Hepatic artery perfusion study: a technical review

Full text: Intra-arterial chemotherapy is an option for unresectable primary and metastatic hepatic tumours. An advantage is that high concentrations of therapeutic drugs are able to be delivered directly to the tumour, while exposure to surrounding organs and tissues can be minimised. Hepatic Artery Perfusion Study (HAPS) may be performed to assess an intra-arterial catheter prior to the commencement of treatment and is useful to ensure that the catheter is correctly positioned and shunting of the therapeutic drugs to surrounding organs is not excessive. A 65-year-old male of Chinese origin with a large hepatocellular carcinoma of the right lobe underwent catheterisation of the hepatic artery. Prior to chemotherapy 150 MBq of 99Tcm MAA was injected through the catheter in the hepatic artery over a one-minute period. The patient was then transferred to the nuclear medicine department. Standard images of the liver were acquired followed by an image of the chest. Additional images over the abdomen were performed after the patient had ingested (1) a carbonated drink to distend the stomach and (2) a glass of water with 40 MBq 99Tcm MAA to assist in anatomical localisation of the stomach. The study showed that 18% of totally administered 99Tcm MAA to be in the lungs (desirable < 12%) and also perfusion to the stomach wall. As both these findings may be associated with an increased complication rate from chemotherapy, a small amount of embolisation material (gelfoam) was instilled into the right hepatic artery to decrease hunting and chemotherapy was commenced. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc