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Title: Use of Intrarterial Carbon Dioxide-Enhanced Ultrasonography (COEUS) in Patient with Renal Insufficiency Undergoing Trans Arterial-Chemo-Embolization (TACE)

Abstract

No abstract prepared.

Authors:
;  [1];  [2]
  1. Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States)
  2. University of Miami Medical School (United States)
Publication Date:
OSTI Identifier:
22642506
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 6; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARBON; CARBON DIOXIDE; KIDNEYS; PATIENTS; ULTRASONOGRAPHY; VASCULAR DISEASES

Citation Formats

Pereira, Keith, E-mail: keithjppereira@gmail.com, Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu, and Puchferran, Chris, E-mail: cpuchferran@gmail.com. Use of Intrarterial Carbon Dioxide-Enhanced Ultrasonography (COEUS) in Patient with Renal Insufficiency Undergoing Trans Arterial-Chemo-Embolization (TACE). United States: N. p., 2016. Web. doi:10.1007/S00270-016-1293-6.
Pereira, Keith, E-mail: keithjppereira@gmail.com, Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu, & Puchferran, Chris, E-mail: cpuchferran@gmail.com. Use of Intrarterial Carbon Dioxide-Enhanced Ultrasonography (COEUS) in Patient with Renal Insufficiency Undergoing Trans Arterial-Chemo-Embolization (TACE). United States. doi:10.1007/S00270-016-1293-6.
Pereira, Keith, E-mail: keithjppereira@gmail.com, Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu, and Puchferran, Chris, E-mail: cpuchferran@gmail.com. 2016. "Use of Intrarterial Carbon Dioxide-Enhanced Ultrasonography (COEUS) in Patient with Renal Insufficiency Undergoing Trans Arterial-Chemo-Embolization (TACE)". United States. doi:10.1007/S00270-016-1293-6.
@article{osti_22642506,
title = {Use of Intrarterial Carbon Dioxide-Enhanced Ultrasonography (COEUS) in Patient with Renal Insufficiency Undergoing Trans Arterial-Chemo-Embolization (TACE)},
author = {Pereira, Keith, E-mail: keithjppereira@gmail.com and Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu and Puchferran, Chris, E-mail: cpuchferran@gmail.com},
abstractNote = {No abstract prepared.},
doi = {10.1007/S00270-016-1293-6},
journal = {Cardiovascular and Interventional Radiology},
number = 6,
volume = 39,
place = {United States},
year = 2016,
month = 6
}
  • A 73-year-old man with hepatitis-C-related cirrhosis and an elevated alpha-fetoprotein level and tumor in segment 3 of his liver was referred for interventional radiologic treatment. He was not a candidate for surgical resection due to impaired liver function and his personal preferences. On conventional ultrasonography no lesion could be detected, but the tumor was clearly depicted by intra-arterial carbon-dioxide-enhanced ultrasonography. Radiofrequency ablation was performed safely and accurately under the guidance of carbon-dioxide-enhanced ultrasonography. By concomitant performance of transcatheter arterial chemoembolization with radiofrequency ablation, extensive necrosis was obtained and adequate tumor volume reduction achieved with only one treatment session.
  • PurposeTo demonstrate that stability is a crucial parameter for theranostic properties of Lipiodol{sup ®}-based emulsions during liver trans-arterial chemo-embolization.Materials and MethodsWe compared the theranostic properties of two emulsions made of Lipiodol{sup ®} and doxorubicin in two successive animal experiments (One VX2 tumour implanted in the left liver lobe of 30 rabbits). Emulsion-1 reproduced one of the most common way of preparation (ratio of oil/water: 1/1), and emulsion-2 was designed to obtain a water-in-oil emulsion with enhanced stability (ratio of oil/water: 3/1, plus an emulsifier). The first animal experiment compared the tumour selectivity of the two emulsions: seven rabbits received leftmore » hepatic arterial infusion (HAI) of emulsion-1 and eight received HAI of emulsion-2. 3D-CBCT acquisitions were acquired after HAI of every 0.1 mL to measure the densities’ ratios between the tumours and the left liver lobes. The second animal experiment compared the plasmatic and tumour doxorubicin concentrations after HAI of 1.5 mg of doxorubicin administered either alone (n = 3) or in emulsion-1 (n = 6) or in emulsion-2 (n = 6).ResultsEmulsion-2 resulted in densities’ ratios between the tumours and the left liver lobes that were significantly higher compared to emulsion-1 (up to 0.4 mL infused). Plasmatic doxorubicin concentrations (at 5 min) were significantly lower after HAI of emulsion-2 (19.0 μg/L) than emulsion-1 (275.3 μg/L, p < 0.01) and doxorubicin alone (412.0 μg/L, p < 0.001), and tumour doxorubicin concentration (day-1) was significantly higher after HAI of emulsion-2 (20,957 ng/g) than in emulsion-1 (8093 ng/g, p < 0.05) and doxorubicin alone (2221 ng/g, p < 0.01).ConclusionStabilization of doxorubicin in a water-in-oil Lipiodol{sup ®}-based emulsion results in better theranostic properties.« less
  • PurposeThis study was performed to evaluate the accumulation of lipiodol emulsion (LE) and adverse events during our initial experience of balloon-occluded trans-catheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC) compared with conventional TACE (C-TACE).MethodsB-TACE group (50 cases) was compared with C-TACE group (50 cases). The ratio of the LE concentration in the tumor to that in the surrounding embolized liver parenchyma (LE ratio) was calculated after each treatment. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Effects (CTCAE) version 4.0.ResultsThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (tmore » test: P < 0.05). Only elevation of alanine aminotransferase was more frequent in the B-TACE group, showing a statistically significant difference (Mann–Whitney test: P < 0.05). While B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation, there was no statistically significant difference in incidence between the groups. Multivariate logistic regression analysis suggested that the significant risk factor for liver abscess/infarction was bile duct dilatation (P < 0.05).ConclusionThe LE ratio at the level of subsegmental showed a statistically significant difference between the groups (t test: P < 0.05). B-TACE caused severe adverse events (liver abscess and infarction) in patients with bile duct dilatation.« less
  • PurposeThis prospective study evaluated the effectiveness and safety of TACE using irinotecan loaded superabsorbent polymer (SAP) microspheres for treatment of colorectal cancer liver metastases (CCLM) in a salvage setting of patients.MethodsA total of 71 TACE procedures were performed in 29 patients with liver only or liver-dominant CCLM. In all patients, systemic chemotherapy before TACE had failed. Two hundred milligrams of irinotecan were loaded into 50–100 mg of SAP microspheres (HepaSphere™ Microspheres) considering tumor size and vascularization. TACE was performed selectively with respect to tumor distribution. Response was evaluated following RECIST and EASL criteria, respectively. Median follow-up after last TACE was 8more » (range 1–54) months. All patients had died at time of analysis.ResultsAll TACE procedures were performed successfully; 35–400 mg (mean 168.3 mg) of irinotecan loaded in 13–100 mg (mean 48.3 mg) SAP microspheres were injected during individual sessions. No major complications occurred. Three, 6, and 12 months after first TACE complete and partial response was present in 72, 32 %, 0 of patients by EASL criteria and stable disease was seen in 86, 48, and 8 % with no complete and no partial response by RECIST criteria. Median overall survival after first TACE was 8 months, and median time to progression was 5 months. Median overall survival was longer in patients with limited (<25 %) compared with extensive (>50 %) intrahepatic disease (21 vs. 5 months, p < 0.005).ConclusionsTACE using irinotecan loaded SAP microspheres is safe and effective in terms of tumor necrosis. Survival benefit in a salvage setting seems to be limited in patients with advanced intrahepatic tumor load.« less
  • Twelve cases of hepatocellular carcinoma treated by arterial embolization were followed with ultrasonography. Shrinkage of the tumor after the therapy was confirmed in all cases. Echo level reduction in the tumor occurred in 10 cases. High-level reverberation echoes with acoustic shadows emerged in seven cases; however, these echoes were not detected in any cases 3 weeks after the procedure. Echoes were considered either as the consequence of gas produced in the tumor of air trapped in the embolic substance. Ultrasonography, therefore, is an effective technique for the posttherapeutic evaluation of arterial embolization therapy for hepatocellular carcinoma.