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Bastiaannet R, Lin M, Frey EC, de Jong HW. Intraprocedural C-arm dual-phase cone-beam enhancement patterns correlate with tumor absorbed dose after radioembolization. Med Phys 2024; 51:3045-3052. [PMID: 38064591 PMCID: PMC10994751 DOI: 10.1002/mp.16882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Recent studies have shown a clear relationship between absorbed dose and tumor response to treatment after hepatic radioembolization. These findings help to create more personalized treatment planning and dosimetry. However, crucial to this goal is the ability to predict the dose distribution prior to treatment. The microsphere distribution is ultimately determined by (i) the hepatic vasculature and the resulting blood flow dynamics and (ii) the catheter position. PURPOSE To show that pretreatment, intra-procedural imaging of blood flow patterns, as quantified by catheter-directed intra-arterial contrast enhancement, correlate with posttreatment microsphere accumulation and, consequently, absorbed dose. MATERIALS AND METHODS Patients who participated in a clinical trial (NCT01177007) and for whom both a pretreatment dual-phase contrast-enhanced cone-beam CT (CBCT) and a posttreatment 90Y PET/CT scan were available were included in this retrospective study. Tumors and perfused volumes were manually delineated on the CBCT by an experienced radiologist. The mean, sum, and standard deviation of the voxels in each volume were recorded. The delineations were transferred to the PET-based absorbed dose maps by coregistration of the corresponding CTs. Linear multiple regression was used to correlate pretreatment CBCT enhancement to posttreatment 90Y PET/CT-based absorbed dose in each region. Leave-one-out cross-validation and Bland-Altman analyses were performed on the predicted versus measured absorbed doses. RESULTS Nine patients, with a total of 23 tumors were included. All presented with hepatocellular carcinoma (HCC). Visually, all patients had a clear correspondence between CBCT enhancement and absorbed dose. The correlation between CBCT enhancement and posttherapy absorbed tumor dose based was strong (R2 = 0.91), and moderate for the non-tumor liver tissue (R2 = 0.61). Limits of agreement were approximately ±55 Gray for tumor tissue. CONCLUSION There is a linear relationship between pretreatment blood dynamics in HCC tumors and posttreatment absorbed dose, which, if shown to be generalizable, allows for pretreatment tumor absorbed dose prediction.
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Affiliation(s)
- Remco Bastiaannet
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Eric C. Frey
- The Russell H Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hugo W.A.M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Jipa AM, Makary MS. Locoregional Therapies for Hepatobiliary Tumors: Contemporary Strategies and Novel Applications. Cancers (Basel) 2024; 16:1271. [PMID: 38610949 PMCID: PMC11010828 DOI: 10.3390/cancers16071271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
A large majority of primary hepatobiliary tumors are hepatocellular carcinomas (HCC), with the remainer being cholangiocarcinoma. While surgical resection remains the gold standard treatment for hepatobiliary tumors, relatively few patients are operative candidates, and systemic treatments have limited effectiveness. Locoregional therapies offer significant promise in the management of HCC. Ablation and radioembolization may offer similar outcomes to surgery for early-stage hepatocellular carcinoma while radioembolization and chemoembolization are valuable in the management of advanced disease. There is significantly less evidence for the role of locoregional therapy in the treatment of cholangiocarcinoma, although it appears to be well tolerated.
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Affiliation(s)
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, USA;
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3
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Ho H, Means S, Safaei S, Hunter PJ. In silico modeling for the hepatic circulation and transport: From the liver organ to lobules. WIREs Mech Dis 2023; 15:e1586. [PMID: 36131627 DOI: 10.1002/wsbm.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/12/2022]
Abstract
The function of the liver depends critically on its blood supply. Numerous in silico models have been developed to study various aspects of the hepatic circulation, including not only the macro-hemodynamics at the organ level, but also the microcirculation at the lobular level. In addition, computational models of blood flow and bile flow have been used to study the transport, metabolism, and clearance of drugs in pharmacokinetic studies. These in silico models aim to provide insights into the liver organ function under both healthy and diseased states, and to assist quantitative analysis for surgical planning and postsurgery treatment. The purpose of this review is to provide an update on state-of-the-art in silico models of the hepatic circulation and transport processes. We introduce the numerical methods and the physiological background of these models. We also discuss multiscale frameworks that have been proposed for the liver, and their linkage with the large context of systems biology, systems pharmacology, and the Physiome project. This article is categorized under: Metabolic Diseases > Computational Models Metabolic Diseases > Biomedical Engineering Cardiovascular Diseases > Computational Models.
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Affiliation(s)
- Harvey Ho
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Shawn Means
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Soroush Safaei
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Peter John Hunter
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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4
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Ortega J, Antón R, Ramos JC, Rivas A, S. Larraona G, Sangro B, Bilbao JI, Aramburu J. Computational study of a novel catheter for liver radioembolization. Int J Numer Method Biomed Eng 2022; 38:e3577. [PMID: 35094497 PMCID: PMC9286848 DOI: 10.1002/cnm.3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/16/2022] [Accepted: 01/29/2022] [Indexed: 06/14/2023]
Abstract
Radioembolization (RE) is a medical treatment for primary and secondary liver cancer that involves the transcatheter intraarterial delivery of micron-sized and radiation-emitting microspheres, with the goal of improving microsphere deposition in the tumoral bed while sparing healthy tissue. An increasing number of in vitro and in silico studies on RE in the literature suggest that the particle injection velocity, spatial location of the catheter tip and catheter type are important parameters in particle distribution. The present in silico study assesses the performance of a novel catheter design that promotes particle dispersion near the injection point, with the goal of generating a particle distribution that mimics the flow split to facilitate tumour targeting. The design is based on two factors: the direction and the velocity at which particles are released from the catheter. A series of simulations was performed with the catheter inserted at an idealised hepatic artery tree with physiologically realistic boundary conditions. Two longitudinal microcatheter positions in the first generation of the tree were studied by analysing the performance of the catheter in terms of the outlet-to-outlet particle distribution and split flow matching. The results show that the catheter with the best performance is one with side holes on the catheter wall and a closed frontal tip. This catheter promotes a flow-split-matching particle distribution, which improves as the injection crossflow increases.
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Affiliation(s)
- Julio Ortega
- Escuela de Ingeniería MecánicaPontificia Universidad Católica de ValparaísoQuilpuéChile
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Raúl Antón
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
| | - Juan Carlos Ramos
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Alejandro Rivas
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Gorka S. Larraona
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
| | - Bruno Sangro
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
| | - José Ignacio Bilbao
- Instituto de Investigación Sanitaria de NavarraIdiSNAPamplonaSpain
- Department of RadiologyClínica Universidad de NavarraPamplonaSpain
| | - Jorge Aramburu
- Universidad de NavarraTecnun ‐ Escuela de IngenieríaDonostia‐San SebastiánSpain
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Aramburu J, Antón R, Fukamizu J, Nozawa D, Takahashi M, Ozaki K, Ramos JC, Sangro B, Bilbao JI, Tomita K, Matsumoto T, Hasebe T. In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization. Biology 2021; 10:biology10121341. [PMID: 34943256 PMCID: PMC8698760 DOI: 10.3390/biology10121341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool.
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Affiliation(s)
- Jorge Aramburu
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- Correspondence:
| | - Raúl Antón
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
| | - Junichi Fukamizu
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Daiki Nozawa
- Terumo Corporation, 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo 163-1450, Japan; (J.F.); (D.N.)
| | - Makoto Takahashi
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Kouji Ozaki
- Terumo Medical Pranex, 1500 Inokuchi, Nakai, Ashigarakami 259-0151, Japan; (M.T.); (K.O.)
| | - Juan Carlos Ramos
- Tecnun Escuela de Ingeniería, Universidad de Navarra, 20018 Donostia-San Sebastián, Spain; (R.A.); (J.C.R.)
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Liver Unit and CIBEREHD, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (B.S.); (J.I.B.)
- Department of Radiology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Kosuke Tomita
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Tomohiro Matsumoto
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan; (K.T.); (T.M.); (T.H.)
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d'Abadie P, Walrand S, Goffette P, Amini N, Maanen AV, Lhommel R, Jamar F. Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres. Diagn Interv Radiol 2021; 27:768-773. [PMID: 34792032 DOI: 10.5152/dir.2021.20785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using 90Y-resin microspheres. METHODS Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For 90Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). 90Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. 99mTc-MAA SPECT and 90Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL[MAA or 90Y]) and tumor dose (TD[MAA or 90Y]) for the planning and therapy. RESULTS Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL90Y and TD90Y were significantly higher than T/NLMAA and TDMAA. Median (IQR) T/NL90Y was 2.16 (2.15) versus 1.74 (1.43) for T/NLMAA (p < 0.001). Median (IQR) TD90Y was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TDMAA (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated. CONCLUSION The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
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Affiliation(s)
- Philippe d'Abadie
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Stephan Walrand
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Pierre Goffette
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Nadia Amini
- Department of Interventional Radiology, Saint Luc University Hospital and King Albert II cancer Institute, Brussels, Belgium
| | - Aline van Maanen
- From the Department of Nuclear Medicine Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Renaud Lhommel
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Saint Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
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7
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d'Abadie P, Walrand S, Hesse M, Amini N, Lhommel R, Sawadogo K, Jamar F. Accurate non-tumoral 99mTc-MAA absorbed dose prediction to plan optimized activities in liver radioembolization using resin microspheres. Phys Med 2021; 89:250-7. [PMID: 34438353 DOI: 10.1016/j.ejmp.2021.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
AIM The manufacturers' recommended methods to calculate delivered activities in liver radioembolization are simplistic and only slightly personalized. Activity planning could also be based on a 99mTc-macroaggregated albumin SPECT/CT (MAA) using the partition model but its accuracy is controversial. This study evaluates the dose parameters in the normal liver and in the tumor compartments using MAA SPECT/CT (pre-therapeutic imaging) and 90Y TOF-PET/CT (post-therapy imaging). Finally, we propose a prescription of the activity as a function of the normal liver MAA distribution. METHOD 66 procedures of RE (with resin microspheres) corresponding to 171 lesions were analyzed. Tumor to normal targeted liver uptake (T/NTL), tumor absorbed dose (TD) and whole normal liver absorbed (WNLD) were assessed with MAA and 90Y imaging. Secondly, activities were recalculated using the MAA distribution in the normal liver compartment to reach the maximal tolerable liver dose. These Activities were compared to activities defined with the BSA method. RESULTS Compared to 90Y imaging, our study demonstrated an accurate estimation of the WNLD using MAA imaging (Pearson's R = 0.97, p < 0.001). On the contrary, significant variations were found for TD (R = 0.65, p < 0.001). The MAA T/NTL ratio has a 85% positive predictive value in identifying patients who will get a 90Y T/NTL ratio above 1.5. Moreover, activities calculated using the MAA distribution in the normal liver compartment were significantly higher to activities defined with the BSA method. CONCLUSION Whole normal liver absorbed doses are accurately predicted with MAA imaging and could be used to optimize the activity planning.
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8
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Lertxundi U, Aramburu J, Ortega J, Rodríguez-fraile M, Sangro B, Bilbao JI, Antón R. CFD Simulations of Radioembolization: A Proof-of-Concept Study on the Impact of the Hepatic Artery Tree Truncation. Mathematics 2021; 9:839. [DOI: 10.3390/math9080839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radioembolization (RE) is a treatment for patients with liver cancer, one of the leading cause of cancer-related deaths worldwide. RE consists of the transcatheter intraarterial infusion of radioactive microspheres, which are injected at the hepatic artery level and are transported in the bloodstream, aiming to target tumors and spare healthy liver parenchyma. In paving the way towards a computer platform that allows for a treatment planning based on computational fluid dynamics (CFD) simulations, the current simulation (model preprocess, model solving, model postprocess) times (of the order of days) make the CFD-based assessment non-viable. One of the approaches to reduce the simulation time includes the reduction in size of the simulated truncated hepatic artery. In this study, we analyze for three patient-specific hepatic arteries the impact of reducing the geometry of the hepatic artery on the simulation time. Results show that geometries can be efficiently shortened without impacting greatly on the microsphere distribution.
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Antón R, Antoñana J, Aramburu J, Ezponda A, Prieto E, Andonegui A, Ortega J, Vivas I, Sancho L, Sangro B, Bilbao JI, Rodríguez-Fraile M. A proof-of-concept study of the in-vivo validation of a computational fluid dynamics model of personalized radioembolization. Sci Rep 2021; 11:3895. [PMID: 33594143 PMCID: PMC7886872 DOI: 10.1038/s41598-021-83414-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/27/2021] [Indexed: 12/15/2022] Open
Abstract
Radioembolization (RE) with yttrium-90 (90Y) microspheres, a transcatheter intraarterial therapy for patients with liver cancer, can be modeled computationally. The purpose of this work was to correlate the results obtained with this methodology using in vivo data, so that this computational tool could be used for the optimization of the RE procedure. The hepatic artery three-dimensional (3D) hemodynamics and microsphere distribution during RE were modeled for six 90Y-loaded microsphere infusions in three patients with hepatocellular carcinoma using a commercially available computational fluid dynamics (CFD) software package. The model was built based on in vivo data acquired during the pretreatment stage. The results of the simulations were compared with the in vivo distribution assessed by 90Y PET/CT. Specifically, the microsphere distribution predicted was compared with the actual 90Y activity per liver segment with a commercially available 3D-voxel dosimetry software (PLANET Dose, DOSIsoft). The average difference between the CFD-based and the PET/CT-based activity distribution was 2.36 percentage points for Patient 1, 3.51 percentage points for Patient 2 and 2.02 percentage points for Patient 3. These results suggest that CFD simulations may help to predict 90Y-microsphere distribution after RE and could be used to optimize the RE procedure on a patient-specific basis.
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Affiliation(s)
- Raúl Antón
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
| | - Javier Antoñana
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Jorge Aramburu
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Ana Ezponda
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Elena Prieto
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Asier Andonegui
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
| | - Julio Ortega
- Universidad de Navarra, TECNUN Escuela de Ingeniería, 20018, Donostia-San Sebastián, Spain
- Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Isabel Vivas
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Lidia Sancho
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 28027, Madrid, Spain
| | - Bruno Sangro
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Hepatology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- CIBEREHD, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas Y Digestivas, 28029, Madrid, Spain
| | - José Ignacio Bilbao
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain
- Department of Radiology, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008, Pamplona, Spain.
- Department of Nuclear Medicine, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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Bomberna T, Koudehi GA, Claerebout C, Verslype C, Maleux G, Debbaut C. Transarterial drug delivery for liver cancer: numerical simulations and experimental validation of particle distribution in patient-specific livers. Expert Opin Drug Deliv 2020; 18:409-422. [PMID: 33210955 DOI: 10.1080/17425247.2021.1853702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Transarterial therapies are routinely used for the locoregional treatment of unresectable hepatocellular carcinoma (HCC). However, the impact of clinical parameters (i.e. injection location, particle size, particle density etc.) and patient-specific conditions (i.e. hepatic geometry, cancer burden) on the intrahepatic particle distribution (PD) after transarterial injection of embolizing microparticles is still unclear. Computational fluid dynamics (CFD) may help to better understand this impact.Methods: Using CFD, both the blood flow and microparticle mass transport were modeled throughout the 3D-reconstructed arterial vasculature of a patient-specific healthy and cirrhotic liver. An experimental feasibility study was performed to simulate the PD in a 3D-printed phantom of the cirrhotic arterial network.Results: Axial and in-plane injection locations were shown to be effective parameters to steer particles toward tumor tissue in both geometries. Increasing particle size or density made it more difficult for particles to exit the domain. As cancer burden increased, the catheter tip location mattered less. The in vitro study and numerical results confirmed that PD largely mimics flow distribution, but that significant differences are still possible.Conclusions: Our findings highlight that optimal parameter choice can lead to selective targeting of tumor tissue, but that targeting potential highly depends on patient-specific conditions.
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Affiliation(s)
- Tim Bomberna
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Gent, Belgium
| | - Ghazal Adeli Koudehi
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium
| | - Charlotte Claerebout
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium
| | - Chris Verslype
- Department of Clinical Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Leuven, Belgium
| | - Charlotte Debbaut
- IBiTech-bioMMeda, Department of Electronics and Information Systems, Ghent University, Gent, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Gent, Belgium
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Taebi A, Pillai RM, S. Roudsari B, Vu CT, Roncali E. Computational Modeling of the Liver Arterial Blood Flow for Microsphere Therapy: Effect of Boundary Conditions. Bioengineering (Basel) 2020; 7:E64. [PMID: 32610459 PMCID: PMC7552664 DOI: 10.3390/bioengineering7030064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Transarterial embolization is a minimally invasive treatment for advanced liver cancer using microspheres loaded with a chemotherapeutic drug or radioactive yttrium-90 (90Y) that are injected into the hepatic arterial tree through a catheter. For personalized treatment, the microsphere distribution in the liver should be optimized through the injection volume and location. Computational fluid dynamics (CFD) simulations of the blood flow in the hepatic artery can help estimate this distribution if carefully parameterized. An important aspect is the choice of the boundary conditions imposed at the inlet and outlets of the computational domain. In this study, the effect of boundary conditions on the hepatic arterial tree hemodynamics was investigated. The outlet boundary conditions were modeled with three-element Windkessel circuits, representative of the downstream vasculature resistance. Results demonstrated that the downstream vasculature resistance affected the hepatic artery hemodynamics such as the velocity field, the pressure field and the blood flow streamline trajectories. Moreover, the number of microspheres received by the tumor significantly changed (more than 10% of the total injected microspheres) with downstream resistance variations. These findings suggest that patient-specific boundary conditions should be used in order to achieve a more accurate drug distribution estimation with CFD in transarterial embolization treatment planning.
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Affiliation(s)
- Amirtahà Taebi
- Department of Biomedical Engineering, University of California Davis, One Shields Ave., Davis, CA 95616, USA
| | - Rex M. Pillai
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA; (R.M.P.); (C.T.V.)
| | | | - Catherine T. Vu
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA; (R.M.P.); (C.T.V.)
| | - Emilie Roncali
- Department of Biomedical Engineering, University of California Davis, One Shields Ave., Davis, CA 95616, USA
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Roncali E, Taebi A, Foster C, Vu CT. Personalized Dosimetry for Liver Cancer Y-90 Radioembolization Using Computational Fluid Dynamics and Monte Carlo Simulation. Ann Biomed Eng 2020; 48:1499-1510. [PMID: 32006268 PMCID: PMC7160004 DOI: 10.1007/s10439-020-02469-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/25/2020] [Indexed: 12/14/2022]
Abstract
Yttrium-90 (Y-90) transarterial radioembolization uses radioactive microspheres injected into the hepatic artery to irradiate liver tumors internally. One of the major challenges is the lack of reliable dosimetry methods for dose prediction and dose verification. We present a patient-specific dosimetry approach for personalized treatment planning based on computational fluid dynamics (CFD) simulations of the microsphere transport combined with Y-90 physics modeling called CFDose. The ultimate goal is the development of a software to optimize the amount of activity and injection point for optimal tumor targeting. We present the proof-of-concept of a CFD dosimetry tool based on a patient's angiogram performed in standard-of-care planning. The hepatic arterial tree of the patient was segmented from the cone-beam CT (CBCT) to predict the microsphere transport using multiscale CFD modeling. To calculate the dose distribution, the predicted microsphere distribution was convolved with a Y-90 dose point kernel. Vessels as small as 0.45 mm were segmented, the microsphere distribution between the liver segments using flow analysis was predicted, the volumetric microsphere and resulting dose distribution in the liver volume were computed. The patient was imaged with positron emission tomography (PET) 2 h after radioembolization to evaluate the Y-90 distribution. The dose distribution was found to be consistent with the Y-90 PET images. These results demonstrate the feasibility of developing a complete framework for personalized Y-90 microsphere simulation and dosimetry using patient-specific input parameters.
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Affiliation(s)
- Emilie Roncali
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.
| | - Amirtahà Taebi
- Department of Biomedical Engineering, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Cameron Foster
- Department of Radiology, UC Davis Medical Center, Sacramento, CA, 95817, USA
| | - Catherine Tram Vu
- Department of Radiology, UC Davis Medical Center, Sacramento, CA, 95817, USA
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Ficai A. Design and Performances of Medical Devices: From Bulk to Surface Modification. Curr Med Chem 2020; 27:1579. [DOI: 10.2174/092986732710200327171513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Anton Ficai
- Department of Science and Engineering of Oxide Materials and Nanomaterials Faculty of Applied Chemistry and Materials Science University POLITEHNICA of Bucharest Gh Polizu St. 1-7, Bucharest, Romania
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