Incorporating Cone-beam CT into the Treatment Planning for Yttrium-90 Radioembolization

John D. Louie, Nishita Kothary, William T. Kuo, Gloria L. Hwang, Lawrence V. Hofmann, Michael L. Goris, Andrei H. Iagaru, Daniel Y. Sze

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To prepare for yttrium-90 (90Y) microsphere radioembolization therapy, digital subtraction angiography (DSA) and technetium- 99m-labeled macroaggregated albumin (99mTc MAA) scintigraphy are used for treatment planning and detection of potential nontarget embolization. The present study was performed to determine if cone-beam computed tomography (CBCT) affects treatment planning as an adjunct to these conventional imaging modalities. Materials and Methods: From March 2007 to August 2008, 42 consecutive patients (21 men, 21 women; mean age, 59 years; range, 21-75 y) who underwent radioembolization were evaluated by CBCT in addition to DSA and 99mTc MAA scintigraphy during treatment planning, and their records were retrospectively reviewed. The contrast-enhanced territories shown by CBCT with selective intraarterial contrast agent administration were used to predict intrahepatic and possible extrahepatic distribution of microspheres. Results: In 22 of 42 cases (52%), extrahepatic enhancement or incomplete tumor perfusion seen on CBCT affected the treatment plan. In 14 patients (33%), the findings were evident exclusively on CBCT and not detected by DSA. When comparing CBCT versus 99mTc MAA scintigraphy, CBCT showed eight cases of extrahepatic enhancement (19%) that were not evident on 99mTc MAA imaging. CBCT findings directed the additional embolization of vessels or repositioning of the catheter for better contrast agent and microsphere distribution. One case of gastric ulcer from nontarget embolization caused by reader error was observed. Conclusions: CBCT can provide additional information about tumor and tissue perfusion not currently detectable by DSA or 99mTc MAA imaging, which should optimize 90Y microsphere delivery and reduce nontarget embolization.

Original languageEnglish (US)
Pages (from-to)606-613
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume20
Issue number5
DOIs
StatePublished - May 1 2009

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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