Planning Arteriography for Yttrium-90 Microsphere Radioembolization

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.

• References

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