterial infusion pumps. We also tried to determine the value of perfusion studies obtained with 99mTc-microspheres or 99mTc-macroaggregated albumin in detecting postoperative hepatic or visceral misperfusion and in predicting complications in patients with anatomic variants despite pre- or intraoperative attempts to correct the arterial abnormality.
We prospectively compared findings on scintigrams obtained after delivering the radionuclide through intrahepatic arterial infusion pumps with anatomic variations in hepatic arteries seen on celiac and superior mesenteric hepatic arteriograms obtained before placement of the pump in 49 consecutive patients with colon carcinoma metastatic to the liver.
Despite pre- or intraoperative attempts to correct arterial abnormalities to ensure optimal perfusion of the liver in 24 patients with hepatic arterial anomalies seen on preoperative arteriograms, only two patients had normal findings on postoperative perfusion studies performed with 99mTc-microspheres and/or 99mTc-macroaggregated albumin. Abnormalities included perfusion of extrahepatic organs, including the spleen in 12 patients, stomach in seven, bowel in four, and pancreas in three. Eight patients had no perfusion of the left lobe of the liver, and three had no perfusion of the right lobe. Two patients had minimal or no perfusion of both lobes. In 23 of 25 patients with no demonstrable variations in vascular anatomy on preoperative celiac and superior mesenteric arteriograms, findings on hepatic pump scintigrams were normal. Of the 24 patients with abnormal scintigraphic findings, 20 had subsequent clinical complications. However, only two of the 25 patients with normal scintigraphic findings had clinical complications.
Our results indicate that patients with anatomic variations in the hepatic arterial system are at high risk for misperfusion during chemotherapy despite pre- or intraoperative efforts to alter the perfusion for chemotherapeutic agents delivered by intrahepatic arterial infusion pumps. Misperfusion can be detected by using pump scintigraphy, and therefore patients should be closely monitored with 99mTc-macroaggregated albumin perfusion studies to ensure successful delivery of the chemotherapeutic agents and to avoid serious clinical complications caused by inadvertent perfusion of other organs.
本研究的一个目的是确定肝动脉存在解剖变异的患者在使用肝内动脉灌注泵时发生并发症的风险是否增加。我们还试图确定用99mTc - 微球或99mTc - 大聚合白蛋白进行的灌注研究在检测术后肝或内脏灌注不良以及预测尽管术前或术中试图纠正动脉异常但仍存在解剖变异的患者并发症方面的价值。
我们前瞻性地比较了49例结肠癌肝转移患者在通过肝内动脉灌注泵注入放射性核素后获得的闪烁图结果与在放置灌注泵前获得的腹腔干和肠系膜上动脉肝动脉造影所见的肝动脉解剖变异情况。
尽管术前或术中对24例术前动脉造影显示肝动脉异常的患者试图纠正动脉异常以确保肝脏的最佳灌注，但只有2例患者在术后用99mTc - 微球和/或99mTc - 大聚合白蛋白进行的灌注研究中结果正常。异常情况包括肝外器官灌注，其中12例患者脾脏灌注、7例患者胃灌注、4例患者肠灌注、3例患者胰腺灌注。8例患者左肝叶无灌注，3例患者右肝叶无灌注。2例患者两叶灌注极少或无灌注。在术前腹腔干和肠系膜上动脉造影未显示血管解剖变异的25例患者中，23例肝灌注泵闪烁图结果正常。在闪烁图结果异常的24例患者中，20例随后出现临床并发症。然而，在闪烁图结果正常的25例患者中，只有2例出现临床并发症。
我们的结果表明，尽管术前或术中努力改变肝内动脉灌注泵输送化疗药物的灌注情况，但肝动脉系统存在解剖变异的患者在化疗期间发生灌注不良的风险很高。灌注不良可通过泵闪烁显像检测到，因此应对患者进行99mTc - 大聚合白蛋白灌注研究密切监测，以确保化疗药物的成功输送，并避免因其他器官意外灌注引起的严重临床并发症。
