REGULAR CONTENT
Final ID
625
Type
Educational Exhibit-Poster Only
Authors
E Priddy1, M Potts1
Institutions
1University of Louisville, Louisville, KY
Purpose
To demonstrate the angiographic correlates for abnormal activity on 99m-Tc-MAA hepatopulmonary shunt studies and to discuss techniques addressing these findings to prevent complications following Y-90 microsphere selective internal radiation treatment.
Materials & Methods
Prior to Y-90 microsphere radioembolization for surgically unresectable malignancy within the liver, patients undergo arteriography and a 99m-Tc-MAA hepatopulmonary shunt study. Arteriography is performed for planning a treatment location and to determine if there are any extrahepatic arteries that should be embolized to prevent extrahepatic administration of Y-90, which can lead to serious complications. While the MAA scan is performed to determine the lung shunt, it can also be utilized to identify unwanted extrahepatic activity. This information can be very beneficial to the interventional radiologist and can be addressed on treatment day to prevent complications.
Results
Our institutional database of patients treated with Y-90 radioembolization was reviewed for patients that had extrahepatic activity on pretreatment MAA imaging. Of the patients with extrahepatic activity, planning and treatment arteriograms were reviewed to identify correlates and subsequent therapy modifications addressing the findings of the MAA study. Angiographic correlates for abnormal extrahepatic activity included patent retroduodenal, falciform, cystic, accessory left gastric, replaced left hepatic, and gastroduodenal arteries. Modifications on the day of therapy included embolization, most commonly with coils, and microcatheter tip placement distal to the artery of concern. Post treatment scintigraphy on all patients demonstrated no extrahepatic activity, and follow up showed no complications.
Conclusions
Tc-99m MAA scans can be very helpful in preventing complications of Y-90 therapy by identifying abnormal extrahepatic activity. Being able to identify the angiographic correlates for these findings and intervene appropriately is crucial for preventing complications related to radioembolization.
Final ID
625
Type
Educational Exhibit-Poster Only
Authors
E Priddy1, M Potts1
Institutions
1University of Louisville, Louisville, KY
Purpose
To demonstrate the angiographic correlates for abnormal activity on 99m-Tc-MAA hepatopulmonary shunt studies and to discuss techniques addressing these findings to prevent complications following Y-90 microsphere selective internal radiation treatment.
Materials & Methods
Prior to Y-90 microsphere radioembolization for surgically unresectable malignancy within the liver, patients undergo arteriography and a 99m-Tc-MAA hepatopulmonary shunt study. Arteriography is performed for planning a treatment location and to determine if there are any extrahepatic arteries that should be embolized to prevent extrahepatic administration of Y-90, which can lead to serious complications. While the MAA scan is performed to determine the lung shunt, it can also be utilized to identify unwanted extrahepatic activity. This information can be very beneficial to the interventional radiologist and can be addressed on treatment day to prevent complications.
Results
Our institutional database of patients treated with Y-90 radioembolization was reviewed for patients that had extrahepatic activity on pretreatment MAA imaging. Of the patients with extrahepatic activity, planning and treatment arteriograms were reviewed to identify correlates and subsequent therapy modifications addressing the findings of the MAA study. Angiographic correlates for abnormal extrahepatic activity included patent retroduodenal, falciform, cystic, accessory left gastric, replaced left hepatic, and gastroduodenal arteries. Modifications on the day of therapy included embolization, most commonly with coils, and microcatheter tip placement distal to the artery of concern. Post treatment scintigraphy on all patients demonstrated no extrahepatic activity, and follow up showed no complications.
Conclusions
Tc-99m MAA scans can be very helpful in preventing complications of Y-90 therapy by identifying abnormal extrahepatic activity. Being able to identify the angiographic correlates for these findings and intervene appropriately is crucial for preventing complications related to radioembolization.