Hepatic Arterial Blood Flow Research Articles

Compartment model analysis of intravenous contrast-enhanced dynamic computed tomography in hepatic hemodynamics: A validation study using intra-arterial contrast-enhanced computed tomography.

To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k1a ) and portal venous inflow velocity (k1p ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k2 ) limits using the nonlinear least square method. The correlation coefficient between the normalized enhancement in IA-CT and CMA of IV-CT was statistically evaluated according to various k2 limits. The highest mean correlation coefficient between k1a and nCTHA (r = 0.65, P < 0.0001) was observed when k2 ≦0.035. The highest mean correlation coefficient between k1p and nCTAP (r = 0.69, P < 0.0001) was observed when k2 ≦0.045. The decrease in correlation coefficient was significant when the upper k2 limit was lower than 0.03 or higher than 0.07 compared to the best mean correlation coefficient (P < 0.05). Hepatic arterial and portal venous flows can be evaluated quantitatively to some extent with appropriate outflow velocity constant limits using the CMA of IV-CT.

Benign and malignant hepatocellular lesions in patients with vascular liver diseases.

A variety of vascular liver disorders can induce hepatocellular tumors. They may be related to portal venous deprivation, venous outflow obstruction, or arterial diseases. Their common feature is an imbalance between hepatic arterial and portal venous blood flow leading to an increased hepatic arterial inflow. Consequently, hepatocellular tumors may arise, most commonly focal nodular hyperplasia-like lesions but hepatocellular adenomas and hepatocellular carcinoma may be seen as well. This article will review the most common vascular liver diseases associated with hepatocellular nodules (Budd-Chiari syndrome, congenital portosystemic shunt, hereditary hemorrhagic telangiectasia, and portal cavernoma). For each condition, imaging findings will be described as well as the differential diagnosis and the diagnostic clues.

Hepatic artery blood flow index for predicting liver fibrosis induced by Schistosoma japonicum

Hepatic artery blood flow index for predicting liver fibrosis induced by Schistosoma japonicum

Ultra-Low-Dose Sparse-View Quantitative CT Liver Perfusion Imaging.

Radiation dose of computed tomography liver perfusion imaging can be reduced by collecting fewer x-ray projections in each gantry rotation, but the resulting aliasing artifacts could affect the hepatic perfusion measurement. We investigated the effect of projection undersampling on the assessment of hepatic arterial blood flow (HABF) in hepatocellular carcinoma (HCC) when dynamic contrast-enhanced (DCE) liver images were reconstructed with filtered backprojection (FBP) and compressed sensing (CS). DCE liver images of a patient with HCC acquired with a 64-row CT scanner were reconstructed from all the measured projections (984-view) with the standard FBP and from one-third (328-view) and one-fourth (246-view) of all available projections with FBP and CS. Each of the 5 sets of DCE liver images was analyzed with a model-based deconvolution algorithm from which HABF maps were generated and compared. Mean HABF in the tumor and normal tissue measured by the 328-view CS and FBP protocols was within 5% differences from that assessed by the reference full-view FBP protocol. In addition, the tumor size measured by using the 328-view CS and FBP average images was identical to that determined by using the full-view FBP average image. By contrast, both the 246-view CS and FBP protocols exhibited larger differences (>20%) in anatomical and functional assessments compared with the full-view FBP protocol. The preliminary results suggested that computed tomography perfusion imaging in HCC could be performed with 3 times less projection measurement than the current full-view protocol (67% reduction in radiation dose) when either FBP or CS was used for image reconstruction.

Comparison of microvascular perfusion evaluation among IVIM-DWI, CT perfusion imaging and histological microvessel density in rabbit liver VX2 tumors

ObjectTo explore microcirculation features with intravoxel incoherent motion (IVIM) and to compare IVIM with CT perfusion imaging (CTPI) and microvessel density (MVD). Materials and methodsHepatic CTPI and IVIM were performed in 16 rabbit liver VX2 tumor models. Hepatic arterial perfusion (HAP), hepatic arterial perfusion index (HPI), Blood flow (BF), and blood volume (BV) from CTPI were measured. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), perfusion fraction (f), and pseudo-diffusion coefficient (D*) from IVIM were measured. MVD was counted with CD34 stain. The microcirculation features with IVIM were compared with CTPI parameters and MVD. ResultsStrong linear correlations were found between D value (0.89±0.21×10−3mm2/s) and HAP (15.83±6.97ml/min/100mg) (r=0.755, P=0.001) and between f value (12.64±6.66%) and BV (9.74±5.04ml/100mg) (r=0.693, P=0.004). Moderate linear correlations were observed between ADC (1.07±0.32×10−3mm2/s) and HAP (r=0.538, P=0.039), respectively; and between D value and MVD (9.31±2.57 vessels at 400×magnification) (r=0.509, P=0.044). No correlations were found between D* (119.90±37.67×10−3mm2/s) and HAP, HPI (68.34±12.91%), BF (4.95±2.16ml/min/100mg), BV. ConclusionIVIM parameters can characterize microcirculation to certain extent and separate it from pure water molecular diffusion. There is fair correlation between D or ADC value and CTPI parameters or MVD, but no correlation between D* or f value and CTPI parameters or MVD except f value and BV, which is still unclear and need further clinical studies to validate.

Computed Tomography Perfusion Following Transarterial Chemoembolization of Hepatocellular Carcinoma: A Feasibility Study in the Early Period.

The aim of this study was to assess the feasibility of computed tomography (CT) perfusion in early follow-up after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Fifteen patients with a total of 16 HCC who were referred to our institution for TACE were included in the study. Computed tomography perfusion was performed within 1 to 3 days before and 4 to 7 days after TACE. Multiphase contrast-enhanced CT was performed 35 (SD, 20) days after TACE. Hepatic arterial blood flow and portal venous blood flow, as well as the perfusion index (PI), were calculated for each HCC using the dual input maximum slope method. Visual grading of the PI and visual grading of the amount of deposition of embolic material within the HCC were performed using a 6-step scale. Differences in perfusion before and after TACE and correlation of perfusion before TACE with the amount of embolization material depositions 1 week and 1 month after TACE were tested. No statistically significant correlation was found between pre-TACE perfusion parameters and the amount of embolization material deposition in the post-TACE studies. There was no statistically significant difference between pre- and post-TACE arterial blood flow and portal venous blood flow, whereas PI was significantly lower after TACE. Congruently, visual grading of PI was statistically significantly lower after TACE. There was no statistically significant difference in quantitative pre-TACE and post-TACE PI between tumors, which showed hypervascularization in the multiphase follow-up CT and tumors that did not show hypervascularization. However, tumors that showed hypervascularization in the multiphase follow-up CT had significantly higher visual grading of PI after TACE than tumors that did not show hypervascularization. Our findings indicate that visual interpretation of the PI of HCC derived from dual-input maximum slope CT perfusion may be an early predictor of response to TACE.

Compensatory Hepatic Artery Blood Flow Increase Prevents Liver Injury During Modified Multivisceral Transplant Evisceration

Compensatory Hepatic Artery Blood Flow Increase Prevents Liver Injury During Modified Multivisceral Transplant Evisceration

Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt.

To evaluate changes in liver perfusion after occlusion of spontaneous portosystemic shunt and to analyze mechanisms of liver profile improvement. Liver function changes and portal venous and hepatic arterial blood flow were evaluated using perfusion CT before and after shunt occlusion in 23 patients who underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n=15) or hepatic encephalopathy (n=8). Portal venous blood flow was significantly higher at 1week (278.7ml/min, 92.7-636.7, p=0.012), 1month (290.0ml/min, 110.1-560.1, p<0.001) and 3months (299.6ml/min, 156.7-618.5, p=0.033) after shunt occlusion than the baseline (220.9ml/min, 49.5-566.7). Hepatic arterial liver blood flow became lower than the baseline (132.3ml/min, 47.9-622.3) after shunt occlusion, but a significant decrease was observed only at 1month later (107.9ml/min, 45.8-263.6 p=0.027). Serum albumin concentration became significantly higher than the baseline (3.4mg/dl, 1.9-4.5) at 1month (3.8mg/dl, 2.3-4.3, p=0.018) and 3months (3.9mg/dl, 2.6-4.3, p=0.024) after shunt occlusion. Shunt occlusion increases portal venous blood flow and decreases hepatic arterial blood flow, thereby improving the liver profile.

Central hemodynamic and splanchnic circulation in children with meningococcal septic shock

Meningococcal infection is caused by the bacterium Neisseria meningitidis (also termed meningococcus). Invasive meningococcal disease remains a rare infectious disease not only with high mortality but also with important morbidity and remains as a leading cause of sepsis and septic shock. The pathogenic mechanisms of microcirculatory disorders in meningococcal septic shock have been subject to controversy. This article presents the results of a study of 11 paediatric patients’ (4 boys and 7 girls) with meningococcal septic shock (Group I) who were hospitalized at the Regional Children's Infectious Hospital from 2009 to 2011. The average age of the patients was 37.4 ± 8.4 mo. Septic shock was diagnosed according to International Pediatric Sepsis Consensus Conference: definitions of criteria for sepsis and organ dysfunction in paediatrics. Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, average blood pressure, SpO2 were monitored. The cardiac output, ejection fraction, fraction shortening, stroke volume were measured by ultrasound in M-mode by Teichholz method. Blood circulation in the a. mesenterica, a. hepatica, a. lienalis, a. renal sinister, v. porta, v. lienalis, v. renal sinister was determined by impulse Doppler’s wave. Acid-base and electrolytes level in serum, nitric oxide (NO), endothelin I, creatinine, C-reactivity protein and lactate blood level were measured. The control group consisted of 21 healthy children (9 boys and 12 girls), aged 37.5 ± 5.4 mo. in average (Group II). We used t-criteria (Student’s) and correlation with R-criteria (Spearmen) for statistical analysis. The data showed a statistically significant lower fraction of ejection, fraction of shortening, stroke volume in Group I. Moreover, our data showed a statistically high level of mesenterial and portal blood flow rate and high pulse index in v. renal sinister compared to healthy children. The blood level of NO was increased in Group I as well as in Group II. Direct correlations were determined between the level of NO and mesenteric, hepatic arterial and venous blood flow rate. Statistically significant inverse correlations between the level of NO and pulse resistive index in splanchnic vessels were discovered as well as inverse correlations between the NO level and the indicator of the severity of condition on PRISM scale (r = –0.952). At the same time, we have found no correlation between splanchnic circulation value and cardiac output. Based on the results of this study, we consider that NO has organ protective effects in children with meningococcal sepsis. Future research should aim to introduce new strategies of intensive care for patients with meningococcal septic shock with early use of inotrope and NO-donor therapy in fluid restriction combination.

Preconditioning by portal vein embolization modulates hepatic hemodynamics and improves liver function in pigs with extended hepatectomy

Portal vein embolization is performed weeks before extended hepatic resections to increase the future liver remnant and prevent posthepatectomy liver failure. Portal vein embolization performed closer to the operation also could be protective, but worsening of portal hyper-perfusion is a major concern. We determined the hepatic hemodynamic effects of a portal vein embolization performed 24hours prior to hepatic operation. An extended (90%) hepatectomy was performed in swine undergoing (portal vein embolization) or not undergoing (control) a portal vein embolization 24hours earlier (n=10/group). Blood tests, hepatic and systemic hemodynamics, hepatic function (plasma disappearance rate of indocyanine green), liver histology, and volumetry (computed tomographic scanning) were assessed before and after the hepatectomy. Hepatocyte proliferating cell nuclear antigen expression and hepatic gene expression also were evaluated. Swine in the control and portal vein embolization groups maintained stable systemic hemodynamics and developed similar increases of portal blood flow (302 ±72% vs 486 ±92%, P=.13). Portal pressure drastically increased in Controls (from 9.4±1.3mm Hg to 20.9±1.4mm Hg, P<.001), while being markedly attenuated in the portal vein embolization group (from 11.4±1.5mm Hg to 16.1±1.3mm Hg, P=.061). The procedure also improved the preservation of the hepatic artery blood flow, liver function, and periportal edema. These effects occurred in the absence of hepatocyte proliferation or hepatic growth and were associated with the induction of the vasoprotective gene Klf2. Portal vein embolization preconditioning represents a potential hepato-protective strategy for extended hepatic resections. Further preclinical studies should assess its medium-term effects, including survival. Our study also supports the relevance of hepatic hemodynamics as the main pathogenetic factor of post-hepatectomy liver failure.

Selective Endothelin-A-Blocker decrease portal pressure in patients with cirrhosis. A feasibility study combining the local intraarterial and systemic administration

Increased levels of the vasoconstrictor Endothelin-1 (ET) in the intrahepatic circulation in cirrhosis is one of the main mechanisms involved in the development of portal hypertension. ET is acting through two different receptors (ET-A and ET-B), in which the ET-A receptor is the responsible one for vasoconstriction. BQ123 and Ambrisentan are selective ET-A receptor blocker. The aim of the study was to investigate, if the selective blockage of the Endothelin-A receptor is decreasing portal pressure and influencing hepatic arterial blood flow.

Prediction of portal and hepatic blood flow from intake level data in cattle.

Interest is growing in developing integrated postabsorptive metabolism models for dairy cattle. An integral part of linking a multi-organ postabsorptive model is the prediction of nutrient fluxes between organs, and thus blood flow. The purpose of this paper was to use a multivariate meta-analysis approach to model portal blood flow (PORBF) and hepatic venous blood flow (HEPBF) simultaneously, with evaluation of hepatic arterial blood flow (ARTBF; ARTBF=HEPBF - PORBF) and PORBF/HEPBF (%) as calculated values. The database used to develop equations consisted of 296 individual animal observations (lactating and dry dairy cows and beef cattle) and 55 treatments from 17 studies, and a separate evaluation database consisted of 34 treatment means (lactating dairy cows and beef cattle) from 9 studies obtained from the literature. Both databases had information on dry matter intake (DMI), metabolizable energy intake (MEI), body weight, and a basic description of the diet including crude protein intake and forage proportion of the diet (FP; %). Blood flow (L/h or L/kg of BW0.75/h) and either DMI or MEI (g or MJ/d or g or MJ/kg of BW0.75/d) were examined with linear and quadratic fits. Equations were developed using cow within experiment and experiment as random effects, and blood flow location as a repeated effect. Upon evaluation with the evaluation database, equations based on DMI typically resulted in lower root mean square prediction errors, expressed as a % of the observed mean (rMSPE%) and higher concordance correlation coefficient (CCC) values than equations based on MEI. Quadratic equation terms were frequently nonsignificant, and the quadratic equations did not outperform their linear counterparts. The best performing blood flow equations were PORBF (L/h)=202 (±45.6) + 83.6 (±3.11) × DMI (kg/d) and HEPBF (L/h)=186 (±45.4) + 103.8 (±3.10) × DMI (kg/d), with rMSPE% values of 17.5 and 16.6 and CCC values of 0.93 and 0.94, respectively. The residuals (predicted - observed) for PORBF/HEPBF were significantly related to the forage % of the diet, and thus equations for PORBF and HEPBF based on forage and concentrate DMI were developed: PORBF (L/h)=210 (±51.0) + 82.9 (±6.43) × forage (kg of DM/d) + 82.9 (±6.04) × concentrate (kg of DM/d), and HEPBF (L/h)=184 (±50.6) + 92.6 (±6.28) × forage (kg of DM/d) + 114.2 (±5.88) × concentrate (kg of DM/d), where rMSPE% values were 17.5 and 17.6 and CCC values were 0.93 and 0.94, respectively. Division of DMI into forage and concentrate fractions improved the joint Bayesian information criterion value for PORBF and HEPBF (Bayesian information criterion=6,512 vs. 7,303), as well as slightly improved the rMSPE and CCC for ARTBF and PORBF/HEPBF. This was despite minimal changes in PORBF and HEPBF predictions. Developed equations predicted blood flow well and can easily be used within a postabsorptive model of nutrient metabolism. Results also suggest different sensitivity of PORBF and HEPBF to the composition of DMI, and accounting for this difference resulted in improved ARTBF predictions.

Use of Caval Subtraction 2D Phase-Contrast MR Imaging to Measure Total Liver and Hepatic Arterial Blood Flow: Preclinical Validation and Initial Clinical Translation.

Purpose To validate caval subtraction two-dimensional (2D) phase-contrast magnetic resonance (MR) imaging measurements of total liver blood flow (TLBF) and hepatic arterial fraction in an animal model and evaluate consistency and reproducibility in humans. Materials and Methods Approval from the institutional ethical committee for animal care and research ethics was obtained. Fifteen Sprague-Dawley rats underwent 2D phase-contrast MR imaging of the portal vein (PV) and infrahepatic and suprahepatic inferior vena cava (IVC). TLBF and hepatic arterial flow were estimated by subtracting infrahepatic from suprahepatic IVC flow and PV flow from estimated TLBF, respectively. Direct PV transit-time ultrasonography (US) and fluorescent microsphere measurements of hepatic arterial fraction were the standards of reference. Thereafter, consistency of caval subtraction phase-contrast MR imaging-derived TLBF and hepatic arterial flow was assessed in 13 volunteers (mean age, 28.3 years ± 1.4) against directly measured phase-contrast MR imaging PV and proper hepatic arterial inflow; reproducibility was measured after 7 days. Bland-Altman analysis of agreement and coefficient of variation comparisons were undertaken. Results There was good agreement between PV flow measured with phase-contrast MR imaging and that measured with transit-time US (mean difference, -3.5 mL/min/100 g; 95% limits of agreement [LOA], ±61.3 mL/min/100 g). Hepatic arterial fraction obtained with caval subtraction agreed well with those with fluorescent microspheres (mean difference, 4.2%; 95% LOA, ±20.5%). Good consistency was demonstrated between TLBF in humans measured with caval subtraction and direct inflow phase-contrast MR imaging (mean difference, -1.3 mL/min/100 g; 95% LOA, ±23.1 mL/min/100 g). TLBF reproducibility at 7 days was similar between the two methods (95% LOA, ±31.6 mL/min/100 g vs ±29.6 mL/min/100 g). Conclusion Caval subtraction phase-contrast MR imaging is a simple and clinically viable method for measuring TLBF and hepatic arterial flow. Online supplemental material is available for this article.

Effect of sevoflurane anaesthesia on hepatic blood flow in infants with obstructive hepatobiliary disease.

Currently most studies on anaesthetic effects on hepatic blood flow of cirrhotic patients have been performed on adults or experimental animals. We performed this study to evaluate the effect of sevoflurane anaesthesia on hepatic blood flow in infants with obstructive jaundice by Doppler ultrasound. Forty-four infants with biliary atresia (1-3 months of age) scheduled for a Kasai procedure were enrolled. Hepatic blood flow was calculated by Doppler ultrasound measurements before induction, and after inhalation of 2% and 3% sevoflurane. Infants were allocated to three groups according to baseline portal blood flow/hepatic artery blood flow: group A (portal blood flow/hepatic artery blood flow < 1), group B (1 ≤ portal blood flow/hepatic artery blood flow < 2) and group C (portal blood flow/hepatic artery blood flow ≥ 2). Changes in portal blood flow, hepatic artery blood flow and hepatic blood flow were compared among groups. In group A (n = 9), the median (IQR) hepatic blood flow increased after inhalation of 2% sevoflurane compared to that before induction (from 49.7 (32.0-89.0) to 116.1 (40.4-159.1) ml/min; P = 0.035). Whereas in groups B and C in whom the ratio of portal blood flow and hepatic artery blood flow was normal or mildly changed, the increases in hepatic blood flow after sevoflurane anaesthesia were not significant. For infants with obstructive jaundice that had reduced portal blood flow and compensatory increase in hepatic artery blood flow, sevoflurane may produce a protective effect on hepatic blood flow.

Increased Hepatic Arterial Blood Flow Measured by Hepatic Perfusion Index in Hepatosplenic Schistosomiasis: New Concepts for an Old Disease.

Portal vein obstructive lesions associated with hypertrophy of the hepatic artery territory are observed in Schistosoma mansoni schistosomiasis. Liver perfusion scintigraphy is a method used for evaluation of hepatic perfusion changes in liver diseases. It has been suggested that, like in cirrhosis, where compensatory increase in perfusion through the hepatic artery is documented, perfusion changes occur in hepatosplenic schistosomiasis (HSS). This study aims to determine changes in liver hemodynamics using hepatic perfusion scintigraphy and correlate them with clinical and laboratory variables and ultrasound findings in HSS. Nineteen patients with schistosomiasis underwent ultrasound evaluation of degree of liver fibrosis, splenic length, and splenic and portal vein diameter, digestive endoscopy, and quantification of platelets. Subsequently, perfusion scintigraphy with measurement of hepatic perfusion index (HPI) was performed. It was observed that patients with hepatosplenic schistosomiasis had significantly higher HPI compared with normal individuals (p=0.0029) and that this increase correlated with splenic length (p=0.038) and diameter of esophageal varices (p=0.0060). Angioscintigraphy showed high accuracy for predicting presence of large esophageal varices. Angioscintigraphy could show that patients with HSS had increased HPI, featuring greater liver "arterialization," as previously described for cirrhotic patients. Correlations were also observed between HPI and longitudinal splenic length, caliber of esophageal varices, caliber of portal vein, and blood platelet count. Angioscintigraphy is a promising technique for evaluation of hepatosplenic schistosomiasis.

Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver.

PREOPERATIVE EMBOLIZATION OF THE COMMON HEPATIC ARTERY IN PATIENTS WITH PANCREATIC BODY AND TAIL TUMORS INVADING THE CELIAC TRUNK

The purpose of the study was to evaluate the efficacy of preoperative embolization of the common hepatic artery in patients with pancreatic body and tail cancer invading the celiac trunk. Material and Methods. Twenty-two patients underwent distal subtotal pancreatectomy with resection of the celiac trunk and the common hepatic artery. Of these 22 patients, 6 underwent preoperative embolization of the common hepatic artery. Results. In spite of invasion of the celiac trunk, the hepatic arterial blood flow was completely blocked in all patients who underwent preoperative embolization of the common hepatic artery. No complications related to endovascular intervention were found. In all cases, control angiography showed an adequate blood supply to the liver due to collateral circulation from the superior mesenteric artery. No ischemic complications were observed in postoperative period. Conclusion. Preoperative embolization of the common hepatic artery appeared to be a safe procedure that could prevent the risk of ischemic complications in patients undergoing distal subtotal pancreatectomy with resection of the celiac trunk and the common hepatic artery without plastics.

Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review.

Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

Ratio of the blood flow in liver and splenic arteries in patients with various forms of portal hypertension

Each type of portal hypertension has clinical and diagnostic peculiarities, which determines the choice of therapeutic approach and subsequently an outcome.Aim. In order to evaluate the arterial blood flow of the liver, which can be ambiguous in the syndrome of portal hypertension, in 85 patients with liver cirrhosis, pre-hepatic and post-hepatic forms of portal hypertension the ratio of arterial blood flow in the hepatic and splenic arteries was studied.Methods and results. To assess the hepatic arterial blood flow, we have introduced a new index – hepato-splenic arterial index, which is determined as the ratio of the flow rates in proper hepatic and splenic arteries. In cirrhosis of the liver, blood flow in the hepatic artery was increased in relation to spleen. With pre-hepatic and post-hepatic forms of portal hypertension which decrease and increase amount of arterial blood in total liver blood flow, respectively, the ratio of arterial blood flow in the hepatic and splenic arteries is unchanged.Conclusion. This suggests that the hepato-splenic arterial index can serve as a differential criterion for determination of causes of portal hypertension syndrome.

Normative Values of Doppler Parameters of Blood Flow in the Fetal Hepatic Artery of Normal Karyotype Fetuses at 11–14 Weeks Gestation

Normative Values of Doppler Parameters of Blood Flow in the Fetal Hepatic Artery of Normal Karyotype Fetuses at 11–14 Weeks Gestation