Planning Angiography for 90 Y-Radioembolization Demonstrates a Variety of Unusual Extrahepatic Perfusion Patterns

Area of Science:

• Nuclear Medicine
• Interventional Radiology
• Oncology

Background:

• 90Y radioembolization is a treatment for hepatic malignancies.
• Premapping with 99mTc-MAA visualizes hepatic arterial anatomy and potential shunting.
• MAA serves as a surrogate for 90Y distribution.

Purpose of the Study:

• To present cases with unusual MAA perfusion patterns in hepatic cancers.
• To highlight the importance of MAA scintigraphy in pre-treatment planning for 90Y radioembolization.
• To demonstrate the utility of MAA in identifying potential risks and optimizing treatment delivery.

Main Methods:

• Hepatic angiography with intra-arterial injection of 99mTc-MAA.
• Scintigraphic imaging to evaluate MAA distribution and hepatopulmonary shunting.
• Case presentation of patients with hepatic malignancies undergoing 90Y radioembolization.

Main Results:

• MAA scintigraphy revealed diverse and unusual perfusion patterns in hepatic tumors.
• These patterns informed the assessment of hepatic arterial anatomy and extrahepatic risks.
• Quantification of hepatopulmonary shunting was performed.

Conclusions:

• MAA premapping is crucial for evaluating hepatic arterial anatomy and identifying potential risks before 90Y radioembolization.
• Unusual MAA perfusion patterns necessitate careful consideration for treatment planning.
• This technique aids in optimizing the delivery of 90Y microspheres for hepatic malignancies.