Intra-arterial CT angiography visualization of arterial supply to inferior vena cava tumor thrombus prior to radioembolization of hepatocellular carcinoma

• Published in: Saudi journal of gastroenterology Vol. 18; no. 6; pp. 384 - 387
• Main Authors: Roche, Glen, Teo, Terence K B, Tan, Andrew E H, Irani, Farah G
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.11.2012; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Angiography, Digital Subtraction - methods; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - therapy; Care and treatment; Case Report; Collateral Circulation; Complications and side effects; CT imaging; Diagnosis; Diagnosis, Differential; Embolization, Therapeutic - methods; Hepatoma; Humans; Injections, Intra-Arterial; Intra-arterial computed tomographic angiography; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - therapy; Male; Metastasis; Middle Aged; radioembolization; Radiopharmaceuticals - administration & dosage; Risk factors; Tomography, X-Ray Computed; tumor thrombus; Vena Cava, Inferior - diagnostic imaging; Saudi Arabia
• ISSN: 1319-3767; 1998-4049
• DOI: 10.4103/1319-3767.103431

Unresectable hepatocellular carcinoma has a high frequency of vascular invasion and arterial parasitization. Trans-arterial radioembolization using yttrium-90 (Y90) microspheres is a possible treatment option. Paramount to its success is the meticulous angiographic interrogation of tumor feeding arteries and extra-hepatic supply. We describe a patient with tumor invasion of the inferior vena cava with arterial supply from the right inferior phrenic artery, which was exquisitely visualized using intra-arterial computed tomographic angiography (IACTA) during the planning technetium-99m macro aggregated albumin phase. This technique was useful in planning which artery to administer Y90 microspheres into for maximal brachytherapy. Although patient outcome was poor due to significant arterio-portal shunting, we believe that IACTA is a useful adjunct to conventional digital subtraction angiography in planning radioembolization therapy.