Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of {sup 99m}Technetium-Albumin Macroaggregates

Journal Article · Sat Oct 15 00:00:00 EDT 2011 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-010-0088-4· OSTI ID:21608580

Barentsz, M W ^[1]; Vente, M A. D.; Smits, M L. J. ^[1]; Nijsen, J F. W. ^[2]; Seinstra, B A; Verkooijen, H M ^[1]; Zonnenberg, B A ^[2]

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1. University Medical Center Utrecht, Center of Interventional Oncology and Department of Radiology (Netherlands)
2. University Medical Center Utrecht, Department of Nuclear Medicine (Netherlands)

Purpose: To evaluate the incidence of extrahepatic deposition of technetium-99m-labeled albumin macroaggregates ({sup 99m}Tc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton ({sup 90}Y-RE), and to report on technical solutions that can be used to ensure safe delivery of {sup 90}Y-microspheres in patients with initial extrahepatic deposition. Materials and Methods: A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with {sup 90}Y-RE in our institution in 2009, was performed. The angiograms and single-photon emission computed tomography images of all patients were reviewed by an interventional radiologist and a nuclear medicine physician, respectively, to identify and localize extrahepatic deposition of {sup 99m}Tc-MAA when present. Subsequently, the technical solutions were used to successfully perform {sup 90}Y-RE in these patients were evaluated and described. Results: Extrahepatic deposition of {sup 99m}Tc-MAA was observed in 8 of 26 patients (31%). In 7 of 8 patients, a second pretreatment angiography was performed to detect the cause of extrahepatic deposition. The technical solutions to enable safe {sup 90}Y microspheres delivery included more distal placement of the microcatheter in the proper/right hepatic artery in 4 of 7 (57%) patients; (super)selective catheterization of multiple segmental branches in 2 of 7 (29%); and additional coiling of a newly detected branch in the remaining patient (14%). This was confirmed by a second MAA procedure. {sup 90}Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed. Conclusion: Extrahepatic deposition of {sup 99m}Tc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe {sup 90}Y-RE delivery in 25 of 26 (96%) patients.

• OSTI ID: 21608580
• Journal Information: Cardiovascular and Interventional Radiology, Vol. 34, Issue 5; Other Information: DOI: 10.1007/s00270-010-0088-4; Copyright (c) 2011 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2010 The Author(s); Country of input: International Atomic Energy Agency (IAEA); ISSN 0174-1551
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
ALBUMINS
ARTERIES
BIOMEDICAL RADIOGRAPHY
DEPOSITION
IMAGES
LIVER
MATERIALS
MICROSPHERES
NEOPLASMS
PATIENTS
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
SOLUTIONS
TECHNETIUM 99
YTTRIUM 90
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
COMPUTERIZED TOMOGRAPHY
DAYS LIVING RADIOISOTOPES
DIAGNOSTIC TECHNIQUES
DIGESTIVE SYSTEM
DISEASES
DISPERSIONS
EMISSION COMPUTED TOMOGRAPHY
GLANDS
HOMOGENEOUS MIXTURES
HOURS LIVING RADIOISOTOPES
INTERMEDIATE MASS NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
MIXTURES
NUCLEAR MEDICINE
NUCLEI
ODD-EVEN NUCLEI
ODD-ODD NUCLEI
ORGANIC COMPOUNDS
ORGANS
PROTEINS
RADIOISOTOPES
RADIOLOGY
TECHNETIUM ISOTOPES
TOMOGRAPHY
YEARS LIVING RADIOISOTOPES
YTTRIUM ISOTOPES