(90)Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target
Juan C Camacho1, Valeria Moncayo1, Nima Kokabi1
1From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
Radioembolization using yttrium 90 ((90)Y)-labeled microspheres offers a new therapy for unresectable liver tumors. Careful patient selection and advanced imaging are crucial for successful treatment outcomes.
Area of Science:
- Interventional Radiology
- Nuclear Medicine
- Oncology
Background:
- Primary and metastatic liver cancers cause significant morbidity and mortality.
- Many liver cancer patients are not curable at initial presentation.
- Yttrium 90 ((90)Y)-labeled microsphere radioembolization is an alternative therapy for unresectable liver tumors.
Purpose of the Study:
- To highlight the importance of patient selection, treatment technique, and complication recognition for successful radioembolization.
- To detail the variables influencing (90)Y microsphere activity.
- To emphasize the role of preprocedural and postprocedural imaging in optimizing treatment.
Main Methods:
- Preprocedural cross-sectional imaging to assess disease extent, liver volumes, and vascular status.
- Multidisciplinary approach involving imaging, nuclear medicine, and flow dynamics experts.
- Preprocedural multimodality imaging, including SPECT/CT, to identify and correct potential nontarget delivery.
- Postprocedural imaging to confirm microsphere delivery and assess distribution.
Main Results:
- Successful radioembolization depends on accurate patient selection and precise treatment technique.
- Variables like tumor burden, liver volume, microsphere type, and shunt fraction affect (90)Y activity.
- Preprocedural imaging identifies factors that may require intervention (e.g., embolization, catheter repositioning).
- Postprocedural imaging confirms appropriate delivery and aids in early complication detection.
Conclusions:
- Radioembolization with (90)Y microspheres is a viable treatment for unresectable liver tumors.
- Meticulous preprocedural planning using advanced imaging is critical for effective and safe treatment.
- A multidisciplinary approach and postprocedural assessment optimize patient outcomes and inform subsequent therapies.
