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Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma

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World Journal of Hepatology 2020年第1期12卷 21-33页

作者： Francisco leonardo Galastri Felipe Nasser Breno Boueri Affonso leonardo guedes m.reira valle Bruno Calazans Odísio Joaquim mauricio motta-Leal Filho Paolo Rogério Salvalaggio Rodrigo Gobbo Garcia márcio Dias de Almeida Ronaldo Hueb Baroni Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Diagnostic Radiology The University of Texas MD Anderson Cancer CenterHoustonTX 77230United States Radiology Department Radiology DepartmentHeart Institute(InCor)University of São PauloSão Paulo 05403-900Brazil Teaching and Research Institute São PauloBrazilHospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Liver Transplant Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Department of Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil

BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to ***,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best *** of the response after DEB-TACE still have not been fully *** is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver *** To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).mETHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to *** patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were *** and post-chemoembolization imaging studies were performed by computed tomography or magnetic *** radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of *** Two hundred patients with 380 HCCs were *** of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(Pmultiple linear regression revealed that the addition of each 1mg of the

关键词： Hepatocellular carcinoma Liver transplantation Response evaluation criteria in solid tumors Neoadjuvant therapy Liver neoplasms

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Diagnosis and management of hepatic artery in-stent restenosis after liver transplantation by optical coherence tomography:A case report

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World Journal of Hepatology 2020年第7期12卷 399-405页

作者： Francisco leonardo Galastri Guilherme moratti Gilberto Breno Boueri Affonso leonardo guedes m.reira valle Priscila mina Falsarella Adriano mendes Caixeta Camila Antunes Lima marcela Juliano Silva Lucas Lembrança Pinheiro Conrado Dias Pacheco Annicchino Baptistella márcio Dias de Almeida Rodrigo Gobbo Garcia Nelson Wolosker Felipe Nasser Hospital Israelita Albert Einstein Department of Interventional RadiologySão Paulo 05652900Brazil Hospital Israelita Albert Einstein Department of Interventional CardiologySão Paulo 0562900Brazil Hospital Israelita Albert Einstein Department of Liver TransplantSão Paulo 05652900Brazil Hospital Israelita Albert Einstein Department of Vascular SurgerySão Paulo 05652-000Brazil

BACKGROUNDPercutaneous transluminal angioplasty and stenting represent an effectivetreatment for hepatic artery stenosis after liver transplantation. In the first yearafter stenting, approximately 22% of patients experience in-stent restenosis,increasing the risk of artery thrombosis and related complications, and 50%experience liver failure. Although angiography is an important tool for diagnosisand the planning of therapeutic interventions, it may raise doubts, especially insmall-diameter arteries, and it provides low resolution rates compared withnewer intravascular imaging methods, such as optical coherence tomography(OCT).CASE SUmmARYA 64-year-old male developed hepatic artery stenosis one year after orthotropicliver transplantation and was successfully treated with percutaneous transluminalangioplasty with stenting. Five months later, the Doppler ultrasound resultsindicated restenosis. Visceral arteriography confirmed hepatic artery tortuositybut was doubtful for significant in-stent restenosis (ISR) and intrahepatic flowreduction. To confirm ISR, identify the etiology and guide treatment, OCT wasperformed. OCT showed severe stenosis due to four mechanisms: Focal andpartial stent fracture, late stent malapposition, in-stent neointimal hyperplasia,and *** diagnostic methods can be useful in evaluating cases in which initialangiography results are not sufficient to provide a proper diagnosis of significantstenosis, especially with regard to ISR. A wide range of diagnoses are provided byOCT, resulting in different treatment options. Interventional radiologists shouldconsider intravascular diagnostic methods as additional tools for evaluatingpatients when visceral angiography results are unclear.

关键词： Liver transplantation Hepatic artery restenosis Tomography Optical coherence Case report Endovascular procedures Angiography

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