title: Technical solutions to ensure safe yttrium-90 radioembolization in patients with initial extrahepatic deposition of (99m)technetium-albumin macroaggregates.
abstract: OBJECTIVE
  To evaluate the incidence of extrahepatic deposition of technetium-99m-labeled albumin macroaggregates ((99m)Tc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton ((90)Y-RE), and to report on technical solutions that can be used to ensure safe delivery of (90)Y-microspheres in patients with initial extrahepatic deposition.
  
  
  METHODS
  A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with (90)Y-RE in our institution in 2009, was performed. The angiograms and single-photon emission computed tomography images of all patients were reviewed by an interventional radiologist and a nuclear medicine physician, respectively, to identify and localize extrahepatic deposition of (99m)Tc-MAA when present. Subsequently, the technical solutions were used to successfully perform (90)Y-RE in these patients were evaluated and described.
  
  
  RESULTS
  Extrahepatic deposition of (99m)Tc-MAA was observed in 8 of 26 patients (31%). In 7 of 8 patients, a second pretreatment angiography was performed to detect the cause of extrahepatic deposition. The technical solutions to enable safe (90)Y microspheres delivery included more distal placement of the microcatheter in the proper/right hepatic artery in 4 of 7 (57%) patients; (super)selective catheterization of multiple segmental branches in 2 of 7 (29%); and additional coiling of a newly detected branch in the remaining patient (14%). This was confirmed by a second MAA procedure. (90)Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (<30 days) were observed.
  
  
  CONCLUSIONS
  Extrahepatic deposition of (99m)Tc-MAA after pretreatment angiography did occur in 8 of 26 (31%) patients. The technical solutions as presented allowed safe (90)Y-RE delivery in 25 of 26 (96%) patients.
authors.affiliation: Center of Interventional Oncology and Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Barentsz
authors.forename: M A D
authors.initials: MA
authors.lastname: Vente
authors.forename: M G E H
authors.initials: MG
authors.lastname: Lam
authors.forename: M L J
authors.initials: ML
authors.lastname: Smits
authors.forename: J F W
authors.initials: JF
authors.lastname: Nijsen
authors.forename: B A
authors.initials: BA
authors.lastname: Seinstra
authors.forename: C E N M
authors.initials: CE
authors.lastname: Rosenbaum
authors.forename: H M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: B A
authors.initials: BA
authors.lastname: Zonnenberg
authors.forename: M A A J
authors.initials: MA
authors.lastname: Van den Bosch
mesh_terms: D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000627:therapeutic use; D013668:Technetium Tc 99m Aggregated Albumin / Q000032:analysis*; D015899:Tomography, Emission-Computed, Single-Photon; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes