Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: Implications for planning 90Y radioembolization?

• Published in: European journal of radiology 2012-12, Vol.81 (12), p.3979-3984
• Main Authors: Burgmans, M.C, Too, C.W, Kao, Y.H, Goh, A.S.W, Chow, P.K.H, Tan, B.S, Tay, K.H, Lo, R.H.G
• Format: Article
• Language: English
• Subjects: 99mTc-macroaggregated albumin SPECT/CT; Adult; Aged; Angiography, Digital Subtraction - methods; Brachytherapy - methods; Computed tomography hepatic arteriography; Digital subtraction angiography; Embolization, Therapeutic - methods; Female; Hepatic Artery - diagnostic imaging; Hepatic falciform artery; Humans; Liver Neoplasms - therapy; Male; Middle Aged; Multimodal Imaging - methods; Positron-Emission Tomography; Prognosis; Radioembolization; Radiology; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin; Tomography, X-Ray Computed - methods; Yttrium Radioisotopes - therapeutic use
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2012.08.007

Abstract Purpose To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization. Material and methods From August 2008 to November 2010, 79 patients (range 23–83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed. Results A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively ( p < 0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively. Conclusion The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.