CT Perfusion Scans in Detecting Changes in Blood Flow to the Liver After Portal Vein Embolization

Study Overview
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Brief Summary
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This trial studies the use of computed tomography (CT) perfusion scans in detecting changes in blood flow to the liver after portal vein embolization in patients with liver cancer. CT perfusion scans use a standard contrast drug given by vein to measure blood flow to the liver. CT perfusion scans may predict the rate and amount of growth of new, healthy tissue on one side of the liver after a portal vein embolization and detect change to the size of the liver tumor as result of the procedure.

Detailed Description
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PRIMARY OBJECTIVES: I. To assess whether perfusion changes to the liver following portal vein embolization (PVE) correlate with hypertrophy of the future liver remnant (FLR). SECONDARY OBJECTIVES: I. To assess perfusion changes to liver tumors following PVE. II. To assess whether PVE may affect tumor growth. OUTLINE: Prior to PVE, patients undergo CT perfusion scan of the liver and liver biopsy over 15 minutes. Patients undergo a second CT perfusion scan immediately after PVE and a third CT perfusion scan 3-6 weeks post PVE.

Official Title
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To Evaluate Perfusion Changes to the Liver Following Pre-Operative Portal Vein Embolization for Patients With Liver Cancer

Conditions
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Liver and Intrahepatic Bile Duct Carcinoma

Intervention / Treatment
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* Radiation: Computed Tomography Perfusion Imaging
* Procedure: Liver Biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients planned to undergo major liver resection for cancer who need PVE to increase the size of the FLR prior to surgery. Patients who are able to understand and give consent to participate in the study. Exclusion Criteria: Pregnant or nursing. Allergy to iodinated contrast which cannot be safely pre-medicated. History of severe renal dysfunction (glomerular filtration rate [GFR] < 30 mL/min/1.73 square meters). Patients with a GFR between 30-50 mL/min/1.73 square meters will receive the standard contrast-induced nephropathy prophylaxis at our institution (i.e. N-acetylcysteine and sodium bicarbonate [150 mEq/L] in D5W intravenous).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Diagnostic (CT perfusion scans, liver biopsy)<br>Prior to PVE, patients undergo CT perfusion scan of the liver and liver biopsy over 15 minutes. Patients undergo a second CT perfusion scan immediately after PVE and a third CT perfusion scan 3-6 weeks post PVE. | Radiation: Computed Tomography Perfusion Imaging<br>* Undergo perfusion CT<br>Procedure: Liver Biopsy<br>* Undergo liver biopsy<br>* Other names: Biopsy of Liver;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perfusion changes to the liver following portal vein embolization (PVE) | Will assess whether perfusion changes to the liver following PVE correlate with hypertrophy of the future liver remnant (FLR). Perfusion and FLR hypertrophy are two continuous variables. Each patient will serve as his/her own control. Perfusion to the liver (1) before PVE, (2) immediately after PVE, and (3) 3-6 weeks following PVE will be measured and compared. The changes in perfusion will be compared with FLR hypertrophy at the 3-6 week time point to assess correlation. | Baseline up to 6 weeks post PVE | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes to tumor cellular proliferation following PVE | Will assess perfusion changes to liver tumors following PVE and whether this may affect tumor growth kinetics. Each patient will serve as his/her own control. Perfusion to the liver tumor(s) (1) before PVE, (2) immediately after PVE, and (3) 3-6 weeks following PVE will be measured and compared. Since a percutaneous biopsy will be performed of a single liver tumor before PVE and the tumor explant will be available following surgical resection, changes to tumor cellular proliferation following PVE can be assessed. | Baseline up to 6 weeks post PVE |