La scintigraphie de perfusion hépatique dans la prise en charge des patients traités par chimiothérapie intra-artérielle hépatique |
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Authors: | A. Bourdon,M.-C. Eberlé -PouzeratteS. Guillemard,F. PortalesF. Quenet,P. FaurousJ.-C. Artus |
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Affiliation: | a Service de médecine nucléaire, CRLC Val d’Aurelle Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France b Service de médecine nucléaire, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France c Service de médecine A2, CRLC Val d’Aurelle Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France d Service de chirurgie A2, CRLC Val d’Aurelle Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5, France |
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Abstract: | 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. |
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Keywords: | Cancer colorectal Mé tastase hé patique 99mTc-MAA Shunt arté rio-veineux intra-hé patique |
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