Abstract No. 466 Quantitative assessment of the effect of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using two-dimensional digital subtraction angiography

Abstract

To evaluate the effects of intra-arterial nitroglycerin on hepatocellular carcinoma perfusion using 2-D perfusion angiography Two-dimensional (2D) perfusion angiograms obtained during planning arteriography for radioembolization of HCCs from September 2019 to February 2020 were retrospectively reviewed. Inclusion criteria included LIRADS-5 lesions and angiographically identifiable tumor and background parenchyma. Exclusion criteria included treated lesions and motion-degraded studies. Tumor and background liver parenchyma 2D perfusion data before and after the administration of intra-arterial nitroglycerin were processed and the area under the curve (AUC) of the time-density curve was calculated. Relative perfusion of HCC to background liver was compared at the 2 time points using a 2-tailed unpaired t-test. Twenty-four arteriograms were reviewed. Twelve were excluded from the analysis due to prior treatment (n = 5), motion degradation (n = 2), and no identifiable background liver (n = 5). Twelve HCCs in 12 patients were included in the final analysis. Mean patient age was 71.7 ± 9.7 years. Ten patients had cirrhosis. Mean maximum tumor dimension was 4.9 ± 2.0 cm. Seven tumors were in the right lobe and 5 in the left lobe. Contrast injection duration was 5 seconds. Mean intra-arterial nitroglycerin dose was 279 ± 69 micrograms. The arteriograms were then analyzed using 2D perfusion software. The ratio of the AUC of HCC to background liver was 2.18 ± 1.11 before intra-arterial nitroglycerin and 3.14 ±1.70 after nitroglycerin administration (P < 0.05). Intra-arterial nitroglycerin significantly increases perfusion to hepatocellular carcinoma when compared to background liver. Further research is needed to determine if nitroglycerin increases the permeability of HCC tumors and thereby increases intra-tumoral dose delivery.