CardioVascular and Interventional Radiology

, Volume 39, Issue 6, pp 847–854

The Caudate Lobe: The Blind Spot in Radioembolization or an Overlooked Opportunity?

  • Manon N. G. J. A. Braat
  • Andor F. van den Hoven
  • Pieter J. van Doormaal
  • Rutger C. Bruijnen
  • Marnix G. E. H. Lam
  • Maurice A. A. J. van den Bosch
Clinical Investigation

Abstract

Purpose

The caudate lobe (CL) is impartial to the functional left and right hemi-liver and has outspoken inter-individual differences in arterial vascularization. Unfortunately, this complexity is not specifically taken into account during radioembolization treatment (RE), potentially resulting in under- or overtreatment of the CL. The objective of this study was to evaluate the CL coverage in RE and determine the detection rate of the CL arteries on CT angiography during work-up.

Methods

In all consecutive patients who underwent RE treatment between May 2012–January 2015, 99mTc-MAA SPECT/CT and posttreatment scans (90Y-bremsstrahlung SPECT/CT, 90Y-PET/CT, or 166Ho-SPECT/CT) were reviewed for activity in the CL. Pretreatment CT angiographies were reviewed for the visibility of the CL arteries.

Results

Eighty-two patients were treated. In 32/82 (39 %) the CL was involved. In 6/32 (19 %) patients, no activity was seen on the posttreatment scan in the CL, whereas in 40/50 (80 %) patients without CL tumor involvement, the CL was treated. 99mTc-MAA SPECT/CT and final posttreatment scans were discordant in 16/78 (21 %). 99mTc-MAA SPECT/CT had a positive and negative predictive value of 94 % and 46 %, respectively, for activity in the CL after RE. In untreated CLs, significant hypertrophy was observed with a median volume increase of 33 % (p = 0.02). CL arteries were seldom visible on the pretreatment CT; the identification rate was 12–17 %.

Conclusion

Currently in RE treatments, targeting or sparing of the CL is highly erratic and independent of tumor involvement. Intentional treatment or bypassing of the CL seems worthwhile to either improve tumor coverage or enhance the functional liver remnant.

Keywords

Liver Radioembolization PET/PET-CT 

Supplementary material

270_2016_1321_MOESM1_ESM.docx (83 kb)
Supplementary material 1 (DOCX 82 kb)

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • Manon N. G. J. A. Braat
    • 1
  • Andor F. van den Hoven
    • 1
  • Pieter J. van Doormaal
    • 1
  • Rutger C. Bruijnen
    • 1
  • Marnix G. E. H. Lam
    • 1
  • Maurice A. A. J. van den Bosch
    • 1
  1. 1.Department of Radiology and Nuclear MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands

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