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Hepatocellular Carcinoma: Regional Therapy with a Magnetic Targeted Carrier Bound to Doxorubicin in a Dual MR Imaging/ Conventional Angiography Suite—Initial Experience with Four Patients¹

¹ From the Departments of Radiology (M.W.W., R.K.K., N.A.F., J.M.L, R.L.G.) and Medicine (A.P.V.), University of California, San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA 94143; and FeRx Incorporated, San Diego, Calif (J.K.). Received November 15, 2002; revision requested January 17, 2003; revision received April 9; accepted June 9. Address correspondence to M.W.W. (e-mail: mark.wilson@radiology.ucsf.edu).

View larger version (70K): [in a new window]   Figure 1a. (a) The 5-kG portable magnet used for magnetic targeted therapy. The overall height of the magnet and holding apparatus is 1.4 m. (b) Diagram depicts the mode of action of magnetic targeted therapy. After leaving the intraarterial catheter, MTC-DOX (MTC) is drawn out of the artery into surrounding tumor and/or liver tissue by the influence of the local magnetic field. (Image courtesy of FeRx.)

View larger version (63K): [in a new window]   Figure 1b. (a) The 5-kG portable magnet used for magnetic targeted therapy. The overall height of the magnet and holding apparatus is 1.4 m. (b) Diagram depicts the mode of action of magnetic targeted therapy. After leaving the intraarterial catheter, MTC-DOX (MTC) is drawn out of the artery into surrounding tumor and/or liver tissue by the influence of the local magnetic field. (Image courtesy of FeRx.)

View larger version (119K): [in a new window]   Figure 2. Dual MR imaging/conventional angiography system, which consists of a full-feature C-arm angiography unit (foreground) and an adjoining short-bore 1.5-T MR imaging unit (background). A common floating dockable tabletop (arrow) allows seamless patient transfer between the MR imaging and C-arm components. The component units can be used independently when the leaded radiofrequency-shielded doors separating them are closed.

View larger version (107K): [in a new window]   Figure 3. Patient 1. A, C, E, Transverse single-shot spin-echo MR images (repetition time msec/echo time msec, 839/80; one signal acquired; 6-mm section thickness); B, D, anteroposterior DSA images. A, Initial pretreatment MR image shows the tumor (arrow) in the right hepatic lobe, and, B, initial pretreatment DSA image of the hepatic artery shows the corresponding tumor vascularity and angiographic tumor blush (arrow). C, Intraprocedural MR image obtained after MTC-DOX administration shows an untreated tumor region (arrow). On the basis of the findings in C, the catheter was repositioned and a more pronounced tumor blush was revealed (arrow in D). E, MR image obtained after the catheter was repositioned shows that treatment of the tumor region that was missed with the first dose of MTC-DOX has been facilitated.

View larger version (118K): [in a new window]   Figure 4. Patient 2. A, C, E, G, Anteroposterior DSA and, B, D, F, H, coronal single-shot spin-echo MR images (839/80, one signal acquired, 6-mm section thickness) obtained, A, B, before MTC-DOX administration and after, C, D, the first, E, F, the second, and, G, H, the third dose of MTC-DOX. The selective hepatic arterial catheter was repositioned between each dose. A, The initial DSA image of the hepatic artery shows multiple arterial branches (arrows) supplying the large liver tumor (arrow in B) seen in B. C, The first dose was injected into a left hepatic artery branch. E, The next dose was injected into the hepatic artery branch in segment IV, and, G, the third dose was injected into a branch of the right hepatic artery. As a result, progressively larger areas of the tumor were affected by MTC-DOX, as documented by the progressive loss of signal intensity (arrows) owing to iron susceptibility artifacts on, D, F, H, the intraprocedural coronal MR images obtained after each injection.

View larger version (19K): [in a new window]   Figure 5. Graph shows the cumulative fraction of tumor volume covered by MTC-DOX in each patient. = patient 1, = patient 2, = patient 3, x = patient 4.

View larger version (21K): [in a new window]   Figure 6. Graph shows the cumulative fraction of normal hepatic parenchyma volume affected by MTC-DOX in each patient. = patient 1, = patient 2, = patient 3, x = patient 4.