Radioembolization of Hepatic Tumors: Flow Redistribution After the Occlusion of Intrahepatic Arteries

Zusammenfassung

Ziel: Radioembolisation mit 90Yttrium ist eine zunehmend verbreitete Therapieform für fortgeschrittene Lebertumore. Um die Anzahl der Yttriuminjektionen zu reduzieren, kann eine endovaskuläre Okklusion von Leberarterienästen durchgeführt werden. Ziel war es, die Perfusionsumverteilung nach Coilembolisation zu bewerteten. Material und Methoden: 27 Patienten mit hepatozellulärem Karzinom (n = 16) oder Lebermetastasen (n = 11) wurden untersucht. Eine digitale Subtraktionsangiografie (DSA) der Leber wurde im Mittel 16 Tage vor der Radioembolisation durchgeführt. Hierbei wurden die Segment-II/III-Arterie (n = 9) bzw. die Segment-IV-Arterie (n = 18) durch Coilembolisation verschlossen. Technetium-99-markierte Albuminpartikel (99mTc-MAA) wurden in die rechte und den offenen Anteil der linken Leberarterie injiziert, um einen möglichen Perfusionsdefekt zu diagnostizieren. Ein SPECT/CT wurde im Mittel 1 Stunde nach der 99mTc-MAA-Injektion angefertigt. Die SPECT/CT-Bilder wurden hinsichtlich nicht perfundierter Leberareale analysiert. Zudem wurde die Leberperfusion mittels DSA am Tag der Radioembolisation bewertet. Ergebnisse: Bei 16 von 27 Patienten (59 %) war eine Perfusion der zuvor coilembolisierten Lebersegmente im SPECT/CT nachweisbar. Bei 8 der 11 Patienten ohne Perfusionsumverteilung im SPECT/CT war eine Reperfusion über intrahepatische Kollaterale zum Zeitpunkt der eigentlichen Radioembolisation sichtbar. Somit konnte insgesamt eine Reperfusion bei 24 von 27 Patienten (89 %) festgestellt werden. Schlussfolgerung: Eine intrahepatische Perfusionsumverteilung nach Coilembolisation von Segmentarterien kann bei einer Mehrzahl von Patienten mit anatomischen Varianten der arteriellen Leberversorgung induziert werden.

Abstract

Purpose: Radioembolization using 90yttrium is an emerging therapy option for unresectable liver malignancies. In order to reduce the number of yttrium injections, endovascular occlusion of a segmental hepatic artery has been proposed. The aim of this study was to assess whether sufficient vascular redistribution of the occluded liver segments through intrahepatic collaterals can be observed. Materials and Methods: 27 patients with hepatocellular carcinoma (n = 16) or hepatic metastases (n = 11) were studied. Hepatic angiography was performed on average 16 days prior to radioembolization. The segment II/III artery (n = 9) or the segment IV artery (n = 18) was occluded using coils. Technectium-99m-labeled macroaggregated albumin (99mTc-MAA) was injected into the right and the remaining part of the left hepatic artery in order to identify any hepatic volume not included in the perfused area. Patients underwent a SPECT/CT on average 1 h after the 99mTc-MAA injection. Two radiologists evaluated the SPECT/CT scans regarding the presence of non-perfused hepatic segments. Furthermore, hepatic perfusion was assessed by digital subtraction angiography (DSA) on the day of radioembolization. Results: In 16 / 27 patients (59 %) a perfusion of the occluded liver segment was visible on the SPECT/CT scan. In 8 / 11 patients without flow redistribution at the time of the SPECT/CT, perfusion of the occluded segment through hepatic collaterals was observed during angiography prior to radioembolization. Hence, flow redistribution was eventually found in 24 / 27 patients (89 %). Conclusion: Flow redistribution after the occlusion of intrahepatic arteries prior to radioembolization can be successfully induced in the majority of patients with anatomical variants of the hepatic arteries.

Key words

radioembolization (RE) - selective internal radiation therapy (SIRT) - hepatic tumors - coil embolization - flow redistribution

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