The effect of catheter-directed CT angiography on yttrium-90 radioembolization treatment of hepatocellular carcinoma

Thomas K. Rhee, Reed A. Omary, Vanessa Gates, Taofic Mounajjed, Andrew C. Larson, Omar Barakat, Kent T. Sato, Mary Mulcahy, Stuart Gordon, Robert J. Lewandowski, Riad Salem

Research output: Contribution to journalArticle

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Abstract

PURPOSE: Yttrium 90 radioembolization is a transcatheter therapy for unresectable hepatocellular carcinoma (HCC) that delivers internal radiation to tumors. In contrast to the usual method of lobar regional delivery, catheter-directed computed tomographic (CT) angiography was investigated as a potentially useful technique to evaluate the administration of segmental 90Y tumor radiation doses superselectively without significantly altering liver function or Child-Pugh classification. MATERIALS AND METHODS: Fourteen patients underwent 90Y therapy for unresectable HCC. After standard angiographic placement of a 3-F microcatheter in a segmental hepatic artery supplying the tumor, each patient underwent CT angiography with use of segmental hepatic artery injection of iodinated contrast agent to confirm segmental perfusion and delineate segmental liver volume. 90Y was later injected into the same segmental artery. Target dose was calculated according to infused 90Y activity and targeted hepatic volume with standard lobar volume (before CT angiography) versus segmental liver volume (after CT angiography). The Wilcoxon signed-rank test (α = 0.05) was used to compare the estimated 90Y dose before CT angiography with the actual 90Y dose after CT angiography, as well as changes in serum bilirubin level and Child-Pugh classification as a result of treatment. RESULTS: The mean estimated tumor dose before CT angiography (SD) was 100 Gy ± 43 (range, 35-169 Gy). The mean actual tumor dose after CT angiography was 348 Gy ± 204 (range, 105-857 Gy), which was significantly greater (P < .001). The mean bilirubin level before treatment was 1.0 mg/dL ± 0.97 (range, 0.2-4.0 mg/dL), whereas the mean bilirubin level after treatment was 1.3 mg/dL ± 0.85 (range, 0.5-3.8 mg/dL). This difference, although statistically significant (P = .03), was not clinically important. Thirteen of 14 patients had no change in Child-Pugh class. CONCLUSION: CT angiography can be used to delineate the blood supply and volume to a targeted hepatic segment, allowing superselective 90Y radioembolization. This approach significantly increases effective 90Y tumor radiation dose without clinically altering liver function or Child-Pugh class.

Original languageEnglish (US)
Pages (from-to)1085-1091
Number of pages7
JournalJournal of Vascular and Interventional Radiology
Volume16
Issue number8
DOIs
StatePublished - Aug 2005
Externally publishedYes

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Yttrium
Hepatocellular Carcinoma
Angiography
Catheters
Liver
Bilirubin
Neoplasms
Therapeutics
Hepatic Artery
Radiation
Nonparametric Statistics
Blood Volume
Contrast Media
Arteries
Perfusion
Injections

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

The effect of catheter-directed CT angiography on yttrium-90 radioembolization treatment of hepatocellular carcinoma. / Rhee, Thomas K.; Omary, Reed A.; Gates, Vanessa; Mounajjed, Taofic; Larson, Andrew C.; Barakat, Omar; Sato, Kent T.; Mulcahy, Mary; Gordon, Stuart; Lewandowski, Robert J.; Salem, Riad.

In: Journal of Vascular and Interventional Radiology, Vol. 16, No. 8, 08.2005, p. 1085-1091.

Research output: Contribution to journalArticle

Rhee, TK, Omary, RA, Gates, V, Mounajjed, T, Larson, AC, Barakat, O, Sato, KT, Mulcahy, M, Gordon, S, Lewandowski, RJ & Salem, R 2005, 'The effect of catheter-directed CT angiography on yttrium-90 radioembolization treatment of hepatocellular carcinoma', Journal of Vascular and Interventional Radiology, vol. 16, no. 8, pp. 1085-1091. https://doi.org/10.1097/01.RVI.0000177063.92678.21
Rhee, Thomas K. ; Omary, Reed A. ; Gates, Vanessa ; Mounajjed, Taofic ; Larson, Andrew C. ; Barakat, Omar ; Sato, Kent T. ; Mulcahy, Mary ; Gordon, Stuart ; Lewandowski, Robert J. ; Salem, Riad. / The effect of catheter-directed CT angiography on yttrium-90 radioembolization treatment of hepatocellular carcinoma. In: Journal of Vascular and Interventional Radiology. 2005 ; Vol. 16, No. 8. pp. 1085-1091.
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abstract = "PURPOSE: Yttrium 90 radioembolization is a transcatheter therapy for unresectable hepatocellular carcinoma (HCC) that delivers internal radiation to tumors. In contrast to the usual method of lobar regional delivery, catheter-directed computed tomographic (CT) angiography was investigated as a potentially useful technique to evaluate the administration of segmental 90Y tumor radiation doses superselectively without significantly altering liver function or Child-Pugh classification. MATERIALS AND METHODS: Fourteen patients underwent 90Y therapy for unresectable HCC. After standard angiographic placement of a 3-F microcatheter in a segmental hepatic artery supplying the tumor, each patient underwent CT angiography with use of segmental hepatic artery injection of iodinated contrast agent to confirm segmental perfusion and delineate segmental liver volume. 90Y was later injected into the same segmental artery. Target dose was calculated according to infused 90Y activity and targeted hepatic volume with standard lobar volume (before CT angiography) versus segmental liver volume (after CT angiography). The Wilcoxon signed-rank test (α = 0.05) was used to compare the estimated 90Y dose before CT angiography with the actual 90Y dose after CT angiography, as well as changes in serum bilirubin level and Child-Pugh classification as a result of treatment. RESULTS: The mean estimated tumor dose before CT angiography (SD) was 100 Gy ± 43 (range, 35-169 Gy). The mean actual tumor dose after CT angiography was 348 Gy ± 204 (range, 105-857 Gy), which was significantly greater (P < .001). The mean bilirubin level before treatment was 1.0 mg/dL ± 0.97 (range, 0.2-4.0 mg/dL), whereas the mean bilirubin level after treatment was 1.3 mg/dL ± 0.85 (range, 0.5-3.8 mg/dL). This difference, although statistically significant (P = .03), was not clinically important. Thirteen of 14 patients had no change in Child-Pugh class. CONCLUSION: CT angiography can be used to delineate the blood supply and volume to a targeted hepatic segment, allowing superselective 90Y radioembolization. This approach significantly increases effective 90Y tumor radiation dose without clinically altering liver function or Child-Pugh class.",
author = "Rhee, {Thomas K.} and Omary, {Reed A.} and Vanessa Gates and Taofic Mounajjed and Larson, {Andrew C.} and Omar Barakat and Sato, {Kent T.} and Mary Mulcahy and Stuart Gordon and Lewandowski, {Robert J.} and Riad Salem",
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AU - Rhee, Thomas K.

AU - Omary, Reed A.

AU - Gates, Vanessa

AU - Mounajjed, Taofic

AU - Larson, Andrew C.

AU - Barakat, Omar

AU - Sato, Kent T.

AU - Mulcahy, Mary

AU - Gordon, Stuart

AU - Lewandowski, Robert J.

AU - Salem, Riad

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N2 - PURPOSE: Yttrium 90 radioembolization is a transcatheter therapy for unresectable hepatocellular carcinoma (HCC) that delivers internal radiation to tumors. In contrast to the usual method of lobar regional delivery, catheter-directed computed tomographic (CT) angiography was investigated as a potentially useful technique to evaluate the administration of segmental 90Y tumor radiation doses superselectively without significantly altering liver function or Child-Pugh classification. MATERIALS AND METHODS: Fourteen patients underwent 90Y therapy for unresectable HCC. After standard angiographic placement of a 3-F microcatheter in a segmental hepatic artery supplying the tumor, each patient underwent CT angiography with use of segmental hepatic artery injection of iodinated contrast agent to confirm segmental perfusion and delineate segmental liver volume. 90Y was later injected into the same segmental artery. Target dose was calculated according to infused 90Y activity and targeted hepatic volume with standard lobar volume (before CT angiography) versus segmental liver volume (after CT angiography). The Wilcoxon signed-rank test (α = 0.05) was used to compare the estimated 90Y dose before CT angiography with the actual 90Y dose after CT angiography, as well as changes in serum bilirubin level and Child-Pugh classification as a result of treatment. RESULTS: The mean estimated tumor dose before CT angiography (SD) was 100 Gy ± 43 (range, 35-169 Gy). The mean actual tumor dose after CT angiography was 348 Gy ± 204 (range, 105-857 Gy), which was significantly greater (P < .001). The mean bilirubin level before treatment was 1.0 mg/dL ± 0.97 (range, 0.2-4.0 mg/dL), whereas the mean bilirubin level after treatment was 1.3 mg/dL ± 0.85 (range, 0.5-3.8 mg/dL). This difference, although statistically significant (P = .03), was not clinically important. Thirteen of 14 patients had no change in Child-Pugh class. CONCLUSION: CT angiography can be used to delineate the blood supply and volume to a targeted hepatic segment, allowing superselective 90Y radioembolization. This approach significantly increases effective 90Y tumor radiation dose without clinically altering liver function or Child-Pugh class.

AB - PURPOSE: Yttrium 90 radioembolization is a transcatheter therapy for unresectable hepatocellular carcinoma (HCC) that delivers internal radiation to tumors. In contrast to the usual method of lobar regional delivery, catheter-directed computed tomographic (CT) angiography was investigated as a potentially useful technique to evaluate the administration of segmental 90Y tumor radiation doses superselectively without significantly altering liver function or Child-Pugh classification. MATERIALS AND METHODS: Fourteen patients underwent 90Y therapy for unresectable HCC. After standard angiographic placement of a 3-F microcatheter in a segmental hepatic artery supplying the tumor, each patient underwent CT angiography with use of segmental hepatic artery injection of iodinated contrast agent to confirm segmental perfusion and delineate segmental liver volume. 90Y was later injected into the same segmental artery. Target dose was calculated according to infused 90Y activity and targeted hepatic volume with standard lobar volume (before CT angiography) versus segmental liver volume (after CT angiography). The Wilcoxon signed-rank test (α = 0.05) was used to compare the estimated 90Y dose before CT angiography with the actual 90Y dose after CT angiography, as well as changes in serum bilirubin level and Child-Pugh classification as a result of treatment. RESULTS: The mean estimated tumor dose before CT angiography (SD) was 100 Gy ± 43 (range, 35-169 Gy). The mean actual tumor dose after CT angiography was 348 Gy ± 204 (range, 105-857 Gy), which was significantly greater (P < .001). The mean bilirubin level before treatment was 1.0 mg/dL ± 0.97 (range, 0.2-4.0 mg/dL), whereas the mean bilirubin level after treatment was 1.3 mg/dL ± 0.85 (range, 0.5-3.8 mg/dL). This difference, although statistically significant (P = .03), was not clinically important. Thirteen of 14 patients had no change in Child-Pugh class. CONCLUSION: CT angiography can be used to delineate the blood supply and volume to a targeted hepatic segment, allowing superselective 90Y radioembolization. This approach significantly increases effective 90Y tumor radiation dose without clinically altering liver function or Child-Pugh class.

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