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CardioVascular and Interventional Radiology

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01-10-2012 | Clinical Investigation

Effectiveness of Repeat Angiographic Assessment in Patients Designated for Radioembolization Using Yttrium-90 Microspheres With Initial Extrahepatic Accumulation of Technitium-99m Macroaggregated Albumin: A Single Center’s Experience

Authors: Oliver Dudeck, Skadi Wilhelmsen, Gerhard Ulrich, David Löwenthal, Maciej Pech, Holger Amthauer, Jens Ricke

Published in: CardioVascular and Interventional Radiology | Issue 5/2012

Abstract

Purpose

To evaluate the efficacy of a workflow consisting of repeat assessment in patients planned for yttrium-90 (⁹⁰Y) radioembolization in case of nontarget visceral technetium-99m (^99mTc)-macroaggregated albumin (MAA) accumulation despite initial prophylactic coil embolization of nonhepatic arteries.

Materials and Methods

In 341 patients with primary and secondary liver cancer, pretreatment hepatic angiograms, as well as single-photon emission computed tomography coregistered with magnetic resonance imaging scans, were obtained. Extrahepatic tracer deposition was identified in 33 patients (9.7%) necessitating repeat assessment. Images were reviewed to correlate the site of MAA accumulation with causative gastrointestinal vessels, and repeat angiograms served as reference standard.

Results

At repeat angiography, the source of extrahepatic flow was identified and eliminated in 31 of 33 patients (93.9%). In 20 patients (60.6%), successful embolization of nontarget vessels was achieved, in 13 patients (39.4%), MAA was administered more distally. Afterward, extrahepatic MAA deposition was eliminated in 30 patients (90.9%).

Conclusion

The algorithm of repeat assessment in case of extrahepatic MAA accumulation has proven highly effective to eliminate extrahepatic shunting, thus decreasing the risk of postradioembolization complications due to inadvertent visceral microsphere deposition.

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Title: Effectiveness of Repeat Angiographic Assessment in Patients Designated for Radioembolization Using Yttrium-90 Microspheres With Initial Extrahepatic Accumulation of Technitium-99m Macroaggregated Albumin: A Single Center’s Experience
Authors: Oliver Dudeck
Skadi Wilhelmsen
Gerhard Ulrich
David Löwenthal
Maciej Pech
Holger Amthauer
Jens Ricke
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 5/2012
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0252-5

At a glance: The STEP trials

Springer Medicine

Effectiveness of Repeat Angiographic Assessment in Patients Designated for Radioembolization Using Yttrium-90 Microspheres With Initial Extrahepatic Accumulation of Technitium-99m Macroaggregated Albumin: A Single Center’s Experience

Abstract

Purpose

Materials and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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