⁹⁰Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target Therapy Delivery

Abstract

Primary and metastatic liver cancers are responsible for considerable morbidity and mortality, and many patients are not curable at presentation. Therefore, new therapies such as radioembolization with yttrium 90 ((90)Y)-labeled microspheres are an alternative method to treat patients with unresectable primary or secondary liver tumors. Patient selection, treatment technique, and early recognition of potential complications are the keys for successful patient outcomes. The activity of administered (90)Y microspheres depends on multiple variables, including the tumor burden, the volume of the liver lobe to be treated, the type of (90)Y microspheres, and the hepatopulmonary shunt fraction. Preprocedural planning relies on the results of cross-sectional imaging to determine the extent of disease, tumoral and nontumoral liver volumes, patency of the portal vein, and the degree of extrahepatic disease. A multidisciplinary approach that combines expertise in cross-sectional imaging, nuclear medicine, and flow dynamics is critical to adequately target malignant tissue. Preprocedural multimodality imaging, particularly combined single photon emission computed tomography (SPECT) and computed tomography (CT) imaging (SPECT/CT), may be used to identify nontarget imaging patterns that, if recognized, can potentially be corrected with either branch vessel embolization or catheter repositioning. Postprocedural multimodality imaging is also useful to confirm the appropriate delivery of (90)Y microspheres, enabling early identification of potential complications and the adequacy of microsphere distribution, thereby optimizing planning for subsequent therapies.

Imaging Evaluation Following 90Y Radioembolization of Liver Tumors: What Radiologists Should Know

“…Angiographic information is critical because if radioactive microspheres are infused into the non-hepatic arteries during radioembolization procedures, serious complications such as gastrointestinal ulcers can occur ( 6 ). Thus, prophylactic embolization of non-target branch vessels, including an accessory left gastric artery, right gastric artery, hepatic falciform artery, and esophageal branches from the replaced left hepatic artery, can be performed, although there are controversies about the indications ( 9 12 13 ).…”

Contribution of Computed Tomographic Angiography to Pretreatment Planning of Radio-embolization of Liver Tumors

“…An examination of liver segment IV should be focused on the possible presence of the middle hepatic artery, which may be a branch of the right hepatic artery or arise directly from the proper hepatic artery as a trifurcation with the end branches of the right or left hepatic artery passing on the other side. Moreover, mapping the distance of normal arterial branches from the point of microsphere application is also important, especially for the gastroduodenal and cystic arteries (10). Specifically, up to 17% of tumors located on the liver surface have a parasitic arterial supply (Table II) (11).…”

“…Despite the limitations associated with CTA, it can be considered a suitable method for planning the catheterization procedure. Specifically, it accelerates and consequently reduces the radiation load and the amount of CM required, which is beneficial, especially for patients with impaired renal function (10,21,28).…”

SIRT and Its Unresolved Problems—Is Imaging the Solution? A Review

“…Selective Internal Radiation Therapy does not only consist of the injection of microspheres itself, but includes necessary multidisciplinary imaging modalities [8]. The interaction of preoperative and postoperative parts included in the treatment procedures give an overview of the complex therapy option and will gain its importance when the limitations of the technique are discussed later in this paper.…”