Pharmacological Manipulation of Intrahepatic Arterial Blood Flow in HCC

This study aims to evaluate the blood flow modifications in liver following injection of norepinephrine in the hepatic artery. These blood flow variations have never been dynamically evaluated before. If indeed blood flow modulation in liver is favorable, the use of norepinephrine prior to localized chemotherapy has great potential to enhance treatment and diminish side effects. Patients with hepatocellular carcinoma, a primary liver cancer, will be selected for this study. Included patients will have a trans-arterial chemoembolization (TACE) procedure scheduled as treatment for their cancer. During their procedure, they will be brought to an advanced CT-scanner. CT perfusion imaging will be performed prior, and after the injection of the study drug in the liver artery. Patient's treatment will then be completed. Perfusion color maps will illustrate blood flow. Perfusion values will be correlated to see how the drug modulates blood flow in tumor and in normal liver.

Inclusion criteria

• Biopsy proven HCC< or confident diagnosis of HCC on multi-phasic CT or MRI
• Selection criteria for chemoembolization must be met, including adequate coagulation profile and serum creatinine, patent portal vein, no severe contrast allergy, cirrhosis Child A or B.
• 5 or less untreated nodular hepatic tumors within the lobe to undergo chemoembolization. Larger nodule must be equal or over 3 cm.
• Patient must be able to provide written, informed consent.

Exclusion criteria

• Symptoms or history of ischemic cardiac disease or arrhythmia
• Uncontrolled hypertension
• Pregnancy or desire to get pregnant
• Severe COPD, FEVS lower than 30%
• Prior documented hypersensitivity to norepinephrine
• Patients receiving MAO inhibitors, or anti-depressants of the triptyline or imipramine types