Radioembolization with Infusion of Yttrium-90 Microspheres into a Right Inferior Phrenic Artery with Hepatic Tumor Supply Is Feasible and Safe

• Published in: Journal of vascular and interventional radiology Vol. 23; no. 10; pp. 1294 - 1301
• Main Authors: Burgmans, Mark Christiaan, MD, Kao, Yung Hsiang, MBBS, MRCP, FAMS, Irani, Farah Gillan, MBBS, FRCR, FAMS, Dames, Erin Leslee, MBBS, Teo, Terence Kiat Beng, MBBS, FRCR, FAMS, Goh, Anthony Soon Whatt, MBBS, MSc, FAMS, Chow, Pierce K.H., MBBS, PhD, MMed, FRSCE, FAMS, Tay, Kiang Hiong, MBBS, FRCR, FAMS, Lo, Richard Hoau Gong, MBBS, MMed, FRCR
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2012
• Subjects: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - radiotherapy; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Feasibility Studies; Female; Humans; Infusions, Intra-Arterial; Liver Neoplasms - blood supply; Liver Neoplasms - diagnosis; Liver Neoplasms - radiotherapy; Magnetic Resonance Imaging; Male; Microspheres; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Predictive Value of Tests; Radiography, Interventional; Radiology; Radiopharmaceuticals - administration & dosage; Radiopharmaceuticals - adverse effects; Retrospective Studies; Technetium Tc 99m Aggregated Albumin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Yttrium Radioisotopes - administration & dosage; Yttrium Radioisotopes - adverse effects; inferior phrenic artery; digital subtraction angiography; single photon emission computed tomography; HCC; parasitized extrahepatic artery; macroaggregated albumin; MAA; PEA; SPECT; inferior vena cava; DSA; polyvinyl alcohol; IVC; transarterial embolization; TAE; PVA; IPA; hepatocellular carcinoma
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2012.07.009

Abstract Purpose To evaluate the feasibility and safety of yttrium-90 (90 Y) radioembolization through the inferior phrenic arteries (IPAs). Materials and Methods Retrospective analysis of 108 patients referred for radioembolization to treat primary (n = 103) or secondary (n = 5) liver malignancy was performed. Five patients had malignant hepatic tumors supplied by the IPA and met criteria for infusion of90 Y spheres into the IPA. Digital subtraction angiography (DSA), catheter-directed computed tomographic (CT) angiography, and technetium-99m (99m Tc) macroaggregated albumin (MAA) single photon emission CT (SPECT)/CT were used to plan treatment. Bremsstrahlung SPECT/CT was performed 1 day after radioembolization. Follow-up included clinical and biochemical tests and cross-sectional CT or magnetic resonance imaging. Results Parasitized extrahepatic arteries were detected in 37% of patients (n = 40). Of these, 62.5% (n = 25) had tumor supply through an IPA. Of the patients with IPA supply, 20% (n = 5) underwent infusion of90 Y into the right IPA. Reasons for disqualifying patients from infusion into the IPA were less than 10% tumor supply (n = 11), failed catheterization of IPA (n = 3), arterioportovenous shunt (n = 2), failed identification of IPA on pretreatment angiography (n = 1), and gastric or esophageal enhancement on catheter-directed CT angiography (n = 3). In all five patients, technical success was demonstrated on90 Y imaging, with no significant extrahepatic radionuclide activity. No adverse events related to IPA radioembolization occurred at mean follow-up of 4.5 months (range, 2.2–10.1 mo). Conclusions Delivery of90 Y microspheres through the right IPA is feasible and safe with the use of catheter-directed CT angiography in addition to DSA and 99m Tc MAA SPECT/CT in patients with tumors with greater than 10% IPA supply.