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Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma

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Abstract

Transarterial radioembolization is a novel therapy that has gained rapid clinical acceptance for the treatment of hepatocellular carcinoma (HCC). Segmental radioembolization [also termed radiation segmentectomy (RS)] is a technique that can deliver high doses (> 190 Gy) of radiation selectively to the hepatic segment(s) containing the tumor. The aim of this comprehensive review is to provide an illustrative summary of the most relevant imaging findings encountered after radiation segmentectomy. A 62-patient cohort of Child–Pugh A patients with solitary HCC < 5 cm in size was identified. A comprehensive retrospective imaging review was done by interventional radiology staff at our institution. Important imaging findings were reported and illustrated in a descriptive account. For the purposes of completeness, specific patients outside our initial cohort with unique educational imaging features that also underwent segmentectomy were included in this pictorial essay. This review shows that response assessment after RS requires a learning curve with common drawbacks that can lead to false-positive interpretations and secondary unnecessary treatments. It is important to recognize that treatment responses and pathological changes both are time dependent. Findings such as benign geographical enhancement and initial benign pathological enhancement can easily be misinterpreted. Capsular retraction and segmental atrophy are some other examples of unique post-RS response that are not seen in any other treatment.

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Author information

Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Ronald A. Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Joseph Ralph Kallini, Samdeep Mouli, Bartley Thornburg, Kush Desai, Ahsun Riaz, Robert J. Lewandowski & Riad Salem

  2. Department of Radiology, Section of Body Imaging, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

    Frank H. Miller & Vahid Yaghmai

  3. Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA

    Robert J. Lewandowski & Riad Salem

  4. Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Robert J. Lewandowski & Riad Salem

Authors
  1. Ronald A. Mora
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  2. Rehan Ali
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  3. Ahmed Gabr
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  4. Nadine Abouchaleh
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  5. Ali Al Asadi
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  6. Joseph Ralph Kallini
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  7. Frank H. Miller
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  8. Vahid Yaghmai
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  9. Samdeep Mouli
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  10. Bartley Thornburg
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  11. Kush Desai
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  12. Ahsun Riaz
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  13. Robert J. Lewandowski
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  14. Riad Salem
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Contributions

Study concept and design: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Joseph Ralph Kallini, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Acquisition of data: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Analysis and interpretation of data: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Drafting of the manuscript: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Joseph Ralph Kallini, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Critical revision of the manuscript for important intellectual content: All Authors. Statistical analysis: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Administrative, technical, or material support: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ahsun Riaz, Robert J Lewandowski, Riad Salem. Study supervision: Ronald A Mora, Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Joseph Ralph Kallini, Ahsun Riaz, Robert J Lewandowski, Riad Salem.

Corresponding author

Correspondence to Riad Salem.

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Conflict of interest

RJL and RS are advisors to BTG. None of the other co-authors report any conflict of interest.

Ethical Compliance

The study was Health Insurance Portability and Accountability Act compliant. All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent was obtained from all individual participants included in the study.

No funding was obtained for this study.

No studies were performed on animal subjects by any of the authors.

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Mora, R.A., Ali, R., Gabr, A. et al. Pictorial essay: imaging findings following Y90 radiation segmentectomy for hepatocellular carcinoma. Abdom Radiol 43, 1723–1738 (2018). https://doi.org/10.1007/s00261-017-1391-1

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  • DOI: https://doi.org/10.1007/s00261-017-1391-1

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