title: Selective internal radiation therapy of hepatic tumours: is coiling of the gastroduodenal artery always beneficial?
abstract: OBJECTIVE
  To assess the effect of gastroduodenal artery (GDA) occlusion prior to selective internal radiation therapy (SIRT) with regards to arterial hepato-intestinal collateralization (HIC).
  
  
  METHODS
  Six hundred and six patients were scheduled for SIRT between 2006 and 2012 at University Hospital Essen, Germany. Digital subtraction angiography (DSA) followed by administration of 99m-technetium labelled human serum albumin microspheres ((99m)Tc-HSAM) and single-photon emission computed tomography combined with computed tomography (SPECT/CT) was initially performed. Depending on vascular anatomy and hepatic tumour load, GDA coil embolization was considered. In subsequent (99m)Tc-HSAM rescans or therapeutic DSA, HIC and its consequences for SIRT were analysed.
  
  
  RESULTS
  The GDA was occluded in 86 of 606 patients (14%). Twenty-two of these 86 patients did not undergo SIRT due to the patients' clinical status or SIRT contraindications. In 28 of the remaining 64 patients, newly apparent or reopened HIC were seen either at the site of the proximal GDA (n = 21) or in the periphery of the hepatic arteries (n = 7). In 25 of these 28 patients, the HIC could be occluded or the catheter position could be changed achieving a safe (90)Y application. However, due to the newly visible HIC in three of 28 patients, SIRT was regarded as unsafe and was abandoned.
  
  
  CONCLUSIONS
  Coil embolization of the GDA may induce arterial hepato-intestinal collaterals. Although most of these collaterals do not impede (90)Y administration, SIRT may become unfeasible in specific occasions. Hence, segmental or lobar SIRT instead of a whole-liver approach with coiling of the GDA is recommended.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany. Electronic address: juliane.schelhorn@uk-essen.de.
authors.forename: J
authors.initials: J
authors.lastname: Schelhorn
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Theysohn
authors.affiliation: Department of Gastroenterology und Hepatology, University Hospital Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Ertle
authors.affiliation: Department of Gastroenterology und Hepatology, University Hospital Essen, Germany.
authors.forename: J F
authors.initials: JF
authors.lastname: Schlaak
authors.affiliation: Clinic of Nuclear Medicine, University Hospital Essen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Clinic of Nuclear Medicine, University Hospital Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Bockisch
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Essen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lauenstein
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006499:Hepatic Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011829:Radiation Dosage; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin