title: Prophylactic embolization of the cystic artery prior to radioembolization of liver malignancies--an evaluation of necessity.
abstract: OBJECTIVE
  Prior to radioembolization (RE) of hepatic tumors, many centers prophylactically occlude the cystic artery (CA) during evaluation angiography (EVA) to prevent radiation-induced cholecystitis. There is no conclusive evidence for the protective effect of CA embolization and it bears the risk of inducing ischemic cholecystitis. The aim of this study is to evaluate the justification for CA embolization by comparing clinical and morphologic imaging parameters between patients undergoing coil occlusion of the cystic artery (COCA) and those with uncoiled CA (UCCA).
  
  
  METHODS
  Retrospective comparison of 37 patients with UCCA versus 68 patients with COCA in terms of clinical findings (CRP, leukocyte count, body temperature, upper abdominal pain) and morphologic imaging parameters associated with cholecystitis (gallbladder (GB) wall thickness, free fluid in GB bed, bremsstrahlung SPECT) after EVA, after RE, and at 6-week follow-up.
  
  
  RESULTS
  At none of the 3 time points (EVA, RE, 6-week follow-up) was there any significant difference in CRP, leukocyte count, body temperature, or upper abdominal pain between the UCCA and COCA group. There was also no significant difference between the two groups with regard to GB wall thickness, fluid in the GB bed, and bremsstrahlung in SPECT. One patient of the UCCA group and two patients of the COCA developed cholecystitis requiring treatment.
  
  
  CONCLUSIONS
  Comparison of clinical and imaging findings between patients with and without CA embolization prior to RE identified no predictors of radiogenic or ischemic cholecystitis after RE. Our study provides no evidence for a benefit of prophylactic CA embolization before RE.
authors.affiliation: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Leipziger Strasse 44, 39120, Magdeburg, Germany, maciej.powerski@med.ovgu.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Powerski
authors.forename: Anke
authors.initials: A
authors.lastname: Busse
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.forename: Frank
authors.initials: F
authors.lastname: Fischbach
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.forename: Katharina
authors.initials: K
authors.lastname: Strach
authors.forename: Oliver
authors.initials: O
authors.lastname: Dudeck
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
mesh_terms: D001918:Brachytherapy; D002764:Cholecystitis / Q000517:prevention & control*; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000098:blood supply* / Q000000981:diagnostic imaging*; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon