Low infusion rate digital subtraction angiography to predict regional perfusion in hepatic arterial chemotherapy

Digital subtraction angiography (DSA) with a low injection rate of contrast (0.5 ml/sec) was studied as a means of predicting the regional perfusion of percutaneously placed catheters for hepatic arterial chemotherapy. In 64 hepatic artery catheter placements, conventional injection rate angiography (3-5 ml/sec) and low infusion rate DSA exams were compared to conventional radionuclide perfusion studies performed with Tc-99m-MAA. In 58 of 64 cases (90.6%) the conventional arteriogram correctly predicted the extent of hepatic perfusion, whereas in 63 of 64 cases (98%), the low flow DSA exam correctly predicted hepatic perfusion. The conventional arteriogram correctly predicted the extent of extrahepatic perfusion in 32 cases (50%), with a sensitivity of 100%, but a specificity of only 39.6%. The DSA exam was correct in defining the presence or absence of extrahepatic perfusion in 57 of 64 cases for a sensitivity of 82% and a specificity of 91%. Despite the quantitative difference between the low infusion rate DSA study and the chemotherapy infusion (10 ml/hr), it is a useful tool to assist in the correct positioning of temporary catheters for hepatic arterial chemotherapy.