title: Hepatic falciform ligament Tc-99m-macroaggregated albumin activity on SPECT/CT prior to Yttrium-90 microsphere radioembolization: prophylactic measures to prevent non-target microsphere localization via patent hepatic falciform arteries.
abstract: Yttrium-90 (Y-90) selective internal radiation therapy (SIRT) is increasingly used to treat inoperable hepatocellular carcinoma. We describe two patients where hepatic falciform ligament Technetium-99m-macroaggregated albumin (Tc-99m-MAA) activity was identified on single photon emission computed tomography with integrated low-dose CT (SPECT/CT) scan during pre-therapy planning, and the steps taken to prevent radiation dermatitis. The first patient underwent prophylactic coil embolization of the patent hepatic falciform artery; the second patient underwent super-selective infusion of Y-90 resin microspheres to avoid the patent hepatic falciform artery. The incidence of falciform ligament Tc-99m-MAA activity detected on SPECT/CT at our institution is 10%. Tc-99m-MAA SPECT/CT scan provides valuable diagnostic information for treatment planning prior to Y-90 SIRT.
authors.affiliation: Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. kao.yung.hsiang@singhealth.com.sg
authors.forename: Yung Hsiang
authors.initials: YH
authors.lastname: Kao
authors.forename: Andrew E H
authors.initials: AE
authors.lastname: Tan
authors.forename: Li Ser
authors.initials: LS
authors.lastname: Khoo
authors.forename: Richard H G
authors.initials: RH
authors.lastname: Lo
authors.forename: Pierce K H
authors.initials: PK
authors.lastname: Chow
authors.forename: Anthony S W
authors.initials: AS
authors.lastname: Goh
mesh_terms: D001158:Arteries / Q000378:metabolism / Q000528:radiation effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging*; D008099:Liver / Q000002:abnormalities* / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011829:Radiation Dosage; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D015021:Yttrium Radioisotopes / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes