Technical solutions to ensure safe yttrium-90 radioembolization in patients with initial extrahepatic deposition of (99m)technetium-albumin macroaggregates

• Published in: Cardiovascular and interventional radiology Vol. 34; no. 5; pp. 1074 - 1079
• Main Authors: Barentsz, M W, Vente, M A D, Lam, M G E H, Smits, M L J, Nijsen, J F W, Seinstra, B A, Rosenbaum, C E N M, Verkooijen, H M, Zonnenberg, B A, Van den Bosch, M A A J
• Format: Journal Article
• Language: English
• Published: United States 01.10.2011
• Subjects: ALBUMINS; ARTERIES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; COMPUTERIZED TOMOGRAPHY; DAYS LIVING RADIOISOTOPES; DEPOSITION; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; DISEASES; DISPERSIONS; Embolization, Therapeutic; EMISSION COMPUTED TOMOGRAPHY; Female; GLANDS; Hepatic Artery; HOMOGENEOUS MIXTURES; HOURS LIVING RADIOISOTOPES; Humans; Injections, Intra-Arterial; INTERMEDIATE MASS NUCLEI; INTERNAL CONVERSION RADIOISOTOPES; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; LIVER; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - radiotherapy; Male; MATERIALS; MEDICINE; MICROSPHERES; Middle Aged; MIXTURES; NEOPLASMS; NUCLEAR MEDICINE; NUCLEI; ODD-EVEN NUCLEI; ODD-ODD NUCLEI; ORGANIC COMPOUNDS; ORGANS; PATIENTS; PROTEINS; RADIOISOTOPES; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; Radiopharmaceuticals - administration & dosage; Radiopharmaceuticals - therapeutic use; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; SOLUTIONS; TECHNETIUM 99; TECHNETIUM ISOTOPES; Technetium Tc 99m Aggregated Albumin - analysis; TOMOGRAPHY; Tomography, Emission-Computed, Single-Photon; YEARS LIVING RADIOISOTOPES; YTTRIUM 90; YTTRIUM ISOTOPES; Yttrium Radioisotopes - administration & dosage; Yttrium Radioisotopes - therapeutic use
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-010-0088-4

To evaluate the incidence of extrahepatic deposition of technetium-99m-labeled albumin macroaggregates ((99m)Tc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton ((90)Y-RE), and to report on technical solutions that can be used to ensure safe delivery of (90)Y-microspheres in patients with initial extrahepatic deposition. A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with (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 (99m)Tc-MAA when present. Subsequently, the technical solutions were used to successfully perform (90)Y-RE in these patients were evaluated and described. Extrahepatic deposition of (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 (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. (90)Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed. Extrahepatic deposition of (99m)Tc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe (90)Y-RE delivery in 25 of 26 (96%) patients.