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Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib.

Coriat R, Gouya H, Mir O, Ropert S, Vignaux O, Chaussade S, Sogni P, Pol S, Blanchet B, Legmann P, Goldwasser F - PLoS ONE (2011)

Bottom Line: All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%.In contrast, no specific change was observed in the azygos vein or the abdominal aorta.Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.

View Article: PubMed Central - PubMed

Affiliation: Center for Research on Angiogenesis Inhibitors (CERIA), Hôpital Cochin, AP-HP, Paris, France. romain.coriat@cch.aphp.fr

ABSTRACT
Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.

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Female Patient, Aged 56 Years (Patient 2).Coronal (a) and transaxial (b) localizing image planned along the course of the portal vein (line). Based on these images, a phase-contrast enconding sequence was planned perpendicular to the course of the portal vein (line). c: Portal vein (arrowhead) velocity-encoded phase-contrast image. d: Portal vein (arrow) magnitude image.
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pone-0016978-g001: Female Patient, Aged 56 Years (Patient 2).Coronal (a) and transaxial (b) localizing image planned along the course of the portal vein (line). Based on these images, a phase-contrast enconding sequence was planned perpendicular to the course of the portal vein (line). c: Portal vein (arrowhead) velocity-encoded phase-contrast image. d: Portal vein (arrow) magnitude image.

Mentions: Flow in the azygos vein and the portal venous systems were quantified with cine-phase contrast magnetic resonance imaging velocity mapping. [20], [21] Magnetic resonance imaging examinations were performed with a 1.5 T MR unit (Siemens Medical Solutions, Avanto, Erlangen, Germany) with electrocardiographic gating, using a cardiac dedicated 32-channel phased-array coil, and parallel acquisition to reduce the duration of acquisition. The time resolution was 16 frames in one cardiac cycle. Azygos flow was measured at the mid-thoracic level. Anatomical evaluation of the azygos and portal venous systems with axial, coronal, and oblique breath-hold sequences was performed to ensure the correct acquisition plane, perpendicular to the vein for flow quantification. Each set was reconstructed to yield a magnitude image and a velocity encoded phase-contrast image. Portal flow was measured in the main segment 20 mm proximal to the portal bifurcation. Volumetric flow rate was obtained from the product of the cross-sectional area and the velocity. Hand-drawn circular regions of interest were placed on the magnitude images so that all pixels of the vessel were included (Fig. 1).


Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib.

Coriat R, Gouya H, Mir O, Ropert S, Vignaux O, Chaussade S, Sogni P, Pol S, Blanchet B, Legmann P, Goldwasser F - PLoS ONE (2011)

Female Patient, Aged 56 Years (Patient 2).Coronal (a) and transaxial (b) localizing image planned along the course of the portal vein (line). Based on these images, a phase-contrast enconding sequence was planned perpendicular to the course of the portal vein (line). c: Portal vein (arrowhead) velocity-encoded phase-contrast image. d: Portal vein (arrow) magnitude image.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3038868&req=5

pone-0016978-g001: Female Patient, Aged 56 Years (Patient 2).Coronal (a) and transaxial (b) localizing image planned along the course of the portal vein (line). Based on these images, a phase-contrast enconding sequence was planned perpendicular to the course of the portal vein (line). c: Portal vein (arrowhead) velocity-encoded phase-contrast image. d: Portal vein (arrow) magnitude image.
Mentions: Flow in the azygos vein and the portal venous systems were quantified with cine-phase contrast magnetic resonance imaging velocity mapping. [20], [21] Magnetic resonance imaging examinations were performed with a 1.5 T MR unit (Siemens Medical Solutions, Avanto, Erlangen, Germany) with electrocardiographic gating, using a cardiac dedicated 32-channel phased-array coil, and parallel acquisition to reduce the duration of acquisition. The time resolution was 16 frames in one cardiac cycle. Azygos flow was measured at the mid-thoracic level. Anatomical evaluation of the azygos and portal venous systems with axial, coronal, and oblique breath-hold sequences was performed to ensure the correct acquisition plane, perpendicular to the vein for flow quantification. Each set was reconstructed to yield a magnitude image and a velocity encoded phase-contrast image. Portal flow was measured in the main segment 20 mm proximal to the portal bifurcation. Volumetric flow rate was obtained from the product of the cross-sectional area and the velocity. Hand-drawn circular regions of interest were placed on the magnitude images so that all pixels of the vessel were included (Fig. 1).

Bottom Line: All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%.In contrast, no specific change was observed in the azygos vein or the abdominal aorta.Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.

View Article: PubMed Central - PubMed

Affiliation: Center for Research on Angiogenesis Inhibitors (CERIA), Hôpital Cochin, AP-HP, Paris, France. romain.coriat@cch.aphp.fr

ABSTRACT
Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.

Show MeSH
Related in: MedlinePlus