title: Computed tomography hepatic arteriography has a hepatic falciform artery detection rate that is much higher than that of digital subtraction angiography and 99mTc-MAA SPECT/CT: implications for planning 90Y radioembolization?
abstract: OBJECTIVE
  To compare the hepatic falciform artery (HFA) detection rates of digital subtraction angiography (DSA), computed tomography hepatic arteriography (CTHA) and 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography with integrated CT (SPECT/CT) and to correlate HFA patency with complication rates of yttrium-90 (90Y) radioembolization.
  
  
  METHODS
  From August 2008 to November 2010, 79 patients (range 23-83 years, mean 62.3 years; 67 male) underwent pre-treatment DSA, CTHA and 99mTc-MAA scintigraphy (planar/SPECT/CT) to assess suitability for radioembolization with 90Y resin microspheres. Thirty-seven patients were excluded from the study, because CTHA was performed with a catheter position that did not result in opacification of the liver parenchyma adjacent to the falciform ligament. DSA, CTHA and 99mTc-MAA SPECT/CT images and medical records were retrospectively reviewed.
  
  
  RESULTS
  A patent HFA was detected in 22 of 42 patients (52.3%). The HFA detection rates of DSA, CTHA and 99mTc-MAA SPECT/CT were 11.9%, 52.3% and 13.3%, respectively (p<0.0001). An origin from the segment 4 artery was seen in 51.7% of HFAs. Prophylactic HFA coil-embolization prior to 90Y microspheres infusion was performed in 2 patients. Of the patients who underwent radioembolization with a patent HFA, none developed supra-umbilical radiation dermatitis. One patient experienced epigastric pain attributed to post-embolization syndrome and was managed conservatively.
  
  
  CONCLUSIONS
  The HFA detection rate of CTHA is superior to that of DSA and 99mTc-MAA SPECT/CT. Complications related to non-target radiation of the HFA vascular territory rarely occur, even in patients undergoing radioembolization with a patent HFA.
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore. mburgmans@hotmail.com
authors.forename: M C
authors.initials: MC
authors.lastname: Burgmans
authors.forename: C W
authors.initials: CW
authors.lastname: Too
authors.forename: Y H
authors.initials: YH
authors.lastname: Kao
authors.forename: A S W
authors.initials: AS
authors.lastname: Goh
authors.forename: P K H
authors.initials: PK
authors.lastname: Chow
authors.forename: B S
authors.initials: BS
authors.lastname: Tan
authors.forename: K H
authors.initials: KH
authors.lastname: Tay
authors.forename: R H G
authors.initials: RH
authors.lastname: Lo
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001918:Brachytherapy / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013668:Technetium Tc 99m Aggregated Albumin; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes