Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases

Herbert Zeh, Peter L. Choyke, H. Richard Alexander, David L. Bartlett, Steven K. Libutti, Richard Chang, Ronald M. Summers

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: Isolated hepatic perfusion (IHP) is a new treatment for patients with isolated unresectable liver metastases, which can result in a partial or complete response in ~75% of patients. Preoperative knowledge of hepatic arterial anatomy is important to adequately perfuse the liver. Digital subtraction angiography (DSA) is currently used to identify the hepatic arterial anatomy. The purpose of this study was to determine if MR angiography (MRA) could replace DSA prior to IHP. Method: Twenty-seven patients scheduled to undergo IHP underwent MRA with a contrast-enhanced 3D time-of-flight gradient echo sequence. Both maximal intensity projections (MIPs) and source coronal images were used to evaluate the images. The results of the MRA were interpreted by two readers who were blinded to the surgical results. The first 17 patients also underwent DSA, and a separate comparison was made with those results. Anatomy was characterized as either normal hepatic arteries (NHAs), normal vasculature with an accessory left hepatic artery (aLHA), or a replaced right hepatic artery (rRHA). Results: MM correctly detected all 22 patients with NHAs but also identified 6 aLHAs, of which only 2 were confirmed surgically. MRA correctly detected till five rRHAs. MIP images alone accurately depicted the hepatic arterial anatomy in only 9 of 27 (33%), usually because significant vessels were not visualized or their origin could not he determined. Source coronal images were required to accurately determine the anatomy in all patients. Among the 17 patients who underwent DSA, MRA detected 14 of 14 with NHA and 3 of 3 with rRHA. Six aLHAs were identified by MRA and five were confirmed by DSA. Conclusion: Enhanced 3D MRA is an accurate method of depicting the hepatic arterial supply. In comparison to surgery, MRA overestimates the number of aLHAs, but this may be because these small vessels are not detected at surgery. Based on the results of this study, DSA has been replaced by MRA in the planning of IHP at our institution. A better display of MRA images is needed as MIP images were usually insensitive for the small caliber arteries supplying the liver.

Original languageEnglish (US)
Pages (from-to)664-669
Number of pages6
JournalJournal of Computer Assisted Tomography
Volume23
Issue number5
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Gadolinium
Angiography
Perfusion
Neoplasm Metastasis
Digital Subtraction Angiography
Hepatic Artery
Liver
Anatomy
Arteries

Keywords

  • Liver
  • Liver, anatomy
  • Liver, blood supply
  • Magnetic resonance angiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Zeh, H., Choyke, P. L., Alexander, H. R., Bartlett, D. L., Libutti, S. K., Chang, R., & Summers, R. M. (1999). Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases. Journal of Computer Assisted Tomography, 23(5), 664-669. https://doi.org/10.1097/00004728-199909000-00003

Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases. / Zeh, Herbert; Choyke, Peter L.; Alexander, H. Richard; Bartlett, David L.; Libutti, Steven K.; Chang, Richard; Summers, Ronald M.

In: Journal of Computer Assisted Tomography, Vol. 23, No. 5, 1999, p. 664-669.

Research output: Contribution to journalArticle

Zeh, H, Choyke, PL, Alexander, HR, Bartlett, DL, Libutti, SK, Chang, R & Summers, RM 1999, 'Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases', Journal of Computer Assisted Tomography, vol. 23, no. 5, pp. 664-669. https://doi.org/10.1097/00004728-199909000-00003
Zeh, Herbert ; Choyke, Peter L. ; Alexander, H. Richard ; Bartlett, David L. ; Libutti, Steven K. ; Chang, Richard ; Summers, Ronald M. / Gadolinium-enhanced 3D MRA prior to isolated hepatic perfusion for metastases. In: Journal of Computer Assisted Tomography. 1999 ; Vol. 23, No. 5. pp. 664-669.
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abstract = "Purpose: Isolated hepatic perfusion (IHP) is a new treatment for patients with isolated unresectable liver metastases, which can result in a partial or complete response in ~75{\%} of patients. Preoperative knowledge of hepatic arterial anatomy is important to adequately perfuse the liver. Digital subtraction angiography (DSA) is currently used to identify the hepatic arterial anatomy. The purpose of this study was to determine if MR angiography (MRA) could replace DSA prior to IHP. Method: Twenty-seven patients scheduled to undergo IHP underwent MRA with a contrast-enhanced 3D time-of-flight gradient echo sequence. Both maximal intensity projections (MIPs) and source coronal images were used to evaluate the images. The results of the MRA were interpreted by two readers who were blinded to the surgical results. The first 17 patients also underwent DSA, and a separate comparison was made with those results. Anatomy was characterized as either normal hepatic arteries (NHAs), normal vasculature with an accessory left hepatic artery (aLHA), or a replaced right hepatic artery (rRHA). Results: MM correctly detected all 22 patients with NHAs but also identified 6 aLHAs, of which only 2 were confirmed surgically. MRA correctly detected till five rRHAs. MIP images alone accurately depicted the hepatic arterial anatomy in only 9 of 27 (33{\%}), usually because significant vessels were not visualized or their origin could not he determined. Source coronal images were required to accurately determine the anatomy in all patients. Among the 17 patients who underwent DSA, MRA detected 14 of 14 with NHA and 3 of 3 with rRHA. Six aLHAs were identified by MRA and five were confirmed by DSA. Conclusion: Enhanced 3D MRA is an accurate method of depicting the hepatic arterial supply. In comparison to surgery, MRA overestimates the number of aLHAs, but this may be because these small vessels are not detected at surgery. Based on the results of this study, DSA has been replaced by MRA in the planning of IHP at our institution. A better display of MRA images is needed as MIP images were usually insensitive for the small caliber arteries supplying the liver.",
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AU - Alexander, H. Richard

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AU - Libutti, Steven K.

AU - Chang, Richard

AU - Summers, Ronald M.

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N2 - Purpose: Isolated hepatic perfusion (IHP) is a new treatment for patients with isolated unresectable liver metastases, which can result in a partial or complete response in ~75% of patients. Preoperative knowledge of hepatic arterial anatomy is important to adequately perfuse the liver. Digital subtraction angiography (DSA) is currently used to identify the hepatic arterial anatomy. The purpose of this study was to determine if MR angiography (MRA) could replace DSA prior to IHP. Method: Twenty-seven patients scheduled to undergo IHP underwent MRA with a contrast-enhanced 3D time-of-flight gradient echo sequence. Both maximal intensity projections (MIPs) and source coronal images were used to evaluate the images. The results of the MRA were interpreted by two readers who were blinded to the surgical results. The first 17 patients also underwent DSA, and a separate comparison was made with those results. Anatomy was characterized as either normal hepatic arteries (NHAs), normal vasculature with an accessory left hepatic artery (aLHA), or a replaced right hepatic artery (rRHA). Results: MM correctly detected all 22 patients with NHAs but also identified 6 aLHAs, of which only 2 were confirmed surgically. MRA correctly detected till five rRHAs. MIP images alone accurately depicted the hepatic arterial anatomy in only 9 of 27 (33%), usually because significant vessels were not visualized or their origin could not he determined. Source coronal images were required to accurately determine the anatomy in all patients. Among the 17 patients who underwent DSA, MRA detected 14 of 14 with NHA and 3 of 3 with rRHA. Six aLHAs were identified by MRA and five were confirmed by DSA. Conclusion: Enhanced 3D MRA is an accurate method of depicting the hepatic arterial supply. In comparison to surgery, MRA overestimates the number of aLHAs, but this may be because these small vessels are not detected at surgery. Based on the results of this study, DSA has been replaced by MRA in the planning of IHP at our institution. A better display of MRA images is needed as MIP images were usually insensitive for the small caliber arteries supplying the liver.

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