Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy

BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12%of such cases.Risk factors for CIN development can be divided into patientand procedure-related.The former includes pre-existing chronic renal insufficiency and diabetes mellitus.The latter includes high contrast volume and repeated exposure over 72 h.The incidence of CIN is relatively low(up to 5%)in patients with intact renal function.However,in patients with known chronic renal insufficiency,the incidence can reach up to 27%.AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic(CT)images obtained immediately following hepatic artery embolization with development of CIN.METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011(n=162)was performed.Patients without intraprocedural CT imaging(n=51),combined embolization/ablation(n=6)and those with chronic kidney disease(n=21)were excluded.The study group comprised of 84 patients with 106 procedures.CIN was defined as 25%increase above baseline serum creatinine or absolute increase≥0.5 mg/dL within 72 h post-embolization.Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications.The association between noncontrast CT findings and CIN development was examined by Fisher’s Exact Test.RESULTS CIN occurred in 11/106(10.3%)procedures(Group A,n=10).The renal enhancement pattern in patients who did not experience CIN(Group B,n=74 with 95/106 procedures)was late excretory in 93/95(98%)and early excretory(EE)in 2/95(2%).However,in Group A,there was a significantly higher rate of EE pattern(6/11,55%)compared to late excretory pattern(5/11)(P<0.001).A significantly higher percentage of patients that developed CIN had renal artery calcifications(6/11 vs 20/95,55%vs 21%,P=0.02).CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle(EE pattern)and presence of renal artery calcifications on immediate post-HAE noncontrast CT images in patients with low risk for CIN are independently associated with CIN development.

Resection of a locally advanced hilar tumor and the hepatic artery after stepwise hepatic arterial embolization: A case report

We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolizationof the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.

Predictive factors for the post embolization fever after transcatheter arterial chemoembolization in hepatocellular carcinoma patients:a single center study in China

Background and Objectives:Post embolization fever(PEF)is one of the most common symptoms of post embolization syndrome(PES).This study aimed to determine and validate a model to predict PEF after transcatheter arterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)patients.Methods:Clinical data of HCC patients who underwent TACE with platinum was retrospectively collected in our center from 2017 to 2018.Predictive factors were screened by multivariate logistic regression.The accuracy and discriminative ability of these factors were evaluated by the receiver operating characteristic(ROC)curve using the derivation cohort and an independent validation cohort.Results:A total of 367 patients were included,of whom 53(14.4%)patients had PEF.Fevers were detected in 44 of 252 patients in the derivation cohort and 9 of 115 patients in the validation cohort.Predictors for PEF identified in multivariate logistic regression included Lipiodol emulsion dose(OR,1.081;95%CI,1.006-1.162),number of concomitants uses of hepatoprotectants(OR,0.619;95%CI,0.419-0.914),K+levels(OR,2.992;95%CI,1.225-7.308),and albumin-bilirubin(ALBI)grade(OR,2.249;95%CI,1.040-4.862).Furthermore,the area under the ROC curve of the derivation and validation cohorts were 0.798 and 0.874,respectively.Conclusions:Our study demonstrated that Lipiodol emulsion dose,number of concomitant uses of hepatoprotectants,K+levels,and ALBI grade are independent risk factors for PEF.The multivariate logistic model of these factors shows a discriminative ability to predict PEF in the patients who underwent TACE.

Studies on Mitomycin C Dextran-microspheres

In this paper,the preparation and properties of mitomycin C dextran-microspheres(MMC-DMS)were reported.The characteristics of pharmacokinetics and embolization effects of MMC-DMS in vivo were studied in dogs.The average diameter of the microspheres was 75±19μm and the content was 5% of MMC.In in vitro experiment, the release rate of drug demonstrated that the microspheres had sustained-release properties. The microspheres and conventional MMC were infused into the hepatic artery of dogs through a catheter for embolization,respectively.The plasma concentration of MMC was de- termined by HPLC.Results showed that the peak concentration of conventional MMC was 2.6 times as much as MMC-DMS.Angiograms revealed that peripheral blood vessels de- creased obviously in liver.The histopathologic examination showed that the microspheres lodged in the hepatic artery and displayed nodular necrosis in the embolized segment.The MMC-DMS were used in clinical trial in 100 patients with hepatic cancer.The tumor reduc- tion and improvement of symptoms in patients were observed after hepatic arterial embolization.The survival duration was prolonged.Results showed that the MMC-DMS is a promising embolic agent for treatment of hepatic cancer.It could aid in the use of intensive chemotherapy with minimum systemic side effect.

Studies on Adriamycin Magnetic Gelatin Microspheres

The preparation and properties of adriamycin magnetic gelatin microspheres(Adr- MG-ms)were reported.The synthesis of magnetic iron oxide ultrafine particle and embolization effects of magnetic gelatin microspheres(MG-ms)in dog were studied.Adr- MG-ms consist of 2%(w/w)of adriamycin(Adr)as the core,and 68% of gelatin and 30% of magnetite as the shell with a mean particle size of 22 μm. In vitro experiment,the release rate of drug demonstrated that the microspheres have sustained-release properties.The average diameter of magnetic iron oxide was approximately l0 nm. Transcatheter embolization with MG-ms and ￣(99m)Tc-labelled MG-ms was performed under external magenet control in dog liver,respectively.Gamma photography and angiogram revealed that MG-ms level was almost equal both in left and right hepatic arteries without magnet,while with magnet(1200 Gs),MG-ms level in left hepatic artery(target site)was about 2.25 fold higher than in right hepatic artery,and few MG-ms in thyroid gland,brain and heart was observed.Results showed that the MG-ms is a promising embolic agent for treatment of hepatic cancer under external magnet control.

Study on Treatment of Primary Hepatic Carcinoma by Arterial Perfusion Embolization with Zedoary Turmeric Oil

To evaluate the effect, side-effect and prospect of hepatic arterial perfusion embolization (HAPE) with Zedoary turmeric oil (ZTO) in treating primary hepatic carcinoma (PHC).Methods: Clinical study was carried out by administration of 1-3 ml ZTO through arterial catheter to induce embolism in 32 patients of PHC, and compared with 32 patients treated by hepatic arterial perfusion embolization with chemical agents (HAPE-C) in the control group. The Chinese herbal medicine was given orally to both groups according to Syndrome Differentiation of TCM. In the experimental study, transplantation hepatic carcinoma model was established in 40 rats. They were randomly divided into the treated group and the control group, 20 in each group, and were perfused with 10 mg/kg ZTO and 0.2-0.3 ml normal saline respectively to observe the effect of treatment.Results: The effect of treatment in the ZTO group was CR in 1 case and PR in 13 cases, the total effective rate being 43.75%, with AFP negative reversed in 7 cases, titer decreased in 7; while in the control group it was PR in 10 cases, the total effective rate being 31.25%, AFP negative reversed in 5, titer decreased in 2, and the difference of therapeutic effect between the two groups was insignificant (P>0.05). The post-perfusion thrombotic syndrome occurrence, with the symptoms of fever, abdominal pain, vomiting, etc. in the two groups was similar, but no bone marrow inhibition occurred in the ZTO group, which was different from the control group (P<0.01, P<0.05). The mean survival time, median survival time, 1-, 2-, 3- and 4-year survival rate in the ZTO group was 13.84 months, 10 months, 37.5%, 18.87%, 9.70% and 6.4% respectively, and in the control group, 8.03 months, 6 months, 15.6%, 6.27%, 0% and 0% respectively, the mean survival time, median survival time and 1-year survival rate in the ZTO group were significantly superior to those in the control group (P<0.05). Experimental study showed that the effect in the treated group was better than that in the control group in tumor growth inhibition with the tumor growth rate as 10.8±4.5%% vs 20.6±12.7%, P<0.05, tumor necrosis degree (P<0.01) and survival time prolonged (14.8±3.4 days vs 11.7±1.9 days, P<0.05).Conclusion: HAPE-ZTO in treating PHC showed the therapeutic effect similar to that of HAPE-C, but superior to the latter in survival time prolongation and bone marrow inhibition.