Current Approach to Planning Angiography and MAA Administration

Abstract

Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.

Keywords

yttrium-90 - radioembolization - liver cancer - diagnostic angiography - interventional radiology

Publikationsverlauf

Artikel online veröffentlicht:
07. Oktober 2021

• References

• 1 Kallini JR, Gabr A, Salem R, Lewandowski RJ. Transarterial radioembolization with yttrium-90 for the treatment of hepatocellular carcinoma. Adv Ther 2016; 33 (05) 699-714
• 2 Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966; 112 (03) 337-347
• 3 Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg 1994; 220 (01) 50-52
• 4 Fonseca-Neto OCLD, Lima HCS, Rabelo P, Melo PSV, Amorim AG, Lacerda CM. Anatomic variations of hepatic artery: a study in 479 liver transplantations. Arq Bras Cir Dig 2017; 30 (01) 35-37
• 5 Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 2002; 224 (02) 542-547
• 6 Padia SA, Lewandowski RJ, Johnson GE. et al; Society of Interventional Radiology Standards of Practice Committee. Radioembolization of hepatic malignancies: background, quality improvement guidelines, and future directions. J Vasc Interv Radiol 2017; 28 (01) 1-15
• 7 Uliel L, Royal HD, Darcy MD, Zuckerman DA, Sharma A, Saad NE. From the angio suite to the γ-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization – a comprehensive pictorial review. J Nucl Med 2012; 53 (11) 1736-1747
• 8 Salem R, Lewandowski RJ, Gates VL. et al; Technology Assessment Committee, Interventional Oncology Task Force of the Society of Interventional Radiology. Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol 2011; 22 (03) 265-278
• 9 Lewandowski RJ, Salem R. Yttrium-90 radioembolization of hepatocellular carcinoma and metastatic disease to the liver. Semin Intervent Radiol 2006; 23 (01) 64-72
• 10 Garin E, Rolland Y, Laffont S, Edeline J. Clinical impact of (99m)Tc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with (90)Y-loaded microspheres. Eur J Nucl Med Mol Imaging 2016; 43 (03) 559-575
• 11 European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56 (04) 908-943
• 12 Lawrence TS, Blackstock AW, McGinn C. The mechanism of action of radiosensitization of conventional chemotherapeutic agents. Semin Radiat Oncol 2003; 13 (01) 13-21
• 13 Brown DB. Hepatic artery dissection in a patient on bevacizumab resulting in pseudoaneurysm formation. Semin Intervent Radiol 2011; 28 (02) 142-146
• 14 Kennedy A, Nag S, Salem R. et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007; 68 (01) 13-23
• 15 Gaba RC. Planning arteriography for yttrium-90 microsphere radioembolization. Semin Intervent Radiol 2015; 32 (04) 428-438
• 16 Louie JD, Kothary N, Kuo WT. et al. Incorporating cone-beam CT into the treatment planning for yttrium-90 radioembolization. J Vasc Interv Radiol 2009; 20 (05) 606-613
• 17 Schiro BJ, Amour ES, Harnain C, Gandhi RT. Management of high hepatopulmonary shunts in the setting of Y90 radioembolization. Tech Vasc Interv Radiol 2019; 22 (02) 58-62
• 18 Hamoui N, Minocha J, Memon K. et al. Prophylactic embolization of the gastroduodenal and right gastric arteries is not routinely necessary before radioembolization with glass microspheres. J Vasc Interv Radiol 2013; 24 (11) 1743-1745
• 19 Atassi B, Bangash AK, Lewandowski RJ. et al. Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 2008; 19 (05) 691-697
• 20 Piana PM, Bar V, Doyle L. et al. Early arterial stasis during resin-based yttrium-90 radioembolization: incidence and preliminary outcomes. HPB (Oxford) 2014; 16 (04) 336-341
• 21 Dezarn WA, Cessna JT, DeWerd LA. et al; American Association of Physicists in Medicine. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys 2011; 38 (08) 4824-4845
• 22 Riaz A, Lewandowski RJ, Kulik LM. et al. Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009; 20 (09) 1121-1130 , quiz 1131
• 23 Ahmed O, Patel MV, Masrani A. et al. Assessing intra-arterial complications of planning and treatment angiograms for Y-90 radioembolization. Cardiovasc Intervent Radiol 2017; 40 (05) 704-711
• 24 Gabr A, Kallini JR, Gates VL. et al. Same-day ⁹⁰Y radioembolization: implementing a new treatment paradigm. Eur J Nucl Med Mol Imaging 2016; 43 (13) 2353-2359
• 25 Gates VL, Marshall KG, Salzig K, Williams M, Lewandowski RJ, Salem R. Outpatient single-session yttrium-90 glass microsphere radioembolization. J Vasc Interv Radiol 2014; 25 (02) 266-270
• 26 Li MD, Chu KF, DePietro A. et al. Same-day yttrium-90 radioembolization: feasibility with resin microspheres. J Vasc Interv Radiol 2019; 30 (03) 314-319
• 27 Sancho L, Rodriguez-Fraile M, Bilbao JI. et al. Is a technetium-99m macroaggregated albumin scan essential in the workup for selective internal radiation therapy with yttrium-90? An analysis of 532 patients. J Vasc Interv Radiol 2017; 28 (11) 1536-1542