Safety and Efficacy Assessment of Flow Redistribution by Occlusion of Intrahepatic Vessels Prior to Radioembolization in the Treatment of Liver Tumors

Journal Article · Tue Jun 15 04:00:00 EDT 2010 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-009-9717-1· OSTI ID:21428993

Garrastachu, Puy ^[1]; Herraiz, Maria J ^[2]; Rodriguez, Macarena ^[1]; Inarrairaegui, Mercedes ^[3]; Rodriguez, Javier ^[4]; Hernandez, Carmen; Arbizu, Javier ^[1]; Sangro, Bruno ^[3]

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1. Clinica Universitaria de Navarra, Department of Nuclear Medicine (Spain)
2. Clinica Universitaria de Navarra, Department of Radiology (Spain)
3. Clinica Universitaria de Navarra, Department of Internal Medicine-Hepatology (Spain)
4. Clinica Universitaria de Navarra, Department of Oncology (Spain)

We evaluated the feasibility, safety, and efficacy of radioembolization (administered from one or two vascular points) after the redistribution of arterial blood flow in the liver in patients with hepatic neoplasms and arterial anatomic peculiarities (AAP). Twenty-four patients with liver neoplasms and AAP (graded according to Michel's classification) were included in the study. During pretreatment angiographic planning, all extrahepatic vessels that could feed the tumor were embolized and the intrahepatic vessels occluded in order to redistribute blood flow. The distribution of microspheres was initially assessed by using technetium-99m-labeled macroaggregated albumin ({sup 99m}Tc-MAA) from one of two vascular points before the administration of yttrium-90 ({sup 90}Y)-radiolabeled resin microspheres. Perfusion of lesions situated in the redistributed segments (L-RS) and nonredistributed segments (L-NRS) were compared by assessing the distribution of {sup 99m}Tc-MAA by SPECT/CT. Perfusion was graded as normal, reduced, or absent. {sup 90}Y resin microspheres were then injected from the same arterial sites as {sup 99m}Tc-MAA and the tumor response recorded 3 months later. The tumor response in L-RS was compared with that in L-NRS and graded as better, similar, or worse. Among 11 patients with type I AAP in whom mainly vessels in segments I-III or IV were occluded, perfusion of L-RS was graded as similar (n = 7) or reduced (n = 4). Among the remaining 13 patients with AAP types III (n = 3), V (n = 4), VIII (n = 3), and others (n = 3) in which aberrant arteries were occluded, perfusion of L-RS was graded as similar (n = 9), reduced (n = 3), or absent (n = 1). Overall, {sup 99m}Tc-MAA was present in the L-RS of 95.8% patients and the distribution of {sup 99m}Tc-MAA in L-RS and L-NRS were graded as similar in 66.6% of patients. Compared with lesions in the L-NRS, tumor response in L-RS was similar in 23 cases and worse in 1 case. No complications were recorded after the administration of {sup 90}Y resin microspheres. Redistribution of flow in L-RS is feasible and enables a safe and effective delivery of {sup 90}Y resin microspheres that are able to be distributed via intrahepatic collaterals and access the microvasculature of L-RS.

• OSTI ID: 21428993
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 3 Vol. 33; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BLOOD FLOW
BODY
COMPUTERIZED TOMOGRAPHY
DAYS LIVING RADIOISOTOPES
DIAGNOSTIC TECHNIQUES
DIGESTIVE SYSTEM
DISEASES
EFFICIENCY
EMISSION COMPUTED TOMOGRAPHY
GLANDS
HOURS LIVING RADIOISOTOPES
INTERMEDIATE MASS NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LIVER
MICROSPHERES
NEOPLASMS
NUCLEI
ODD-EVEN NUCLEI
ODD-ODD NUCLEI
ORGANIC COMPOUNDS
ORGANIC POLYMERS
ORGANS
PETROCHEMICALS
PETROLEUM PRODUCTS
POLYMERS
RADIOISOTOPES
RESINS
SAFETY
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
TECHNETIUM 99
TECHNETIUM ISOTOPES
TOMOGRAPHY
YEARS LIVING RADIOISOTOPES
YTTRIUM 90
YTTRIUM ISOTOPES