Semin intervent Radiol 2015; 32(04): 428-438
DOI: 10.1055/s-0035-1564708
How I Do It
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Planning Arteriography for Yttrium-90 Microsphere Radioembolization

Ron C. Gaba
1  Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

Publication Date:
10 November 2015 (online)

Yttrium-90 radioembolization (90Y RE) is a contemporary transcatheter locoregional therapy for primary and secondary hepatic malignancies that is commonly utilized in modern Interventional Radiology (IR) practice.[1] Unlike other targeted endovascular therapies, such as transarterial chemoembolization (TACE) and transarterial embolization (TAE), the current standard of care protocol for 90Y RE treatment of liver tumors involves a two-stage treatment process consisting of a planning arteriography procedure followed by the therapeutic 90Y RE, typically performed 1 to 2 weeks later. The diagnostic planning procedure has threefold intent: (1) to delineate hepatic and tumor vascular anatomy relevant to 90Y microsphere dosimetry and administration; (2) to identify and possibly embolize extrahepatic vessels at risk for nontarget microsphere deposition; and (3) to quantify the degree of hepatopulmonary shunting using technetium-99m macroaggregated albumin (99mTc-MAA) scanning.[2] Given the multifactorial basis for performance of mapping arteriography, and despite some literature guidelines outlining procedure methodology,[3] [4] this procedure is often technically challenging, labor intensive, and time consuming. This article aims to present a simple overview of a single operator's technical approach to planning arteriography performed prior to 90Y RE—including tips, tricks, and pitfalls—based on experience gained in having performed hundreds of hepatic arteriography procedures. Technical details of 90Y RE dosimetry and microsphere administration are beyond the scope of the current topic, and will not be discussed.