Angiography-Based C-Arm CT for the Assessment of Extrahepatic Shunting before Radioembolization

Abstract

C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies.

C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications

“…In contrast to transarterial chemoembolization (TACE), an angiographic work-up is required prior to yttrium-90 (Y-90) loaded microsphere infusion into the hepatic artery [48]. Angiographic work-up mainly consists in identifying (and, if indicated, coil-embolizing) hepatoenteric arteries, originating from the hepatic arteries [49]; defining the vascular territory of all targeted hepatic arteries; and identifying the tumoral lesions within these vascular territories. Additionally, total volume calculation of the hepatic vascular territory and targeted liver tumors is important to correctly calculate the total dose of yttrium-90 microspheres to be injected in the targeted hepatic arteries (Fig.…”

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

“…However, a better estimation of the lung dose (and anticipated treatment individualization) seems to outweigh the risk. Additionally, improved pretreatment imaging and additional C-arm CT imaging may decrease the risk and severity of extrahepatic depositions (5,34). The workup for 166 Ho radioembolization in 2 clinical studies that recently started recruitment in our center has now been changed.…”

“…Deposition of microspheres in gastrointestinal organs can result in ulceration or inflammation of tissue by a combination of embolization and radiation damage (2)(3)(4). To prevent this, vessels leading to gastrointestinal organs may be coil-embolized in patients scheduled for radioembolization treatment, during a pretreatment session using contrastenhanced images (i.e., digital subtraction angiography complemented by C-arm CT) to identify the culprit vessel (5). 99m Tc-macroaggregated albumin ( 99m Tc-MAA) is administered in this pretreatment session to simulate intrahepatic treatment biodistribution and to assess lung shunting and the possibility of extrahepatic deposition of the microspheres (6).…”

Radiologisches Vorgehen bei der Durchführung einer SIRT

“…Die Suche nach der Vielzahl m ö glicher, arterieller Gef ä ß varianten, die aus dem arteriellen Gef ä ß netz der Leber entspringen, beispielsweise einer akzessorischen A. phrenica inferior, muss aufgrund des Risikos, diese Gef ä ß e aufgrund ihres geringen Durchmessers und ihrer atypischen Lagen zu ü bersehen, unbedingt sorgf ä ltig erfolgen. Die Rotationsangiografi e kann die Identifi kation solcher Gef ä ß e unterst ü tzen [8] . Die A. cystica stellt einen Sonderfall dar.…”

“…Ist eine 3-dimensionale Visualisierung der Vaskularisierung (z. B. zur Detektion nur geringer, randst ä ndiger Hypervaskularisierung zentral nekrotischer Metastasen) gew ü nscht, kann dies mithilfe der Flachdetektor-Rotationsangiografi e direkt in der Angiografi eeinheit oder, sofern nicht verf ü gbar, mithilfe einer arteriellen CT-Angiografi e nach Umlagern des Patienten in die CT-Einheit geschehen[8] ( • ▶ Abb. 5, 6 ).…”