Liver tumour blood flow and responses to arterial embolization measured by dynamic hepatic scintigraphy

Abstract

Summary Liver and tumour blood flow has been studied in 30 patients with multiple liver metastases and in 14 patients with solitary liver tumours by means of dynamic hepatic scintigraphy. Observations were compared with those of a group of 33 control subjects. Haemodynamic changes were also measured in 10 patients who underwent hepatic arterial embolization (HAE).The mesenteric fraction (MF) to tumour regions in 32 subjects showed a wide range compared with control subjects. In 9 patients the MF to the tumour region was within the normal range suggesting that some tumours may possess a portal venous supply. The MF to the uninvolved liver regions was below the normal range in 25% of patients, indicating that HAE could be hazardous in this group. Following HAE the MF rose in all 4 tumour regions and fell in 4 non-embolized uninvolved liver regions. No increase in colloid clearance rate (k) was seen though a significant decrease occurred in 4 patients. These changes may well represent increased portal venous flow into tumours.The treatment of malignant liver neoplasms, apart from those that are truly solitary and accordingly suitable for resection, has been unrewarding in terms of prolonging survival (Taylor, 1985). Since therapeutic ligation of the hepatic artery was first performed for a liver tumour (Reinhoff & Woods, 1953), various forms of hepatic arterial manipulation have been attempted because tumour neovascularization is predominantly arterial (Breedis & Young, 1954). The hope was that hepatic arterial occlusion might result in tumour regression and increased survival. Unfortunately, initial optimism has largely been unrealized. Morbidity and mortality associated with the procedures (Almersjo et al., 1972) as well as the development of arterial collaterals (Bengmark & Rosengren, 1970) has been responsible for the limited benefit in terms of survival.A recent and perhaps more rational method of dearterialization is by percutaneous radiological hepatic arterial embolization (HAE). Laparotomy is avoided and should the vessels recanalise or arterial collaterals develop, they can be embolized at a later date. Although there is good evidence that this procedure provides temporary palliation of symptoms from the carcinoid syndrome (Odurny & Birch, 1985), the effects on survival have not been marked, particularly in other types of liver metastases (Chuang & Wallace, 1981). However, pain due to stretching of the liver capsule by metastases can sometimes be relieved.In general, the contribution of the portal vein has largely been ignored as a potential source of significant tumour blood flow and nutrition, particularly following dearterialisation procedures, principally because of the difficulty of studying relative hepatic haemodynamics in vivo. Dynamic hepatic scanning The validity of dynamic liver scanning using 99mTc sulphur colloid has been established in animals (Fleming et al., 1981) and humans (Fleming et al., 1983). Each study is performed with the patient fasted overnight beforehand. A rapid intravenous in...

An association between parameters of liver blood flow and percentage hepatic replacement with tumour

“…A reduction in the MF of specific.tumour regions of interest compared to neighbouring 'normal' liver regions in the same patients with hepatic tumours, or to liver regions in a control group has previously been reported (Flowerdew et al, 1987). An increased arterial index for the maximal liver ROI that can be investigated has also been reported in tumour-bearing liver (Leveson et al, 1985).…”

The influence of hepatic artery ligation and of vasopressin on liver tumour blood flow in rats

“…After hepatic artery occlusion there is a compensation of liver tumour blood flow from the portal bed [7,19]. Clinical studies with angiography revealed a rearterialization of the liver 4 days after HAL or dearterialization [ 20,2 1 1.…”