RESUMO
PURPOSE: To evaluate the safety and feasibility of sonographically-assisted catheter placement in interstitial high-dose-rate brachytherapy of abdominal malignancies. MATERIALS AND METHODS: In an initial cohort of 12 patients and 16 abdominal tumors (colorectal liver metastases nâ=â9; renal cell cancer nâ=â3; hepatocellular carcinoma nâ=â2; cholangiocellular carcinoma nâ=â2), initial puncture and catheter placement for CT-guided brachytherapy were performed under sonographic assistance when possible. The interventional procedure was prospectively recorded and in-patient data were collected. All data underwent descriptive statistics and comparative analysis by the Mann-Whitney test. RESULTS: In 12 out of 16 lesions (diameter 1.5â-â12.9âcm), initial puncture was successfully achieved under ultrasound guidance without utilization of CT fluoroscopy, yielding a significantly shorter mean total fluoroscopy time (14.5 vs. 105.5âs; pâ=â0.006). In 8 lesions visibility was rated better in ultrasound than in CT fluoroscopy (pâ=â0.2). No major or minor complications occurred within 30 days after treatment. CONCLUSION: Ultrasound-assisted catheter placement during interstitial CT-guided brachytherapy of abdominal tumors could improve catheter positioning and reduce radiation exposure for medical staff. KEY POINTS: Ultrasound-assisted catheter placement in CT-guided brachytherapy is safe and feasible. Ultrasound puncture may improve catheter positioning. Reduced CT fluoroscopy time can significantly help to minimize radiation exposure for medical staff. CITATION FORMAT: · Damm R, El-Sanosy S, Omari J etâal. Ultrasound-assisted catheter placement in CT-guided HDR brachytherapy for the local ablation of abdominal malignancies: Initial experience. Fortschr Röntgenstr 2019; 191: 48â-â53.
Assuntos
Braquiterapia/métodos , Cateterismo/métodos , Neoplasias Renais/radioterapia , Neoplasias Hepáticas/radioterapia , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Idoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/radioterapia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/radioterapia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/radioterapia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/radioterapia , Estudos de Viabilidade , Feminino , Fluoroscopia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Estudos ProspectivosRESUMO
PURPOSE: 3 and 9 o'clock arteries (3&9As) which supply the common hepatic duct connect hepatic with duodenal/pancreatic territories. The study purpose is to describe the angiographic anatomy of 3&9As and discuss their relevance when performing radioembolization (RE) of liver malignancies. MATERIALS AND METHODS: The anatomy of the 3&9As was systematically investigated by a retrospective analysis of angiograms, technetium Tc-99 m-macroaggregated albumin (MAA) scintigrams, yttrium-90 (Y90) Bremsstrahlung-SPECT/CT datasets, and clinical data of 153 patients who underwent RE between 2010 and 2013. RESULTS: Analysis of preprocedural angiograms identified 3&9As in 36 (24%) of the 153 patients. Following embolization of the gastroduodenal artery, 3&9As were seen in 53 cases (35%). The three most common origins of the 3&9As were the right hepatic artery (n = 14), the cystic artery (n = 11), and S5 and S6 segmental arteries (n = 5 each). Extrahepatic Tc-99 m-MAA deposition in the territory of the 3&9As was significantly more frequent when 3&9As were detectable on preprocedural angiograms (28%visible vs. 11%not visible; p = 0.001) and especially when the 3&9As were not embolized or bridged prior to RE (50%not occluded/bridged vs. 19%occupied/bridged; p = 0.043). The presence of extrahepatic Y90 Bremsstrahlung after RE (n = 17) was attributable to microsphere diversion via the 3&9A territory in four patients and possible diversion via this territory in nine patients. Five of these 13 patients presented with epigastric pain, nausea, or vomiting (CTCAE severity grade ≤ 3) (p = 0.014). CONCLUSION: 3&9As are commonly detectable during evaluation angiography prior to RE, have a variable angioanatomic origin, and should be prophylactically occluded to prevent complications.