胸廓内动脉参与肝脏肿瘤供血的影像表现与介入治疗(附6例报告)

观察胸廓内动脉参与肝脏肿瘤供血的影像表现和介入治疗效果。材料与方法４年间发现ＩＴＡ参与肝癌供血６例，经血管造影证实，男性５例，女１例，年龄３６－５２岁，均有超声波与ＣＴ检查资料，３例曾做ＭＲＩ检查。既往均曾行肝动脉化疗栓塞。ＩＴＡ造影用５Ｆ眼镜蛇形导管，对向肿瘤供血的ＩＴＡ分支行栓塞治疗，２例用同轴微导管。     

动脉灌注化疗并栓塞治疗中晚期恶性肿瘤935例临床疗效及并发 …

目的：为总结动脉灌注化疗合并栓塞治疗各种恶性肿瘤的临床疗效以及并发症发生的原因。材料与方法：采用回性临床总结过去６年中９３５例各种中晚期肿瘤，并进行支经疗药物灌注２７１５例闪，肿瘤供血动脉栓塞６７５例次，所用化疗药物一般２－３联，所用栓塞霁眯４０％碘化油５－２０ｍｌ以及明胶海绵碎屑。结果：９３５例病人ＣＲ１１３例，ＰＲ２０１例，ＭＲ２８８例，ＳＤ２４１例，ＰＤ９２例，总有效率（ＣＲ＋ＰＲ＋ＭＲ）为     

恶性肌肿瘤的介入治疗：附20例报告

笔者对２０例恶性骨肿瘤做了介入治疗，全部病例均经动脉内灌注化疗，并对其中发生于骨盆区域的１２例肿瘤加做动脉内栓塞治疗。手术及病理证实：肿瘤均有不同程度的坏死，液化和囊变。笔者认为，在介入治疗中，动脉内栓塞较灌注化疗更为重要，提出了栓塞材料的选择与方法，并认为血管造影有助于肿瘤的良恶性判别。最后对介入治疗后影像学评价和副反应的预防进行了探讨。     

腰骶部骨肿瘤的介入性动脉栓塞治疗

目的探讨选择性腰动脉及髂动脉栓塞及化疗栓塞在腰骶部肿瘤治疗中的价值。方法采用选择性动脉插管,用经高温处理的明胶海绵栓塞或化疗性栓塞供应肿瘤的腰动脉、髂内动脉。结果本组共6例,2例骨巨细胞瘤栓塞后行手术治疗,术中出血量明显减少,平均为1 600 m l,且手术顺利,肿瘤切除彻底;2例血管瘤及2例转移瘤行栓塞及化疗栓塞,肿瘤缩小,症状明显减轻,生活质量提高,延长了生存期。结论在腰骶部骨肿瘤中,选择性腰动脉加髂内动脉栓塞及化疗栓塞是一种安全有效的治疗方法。     

恶性梗阻性黄疸双介入疗法姑息性治疗

目的：探讨梗阻性黄疸的介入治疗方法．对经皮肝穿刺植入胆道支架及动脉灌注或栓塞化疗的临床效果给予讨论。方法：采用金属支架植入并与动脉灌注或栓塞化疗相结合的双介入治疗方法。结果：在30例患者中(男18例，女12例)，30例均成功植入胆道内支架，所有病例定期行肿瘤供血动脉插管灌注化疗或栓塞化疗。CR2例，PR16例，无变化10例，肿瘤增大2例，全组病例生存时间3—21．5个月，平均9．5个月。结论：双介入疗法治疗恶性梗阻性黄疸是比较理想的姑息性治疗方法．能明显的提高生活质量，延长患者的生存期。     

肝动脉化疗、栓塞治疗原发性肝癌的临床研究（附188例分析）

目的：研究原发性肝癌肝动脉化疗、栓塞的疗效及其影响因素。材料与方法：回顾性分析１８８例肝癌肝动脉化疗、栓塞的临床随访资料。结果：总疗效为症状缓解占５９．６％，肿瘤缩小占５５％，ＡＦＰ下降占３７．８％，半年及１、２、３年生存率分别为７５．４％、４６％、２３．５％、１４．７％，平均生存期１２．２月，最长已存活５０月，获二步手术切除１８例，对比分析了７个影响疗效的有关因素。结论：无或轻度肝硬化、早中期、单个肿瘤、直径＜１０ｃｍ、无门脉癌栓或肝动－静脉瘘、行栓塞治疗、治疗次数在３次以上者，其中远期疗效明显优于对应组。克服有关影响因素及综合治疗将会进一步提高肝癌化疗栓塞的疗效     

中药白芨作为栓塞剂运用于骨骼肿瘤的治疗

目的：评价中药白芨作为栓塞的对骨骼系统肿瘤治疗的临床疗效。材料与方法：６例患分别患有骨母细胞肉瘤，软骨母细胞肉瘤，纤维肉瘤并骨转移，肺癌耻骨转移，脊索瘤及纤维异常增殖症，行动脉选择性造影后病人知动脉注入白芨颗粒达到完全栓塞，再采用平片，血管造影及手术后病理分析评价疗效。结果：（１）３例恶性骨肿瘤栓塞后使原有剧疼症状明显减轻；（２）２例恶性骨肿瘤栓塞后１个月显示病灶内明显钙化；（３）５例手术后病理     

腰骶椎肿瘤的选择性动脉造影及栓塞治疗

目的 探索造反性动脉造影及化疗栓塞在腰骶肿瘤治疗中的应用价值。方法 搜集９例腰骶椎肿瘤病例，靠拢性腰动脉造影后，７例行明胶海绵栓塞，其中３例栓塞后行手术治疗。结果 选择性动脉造影可清楚显示肿瘤的大小及血供特点，３例栓塞后行手术治疗的病人，术中出血量大大减少，平均出血５６０ｍｌ，１例未栓塞病人出血量约３０００ｍｌ。４例非手术的病人，腰部疼痛明显减轻。结论 选择性动脉造影栓塞术在腰骶椎肿瘤治疗中具有较     

肝动脉化疗,栓塞治疗原发性肝癌的临床观察

目的：研究原发性肝癌肝动脉化疗、栓塞的疗效及其影响因素。材料与方法：Ｌ回顾性分析１８８例肝癌肝动脉化疗、栓塞的临床随访资料。结果：总疗效为症状缓解占５９．６％，肿瘤缩小占５５％，ＡＦＰ下降占３７．８％，半年及１、２、３年生存率分别为７５．４％、４６％、２３．５％、１４．７％，平均生存期１２．２月，最长已存活５０月，获二步手术切除１８例，对比分析了７个影响疗效的有关因素。结论：无或轻度肝硬化、早中期     

肝癌合并门脉癌栓的化疗栓塞治疗

１２８例肝癌合并门脉癌栓病人经２次以上插管治疗，Ａ组肝动脉内灌注化疗药物，Ｂ组药物灌注加碘油栓塞，Ｃ组化疗加碘油及明胶海绵粒栓塞。三组１年生存率分别为２５．００％，２８．５２％，４１．７６％，平均生存７．２个月、８．４个月及１０．３个月。Ｃ组疗效最好，１例病人存活达７年，说明、门脉癌栓不应是肝动脉化疗栓塞的禁忌证，对没有严重肝硬化及肝功能损害的门脉癌栓病人均应进行化疗栓塞治疗。     

Transacatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results

Purpose: To evaluate the clinical effects of transcatheter arterial embolization (TAE) on malignant bone and soft tissue tumors. Methods: TAE was performed in 10 patients with primary bone and soft tissue sarcomas and in 31 patients with metastatic bone tumors. The embolized arteries were the internal iliac artery in 30 cases, the intercostal artery in six cases, the lumbar artery in five cases, the suprascapular artery in three cases, and the iliolumbar artery, the internal pudendal artery, and the lateral sacral artery in one case each. The embolized material was gelatin sponge particles. The chemotherapeutic drugs were usually 20–40 mg of doxorubicin for primary and metastatic tumors and 50–100 mg of cisplatin only for primary tumors. In addition, 50–60 Gy of 10-MV radiotherapy with or without radiofrequency (RF)-capacitive hyperthermia in four sessions was administered before TAE for primary tumors only. Results: Even though the pain score increased immediately after TAE, 30 of 38 (79%) patients with pain (8 of 9 with primary tumors, and 22 of 29 with metastases) achieved pain control after TAE. A necrotic low-density area shown by computed tomography (CT) after TAE was found in 31 of 41 (76%) tumors [8 of 10 (80%) with primary tumors, and 23 of 31 (74%) with metastatic tumors]. The tumor size decreased in 14 of 25 (56%) primary and metastatic tumors after 3 months. Osteosclerotic changes appeared in two cases of metastatic tumors after 6 months. In five tumors resected after TAE, large areas of necrosis within the tumor were confirmed histologically. Transient local pain and numbness appeared after TAE, but were relieved by drug treatment within 1 week. No severe complications except a case of gluteal muscle necrosis were encountered after TAE. The 1-year survival rate of the patients with primary tumors was 38.1%, and the median survival was 18 months. The longest survival was 84 months. The 1-year survival rate of the patients with metastatic bone tumors was 38.9%; the median survival was 12 months. The longest survival was 24 months. Conclusion: TAE could be an effective treatment for pain control and local control of malignant bone and soft-tissue tumors.     

6. 18F-FDG Whole Body Positron Emission Tomography (PET) in the Detection of Unknown Primary Tumors

Purpose: To evaluate the utility of FDG-PET in detecting primary tumors in patients with metastatic disease from unknown primary tumors.Methods: 12 patients with metastases from unknown origin after unsuccessful conventional diagnostic procedures were studied. 5 had lymph node metastases (2 axillary, 2 cervical, 1 mediastinal), 3 multiple metastases, 1 in the lung, 1 in the cava vein, 1 in the brain and 1 in adrenal glands. Patients received 400MBq FDG intravenously, and whole body images were acquired 60 min. after injection with an ECAT EXACT HR+. PET results were compared with histological and clinical findings.Results: All but one metastatic lesion was identified by PET. Additional metastases were visualized in 4 patients. In one helped to guide biopsy for histological diagnosis. In 4/11 patients FDG-PET did not reveal lesions suspected to be primary tumor. FDG-PET identified primary tumor in 8/11 patients (breast: 2, pancreas: 2, base of tongue: 1, adrenal gland: 1, lung: 1, stomach: 1). In 4 of them (33% of total) primary tumor was confirmed either histologically or by the clinical evolution (breast: 2, lung: 1, pancreas: 1). In 1 patient FDG-PET was false positive (base of tongue). 3 patients positive FDG-PET have not yet been confirmed. FDG-PET influenced therapeutic procedures in 4 patients (33% of total). 2 underwent surgery (breast), 1 received specific chemotherapy (lung) and 1 palliative chemotherapy (pancreas).Conclusions: Our preliminary results suggest that FDG-PET is a non-invasive technique useful in the detection of unknown primary tumors, can influence in selecting appropriate therapeutic management and could guide biopsies for histologic analysis.     

Image-Guided Radiofrequency Ablation (RFA) of Unresectable Hepatic Tumors Using a Triple-Spiral-Shaped Electrode Needle: Initial Experience in 34 Patients

We evaluated the safety and efficacy of image-guided radiofrequency ablation (RFA) using a triple-spiral-shaped electrode needle for unresectable primary or metastatic hepatic tumors. Thirty-four patients with 46 index tumors were treated. Ablation zone, morbidity, and complications were assessed. The lesions were completely ablated with an ablative margin of about 1 cm. Five patients (14.7%) with a lesion larger than 4.5 cm had local tumor progression after 1 month and were retreated. Hemothorax, as a major complication, occurred in 1 of 34 patients (3.0%) or 1 of 46 lesions ablated (2.2%). RFA using this new electrode needle can be effective in the treatment of large unresectable hepatic tumors.     

介入化疗治疗晚期恶性胰岛细胞瘤：附4例报道

目的探讨经导管动脉内灌注化疗(TAI)治疗晚期恶性胰岛细胞瘤的近期疗效。方法4例经病理证实晚期恶性胰岛细胞瘤,原发灶位于胰颈部1例,胰体尾部3例。3例为恶性胰岛素瘤伴有肝脏弥漫、多发转移,1例无功能恶性胰岛细胞瘤,因肿瘤侵及周围大血管和脾脏无法切除。4例患者接受腹腔干TAI,其中对3例肝脏转移瘤进行化疗栓塞。间隔1～2个月重复治疗。结果4例患者均获得随访,接受介入化疗共11疗程,平均2.8疗程。随访2～8个月,原发肿瘤部分缓解(PR)3例,稳定(SD)1例;转移瘤PR4例。伴有低血糖恶性胰岛素瘤患者空腹血糖全部恢复正常水平,1例无功能恶性胰岛细胞瘤临床腹胀、腹痛缓解。介入术后出现一过性发热3例,余未见介入化疗相关不良反应。结论对外科无法切除晚期恶性胰岛细胞瘤行TAI安全、疗效良好。     

Chemotherapy and embolization via the inferior epigastric artery for the treatment of primary and metastatic cancer

We evaluated the results of arterial chemotherapy and embolization via the inferior epigastric artery and its branches in 10 patients with a variety of primary and metastatic neoplasms supplied by that vessel. A total of 15 infusions and five occlusions were performed. There were no complications related to arteriography, indwelling catheters, or arterial occlusion. The effects on tumor bulk ranged from complete necrosis in one patient to partial necrosis in three patients. Surgical resection was facilitated in four of six patients. Local recurrence of tumor occurred in two of these patients. Three of four patients with intractable pain had effective relief. Our experience suggests that transarterial therapy of tumors supplied by the inferior epigastric artery or its branches is a safe procedure and may be useful in tumor management.     

Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres

Purpose Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations. Methods In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n = 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.     

Transcatheter arterial embolization in gastric cancer patients with acute bleeding

The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure.     

Interventional radiology for advanced hepatocellular carcinoma: comparison of hepatic artery infusion chemotherapy and transcatheter arterial lipiodol chemoembolization

OBJECTIVE: The prognosis of advanced hepatocellular carcinoma remains poor. The aim of this study was to compare the efficacy of hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization for treatment of advanced tumor. SUBJECTS AND METHODS. Thirty-seven patients with hepatocellular carcinoma and unresectable tumors were enrolled. In the hepatic artery infusion chemotherapy group (n = 16), cisplatin (10 mg/person, on days 1-5) and subsequent 5-fluorouracil (250 mg/person, on days 1-5) were administered for four serial courses. In the transcatheter arterial Lipiodol chemoembolization group (n = 21), an emulsion of Epirubicin (20-30 mg/person) and Lipiodol was administered every 3-4 weeks. RESULTS: The tumor response rates (complete response plus partial response for all cases) of the hepatic artery infusion chemotherapy and transcatheter arterial Lipiodol chemoembolization groups were 56.3% and 23.8%, respectively, showing the significantly higher rate in the former than in the latter group. The cumulative survival rates between the two groups were not significantly different; whereas in those patients whose tumors were classified as TNM stage IV or as having the maximal tumor size of greater than 5 cm, patients tended to have higher survival rates in the hepatic artery infusion chemotherapy group than in the transcatheter arterial Lipiodol chemoembolization group. Univariate analysis identified the serum aspartate aminotransferase value as solely significant. Patients' adverse reactions were successfully managed by treatment of symptoms. Adverse events, such as obstructions of the catheter or hepatic artery or infection around the catheter, rarely occurred. CONCLUSION: Hepatic artery infusion chemotherapy had a better antitumor effect than transcatheter arterial Lipiodol chemoembolization and may be a useful therapeutic option for more advanced hepatocellular carcinoma.     

Carbon dioxide-enhanced sonographically guided percutaneous ethanol injection: treatment of patients with viable and recurrent hepatocellular carcinoma

OBJECTIVE: Viable portions of tumors can persist and recurrent tumors sometimes appear in patients with hepatocellular carcinoma who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two. Some of these tumors are difficult to treat or do not respond to additional treatment using the same protocol. In this article, we examine the use of carbon dioxide (CO(2))-enhanced sonographically guided percutaneous ethanol injection to treat patients with such tumors. SUBJECTS AND METHODS. Our study population was 44 patients with 53 viable portions of tumors or recurrent hepatocellular carcinomas that had developed after the initial treatment of the primary tumor. The tumors were treated with CO(2)-enhanced sonographically guided percutaneous ethanol injection via the catheter that had been placed in the hepatic artery for angiography. Thirty-seven (84.1%) of the 44 patients had cirrhosis. Of these 37 patients, 23 had Child-Pugh class A cirrhosis, and 14 had Child-Pugh class B. RESULTS: Overall, thirty-four (64.2%) of the 53 tumors showed complete necrosis after treatment, eight (15.1%) of the 53 showed partial necrosis, and 11 (20.8%) of the 53 showed no response. The cumulative survival rates of patients who underwent CO(2)-enhanced sonographically guided percutaneous ethanol injection were 81%, 71%, and 44% for 1, 2, and 3 years, respectively. The small tumors were more responsive to the treatment. The tumor recurrence rate was 56.8%. In 9.1% of these cases, carcinoma had metastasized to other organs. CONCLUSION: CO(2)-enhanced sonographically guided percutaneous ethanol injection is effective for patients with viable portions of a treated tumor or new tumors who have undergone transcatheter arterial chemoembolization, percutaneous ethanol injection, or a combination of the two treatments. This finding is especially true of patients who are not good candidates for repeated treatments.     

Evaluation of Intrahepatic Perfusion on Fusion Imaging Using a Combined CT/SPECT System: Influence of Anatomic Variations on Hemodynamic Modification Before Installation of Implantable Port Systems for Hepatic Arterial Infusion Chemotherapy

BACKGROUND: In some patients with hepatic tumors, anatomic variations in the hepatic arteries may require hemodynamic modification to render effective hepatic arterial infusion chemotherapy delivered via implantable port systems. We used a combined CT/SPECT system to obtain fused images of the intrahepatic perfusion patterns in patients with such anatomic variations and assessed their effects on the treatment response of hepatic tumors. METHODS: Using a combined SPECT/CT system, we obtained fused images in 110 patients with malignant liver tumors (n = 75) or liver metastasis from unresectable pancreatic cancer (n = 35). Patients with anatomic hepatic arteries variations underwent hemodynamic modification before the placement of implantable port systems for hepatic arterial infusion chemotherapy. We evaluated their intrahepatic perfusion patterns and the initial treatment response of their liver tumors. The perfusion patterns on the fused images were classified as homogeneous, local hypoperfusion, and/or perfusion defect. Using the WHO criteria of complete response (CR), partial response (PR), no change (NC), and progressive disease (PD), we evaluated the patients' tumor responses after 3 months on multislice helical CT scans. The treatment was regarded as effective in patients who achieved a complete response or partial response. RESULTS: Anatomic hepatic artery variations were present in 15 of the 110 patients (13.6%); 5 manifested replacement of the left hepatic artery (LHA), 8 of the right hepatic artery (RHA), and 1 each had replacement of the RHA and LHA, and replacement of the LHA plus an accessory RHA. In 13 of these 15 patients (87%), occlusion with metallic coils was successful. On fusion imaging, the perfusion patterns were recorded as homogeneous in 6 patients (43%), as hypoperfusion in 7 (50%), and 1 patient had a perfusion defect (7.1%) in the embolized arterial region. Of the 8 patients with RHA replacement, 4 manifested a homogeneous distribution and 3 hypoperfusion. In 2 of 5 patients with LHA replacement, the distribution was homogeneous. In 1 patient with RHA and LHA replacement, and in 1 patient with LHA replacement and an accessory RHA, we noted hypoperfusion in the RHA territory. All 6 patients with homogeneous distribution were classified as PR or NC on follow-up multidetector CT. Of the 7 patients manifesting hypoperfusion, 3 were classified as PD (43%), 3 as NC (43%), and 1 as PR (14%) on follow-up CT. CONCLUSION: Hemodynamic modification of anatomic hepatic artery variations resulted in hypoperfusion on fusion images. Differences in the intrahepatic perfusion patterns may affect the response to hepatic arterial infusion chemotherapy.