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.

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.

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.