Article

Transhepatic Portal Vein Embolization: Anatomy, Indications, and Technical Considerations1

Department of Diagnostic Imaging, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030-4009, USA.
Radiographics (Impact Factor: 2.6). 09/2002; 22(5):1063-76. DOI: 10.1148/radiographics.22.5.g02se161063
Source: PubMed

ABSTRACT

Portal vein embolization (PVE) is increasingly being accepted as a useful procedure in the preoperative treatment of patients selected for major hepatic resection. PVE is performed via either the percutaneous transhepatic or the transileocolic route and is usually reserved for patients whose future liver remnants are too small to allow resection. It is a safe and effective method for inducing selective hepatic hypertrophy of the nondiseased portion of the liver and may thereby reduce complications and shorten hospital stays after resection. A thorough knowledge of hepatic segmentation and portal venous anatomy is essential before performing PVE. In addition, the indications and contraindications for PVE, the methods for assessing hepatic lobar hypertrophy, the means of determining optimal timing of resection, and the possible complications of PVE need to be fully understood before undertaking the procedure. Technique may vary among operators, and further research is necessary to determine the best embolic agents available and the expected rates of liver regeneration for PVE. Nevertheless, as hepatobiliary surgeons become more experienced at performing extended hepatic resections, PVE may be requested more frequently.

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    • "Preoperative portal vein embolization (PVE) is an effective modality to induce hepatic hypertrophy by obstructing the selective portal vein supplying the diseased segment of the liver [1]–[4]. In order to prevent blockage in the wrong region, it is quite essential to determine the distribution of the embolic agents inside target liver during and after the embolization. "
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    ABSTRACT: It is crucial to understand the distribution of embolic agents inside target liver during and after the hepatic portal vein embolization (PVE) procedure. For a long time, the problem has not been well solved due to the radiolucency of embolic agents and the resolution limitation of conventional radiography. In this study, we first reported use of fluorescent carboxyl microspheres (FCM) as radiolucent embolic agents for embolizing hepatic portal veins. The fluorescent characteristic of FCM could help to determine their approximate location easily. Additionally, the microspheres were found to be fairly good embolizing agents for PVE. After the livers were excised and fixed, they were imaged by in-line phase contrast imaging (PCI), which greatly improved the detection of the radiolucent embolic agents as compared to absorption contrast imaging (ACI). The preliminary study has for the first time shown that PCI has great potential in the pre-clinical investigation of PVE with radiolucent embolic agents.
    Full-text · Article · Dec 2013 · PLoS ONE
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    • "A reszekábilitási arányt a kemoterápia mellé adott monoklonális antitestek – mint amilyen a cetuximab és a bevacizumab – tovább javíthatják [18] [19] [20]. Azoknál a betegeknél, akiknél a kemoterápia nem elegendő arra, hogy a metasztázis reszekábilissá váljon, speciális intervenciókat lehet alkalmazni [21]. A vena portae embolisatióval a maradék májszövet hipertrófi áját lehet elérni. "

    Full-text · Dataset · Sep 2013
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    • "A reszekábilitási arányt a kemoterápia mellé adott monoklonális antitestek – mint amilyen a cetuximab és a bevacizumab – tovább javíthatják [18] [19] [20]. Azoknál a betegeknél, akiknél a kemoterápia nem elegendő arra, hogy a metasztázis reszekábilissá váljon, speciális intervenciókat lehet alkalmazni [21]. A vena portae embolisatióval a maradék májszövet hipertrófi áját lehet elérni. "
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    ABSTRACT: Modern imaging techniques have an important role in the diagnostic procedures of malignancies, and assessing response to therapy. The 18F-FDG PET/CT revolutionized the evaluation of colorectal cancer in terms of preoperative staging and monitoring of recurrence. Conventional imaging techniques have limitations in early assessment of response to therapy. 18F-FDG PET has been shown to allow earlier treatment monitoring, because the metabolic change appears before any anatomic change occurs. The Response Evaluation Criteria in Solid Tumours (RECIST) are widely applied, but they have some limitations. There are new international guidelines for treatment response assessment using PET/CT in solid tumours. The authors review indications and the role of hybrid PET/CT in colorectal cancer. Orv. Hetil., 2013, 154, 1447-1453.
    Full-text · Article · Sep 2013 · Orvosi Hetilap
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