title: (90)Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target Therapy Delivery.
abstract: Primary and metastatic liver cancers are responsible for considerable morbidity and mortality, and many patients are not curable at presentation. Therefore, new therapies such as radioembolization with yttrium 90 ((90)Y)-labeled microspheres are an alternative method to treat patients with unresectable primary or secondary liver tumors. Patient selection, treatment technique, and early recognition of potential complications are the keys for successful patient outcomes. The activity of administered (90)Y microspheres depends on multiple variables, including the tumor burden, the volume of the liver lobe to be treated, the type of (90)Y microspheres, and the hepatopulmonary shunt fraction. Preprocedural planning relies on the results of cross-sectional imaging to determine the extent of disease, tumoral and nontumoral liver volumes, patency of the portal vein, and the degree of extrahepatic disease. A multidisciplinary approach that combines expertise in cross-sectional imaging, nuclear medicine, and flow dynamics is critical to adequately target malignant tissue. Preprocedural multimodality imaging, particularly combined single photon emission computed tomography (SPECT) and computed tomography (CT) imaging (SPECT/CT), may be used to identify nontarget imaging patterns that, if recognized, can potentially be corrected with either branch vessel embolization or catheter repositioning. Postprocedural multimodality imaging is also useful to confirm the appropriate delivery of (90)Y microspheres, enabling early identification of potential complications and the adequacy of microsphere distribution, thereby optimizing planning for subsequent therapies.
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Juan C
authors.initials: JC
authors.lastname: Camacho
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Valeria
authors.initials: V
authors.lastname: Moncayo
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Nima
authors.initials: N
authors.lastname: Kokabi
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Hamilton E
authors.initials: HE
authors.lastname: Reavey
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: James R
authors.initials: JR
authors.lastname: Galt
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Kei
authors.initials: K
authors.lastname: Yamada
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Darren D
authors.initials: DD
authors.lastname: Kies
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Roger S
authors.initials: RS
authors.lastname: Williams
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.affiliation: From the Division of Interventional Radiology and Image-guided Medicine (J.C.C., N.K., K.Y., D.D.K., R.S.W.) and Division of Nuclear Medicine and Molecular Imaging (V.M., J.R.G., D.M.S.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322; Department of Radiology, Kaiser Permanente, Atlanta, Ga (H.E.R.); and Division of Interventional Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (H.S.K.).
authors.forename: David M
authors.initials: DM
authors.lastname: Schuster
mesh_terms: D000792:Angiography / Q000379:methods*; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D054893:Cone-Beam Computed Tomography; D004621:Embolization, Therapeutic / Q000379:methods*; D005898:Glass; D006801:Humans; D007269:Injections, Intra-Arterial; D033183:Interdisciplinary Communication; D007475:Ion Exchange Resins; D008099:Liver / Q000528:radiation effects; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008863:Microspheres; D064847:Multimodal Imaging / Q000379:methods*; D011300:Preoperative Care; D011836:Radiation Tolerance; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D007475:Ion Exchange Resins; D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; C082426:technetium Tc99m-mercaptoacetyl albumin