Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

Kao, Yung Hsiang; Tan, A.; Khoo, Li Ser; Lo, Richard Hoau Gong; Chow, Pierce K. H.; Goh, Anthony

doi:10.1007/s12149-010-0464-9

Cited by 11 publications

(4 citation statements)

References 13 publications

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“…Furthermore, we only considered gastrointestinal shunt vessels, while the cystic artery and falciform artery, which may also represent extrahepatic shunt vessels, were excluded from our analysis. However, perfusion of either cystic or falciform artery has only minor clinical importance as possible side effects such as microsphere deposition in the abdominal wall or gallbladder wall will usually not lead to severe complications [ 27 , 28 , 29 , 30 ]. Finally, all extrahepatic HSA accumulations were judged as real and made generation and evaluation of false positive cases impossible, since patients with extrahepatic HSA deposition were never treated with SIRT.…”

Section: Discussionmentioning

confidence: 99%

Radioembolization with Y-90 Glass Microspheres: Do We Really Need SPECT-CT to Identify Extrahepatic Shunts?

et al. 2015

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PurposeSelective Internal Radiation Therapy (SIRT) with 90yttrium (Y-90) is an increasingly used therapeutic option for unresectable liver malignancies. Nontarget embolization of extrahepatic tissue secondary to vascular shunting can lead to SIRT associated complications. Our aim was to assess whether extrahepatic shunts can reliably be diagnosed based on hepatic digital subtraction angiography (DSA) or whether subsequent SPECT/CT data can provide additional information.Materials and Methods825 patients with hepatocellular carcinoma (n = 636), hepatic metastases (n = 158) or cholangiocellular carcinoma (n = 31) were retrospectively analyzed. During hepatic DSA 128 arteries causing shunt flow to gastrointestinal tissue were coilembolized (right gastric artery n = 63, gastroduodenal artery n = 29; branches to duodenum / pancreas n = 36). Technectium-99m-labeled human serum albumin (HSA) was injected in all 825 patients. SPECT/CT data was used to identify additional or remaining shunts to extrahepatic tissue.ResultsAn unexpected uptake of HSA in extrahepatic tissue was found by SPECT/CT in 54/825 (6.5%) patients (located in stomach n = 13, duodenum n = 26, distal bowel segments n = 12, kidney n = 1, diaphragm n = 2). These patients underwent repeated DSA and newly identified shunt vessels were coilembolized in 22/54 patients, while in 12/54 patients a more distal catheter position for repeat injection of HSA was chosen. In 20/54 patients the repeated SPECT/CT data still revealed an extrahepatic HSA uptake. These patients did not receive SIRT.ConclusionMost extrahepatic shunts can be identified on DSA prior to Y-90 therapy. However, SPECT-CT data helps to identify additional shunts that were initially not seen on DSA.

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Section: Discussionmentioning

confidence: 99%

Radioembolization with Y-90 Glass Microspheres: Do We Really Need SPECT-CT to Identify Extrahepatic Shunts?

et al. 2015

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“…Inadvertent distribution of 90-yttrium to the ventral abdominal wall via a patent HFA has been described as a complication of SIRT which may result in acute radiation dermatitis, periumbilical skin rash, or severe mid abdominal pain (Leong et al 2009 ; Bhalani and Lewandowski 2011 ). For protective reasons, in cases of a patent HFA a pretherapeutic occlusion of the HFA or a superselective SIRT sparing the HFA dispensing vessel have been proposed (Bhalani and Lewandowski 2011 ; Kao et al 2011 ; Haggerty et al 2012 ). But recently, Wang et al ( 2013 ) reported on radioembolization in five patients with a patent HFA.…”

Section: Discussionmentioning

confidence: 99%

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

et al. 2014

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Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including 99mTc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall 99mTc-HSAM accumulation. The other four patients presented with an abdominal wall 99mTc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall 99mTc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

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“…If falciform artery cannot be embolized, an alternative has been attempted in past cases of super selective therapy to avoid falciform artery. [7][8][9][10] This case was discussed in tumor board, and the patient has been considered for transplant. This case demonstrates the necessity of preprocedural mapping in planning of selective internal radiation therapy 90 Y by using 99m Tc-MAA and highlights the importance of awareness of falciform artery that may affect management of hepatocellular carcinoma with radioablative therapy.…”

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confidence: 99%

“…Embolization of falciform was not attempted in this patient because of difficulty in visualization and inability to target the lesion. If falciform artery cannot be embolized, an alternative has been attempted in past cases of super selective therapy to avoid falciform artery 7–10 . This case was discussed in tumor board, and the patient has been considered for transplant.…”

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confidence: 99%

99mTc–Macroaggregated Albumin Liver Lung Shunt Study With Uptake Indicative of Patent Falciform Artery

2022

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Intra-arterial injection of radioactive isotope 90-yttrium 90Y has been used for elective internal radiation therapy for the treatment of localized hepatocellular carcinoma deemed surgically unresectable. It has also been used to treat intrahepatic cholangiocarcinoma and colorectal cancer that has metastasized to the liver. To prepare for 90Y treatment, preprocedural mapping via hepatic angiography and 99mTc–macroaggregated albumin liver lung shunt study followed by postprocedural 90Y SPECT/CT is essential to ensure a targeted therapy. Therapy is contraindicated if lung shunt fraction is greater than 20% for SIR-Spheres. Anatomic variation in hepatic angiography may be present that can lead to complications if unaccounted for.

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Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries

Cited by 11 publications

References 13 publications

Radioembolization with Y-90 Glass Microspheres: Do We Really Need SPECT-CT to Identify Extrahepatic Shunts?

Radioembolization with Y-90 Glass Microspheres: Do We Really Need SPECT-CT to Identify Extrahepatic Shunts?

Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery

99mTc–Macroaggregated Albumin Liver Lung Shunt Study With Uptake Indicative of Patent Falciform Artery

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