La scintigraphie de perfusion hépatique dans la prise en charge des patients traités par chimiothérapie intra-artérielle hépatique

Nearly 50 % of patients with colorectal cancer (CRC) develop liver metastases (LM) during their disease. Only 10 % of these patients are candidates for an initial surgical resection. Compared to systemic chemotherapy alone, intra-arterial hepatic chemotherapy showed a benefit in overall survival in patients with unresectable LM. This treatment requires surgical or endovascular introduction of an intra-arterial hepatic catheter (IAHC). A precise vascular assessment is necessary due to the frequency of anatomic variations of hepatic arterial vasculature. Complications of intra-arterial hepatic chemotherapy are related to both IAHC and chemotherapy. ^99mTc-MAA hepatic perfusion scanning plays a key role before treatment initiation and during follow-up. Moreover, intra-hepatic distribution of tracer can be analysed and objectify a possible extra-hepatic spread that may lead to increased toxicity and/or less effective treatment. The different protocols, the place of ^99mTc-MAA scanning compared with other imaging techniques, or frequency of checks are still debated. A literature review is presented, illustrated with some cases of normal and pathological liver perfusion scans from the department of Nuclear Medicine, Val d’Aurelle Regional Cancer Center, Montpellier.