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Catheter-Directed Computed Tomography Hepatic Angiography for Yttrium-90 Selective Internal Radiotherapy of Hepatocellular Carcinoma Reduces Prophylactic Embolization of Extrahepatic Vessels



To determine the rate of prophylactic embolization of extrahepatic vessels in patients undergoing yttrium-90 selective internal radiotherapy (90Y SIRT) for hepatocellular carcinoma (HCC) with the use of catheter-directed computed tomography hepatic angiography (CD-CTHA).

Materials and Methods

This retrospective study included 186 HCC patients who received 90Y SIRT from May 2010 to June 2015 in a single institution. All procedures were performed in a hybrid angiography-CT suite equipped with digital subtraction angiography (DSA) and CD-CTHA capabilities. CD-CTHA was performed during pre-treatment hepatic angiography. 90Y SIRT was administered approximately 2 weeks later. Selective prophylactic embolization of extrahepatic vessels was performed if extrahepatic enhancement was seen on CD-CTHA or if an extrahepatic vessel opacified on DSA/CD-CTHA despite the final microcatheter position for 90Y microsphere delivery being beyond the origin of this vessel.


Thirty-five patients (18.8%) required selective embolization of extrahepatic vessels. Technical success of 90Y SIRT was 99.5%. Two patients (1.1%) developed radiation-induced gastrointestinal ulceration, and one (0.54%) developed radiation-induced pneumonitis. Extrahepatic uptake of 90Y microspheres was seen in the gallbladder of one patient without significant complications.


The use of CD-CTHA in 90Y SIRT of HCC was associated with a low rate of prophylactic embolization of extrahepatic vessels while maintaining a high technical success rate of treatment and low rate of complications.

Level of Evidence

Level 4, case series.

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WXT Goh would like to thank the AM-ETHOS Duke-NUS Medical Student Fellowship Award and the SingHealth Medical Student Talent Development Award for giving him the opportunity to work with faculty from the SingHealth Duke-NUS Radiological Sciences Academic Clinical Programme. The authors also thank Miss Hlaing Hlaing Win (clinical research coordinator) and Mr Cornelio Gutierrez Padre (principal radiographer) from Department of Vascular and Interventional Radiology SGH for their contributions to this publication.


This study was not supported by any funding.

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Correspondence to Sum Leong.

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We would like to declare the following financial disclosures: CW Too—research and travel grants from Sirtex Medical, RHG Lo—proctor for Sirtex Medical, A Gogna—proctor for Sirtex Medical, grant support from Boston Scientific, FG Irani—proctor for Sirtex Medical, N Venkatanarasimha—travel grants from Sirtex Medical, PKH Chow—research grants and honorarium from Sirtex Medical, DCE Ng—research grants from Sirtex Medical, Merck, and Bayer, BS Tan—research grants from Boston Scientific.

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Goh, W.X.T., Leong, S., Too, C.W. et al. Catheter-Directed Computed Tomography Hepatic Angiography for Yttrium-90 Selective Internal Radiotherapy of Hepatocellular Carcinoma Reduces Prophylactic Embolization of Extrahepatic Vessels. Cardiovasc Intervent Radiol 43, 478–487 (2020).

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  • Hepatocellular carcinoma
  • Selective internal radiotherapy
  • Intra-arterial CT
  • Prophylactive embolization