, Volume 34, Issue 5, pp 1074-1079,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 30 Dec 2010

Technical Solutions to Ensure Safe Yttrium-90 Radioembolization in Patients With Initial Extrahepatic Deposition of 99mTechnetium–Albumin Macroaggregates

Abstract

Purpose

To evaluate the incidence of extrahepatic deposition of technetium-99m–labeled albumin macroaggregates (99mTc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton (90Y-RE), and to report on technical solutions that can be used to ensure safe delivery of 90Y-microspheres in patients with initial extrahepatic deposition.

Materials and Methods

A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with 90Y-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 99mTc-MAA when present. Subsequently, the technical solutions were used to successfully perform 90Y-RE in these patients were evaluated and described.

Results

Extrahepatic deposition of 99mTc-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 90Y 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. 90Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed.

Conclusion

Extrahepatic deposition of 99mTc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe 90Y-RE delivery in 25 of 26 (96%) patients.