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Identifying Aberrant Hepatic Arteries Prior to Intra-arterial Radioembolization

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Abstract

Purpose

Failing to identify aberrant hepatic arteries before radioembolization (RE) may compromise its treatment efficacy due to inadequate biodistribution of radioactive microspheres. The purpose of this study was to evaluate how often aberrant hepatic arteries were identified correctly in clinical practice, with computed tomography (CT), and during angiography in patients with liver tumors who received a workup for RE.

Methods

The presence and vascularization pattern of aberrant (i.e., accessory and replaced) hepatic arteries was assessed on triphasic liver CT in 110 patients. Subsequently, radiological reports on CT and angiographic procedures were reviewed to determine whether aberrant hepatic arteries were identified correctly in clinical practice. The intrahepatic biodistribution of 99mTc-MAA and radioactive microspheres was assessed on SPECT/CT and PET/CT in all patients with unidentified aberrant hepatic arteries.

Results

Thirty-seven of 110 patients (34 %) had aberrant hepatic arteries. In 18 of 37 (49 %) patients, the aberrant hepatic arteries were correctly identified on CT and in 32 of 37 (86 %) during angiography. Aberrant right hepatic arteries were identified more frequently than aberrant left hepatic arteries on CT (54 vs. 44 %) and during angiography (100 vs. 69 %, p = 0.007). In five patients (14 %), an aberrant left hepatic artery remained unidentified, resulting in a lack of 99mTc-MAA and 90Y activity in the segmental territory of the unidentified aberrant hepatic arteries.

Conclusions

Aberrant left hepatic arteries were the most common unidentified aberrant hepatic arteries, resulting in incomplete radiation coverage. We formulated a practical approach to identify aberrant hepatic arteries correctly before RE.

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Conflict of interest

Andor F. van den Hoven, Maarten L.J. Smits, Bart de Keizer, Maarten S. van Leeuwen, Maurice A.A.J. van den Bosch, Marnix G.E.H. Lam have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Andor F. van den Hoven, Maarten L. J. Smits, Bart de Keizer, Maarten S. van Leeuwen, Maurice A. A. J. van den Bosch & Marnix G. E. H. Lam

Authors
  1. Andor F. van den Hoven
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  2. Maarten L. J. Smits
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  3. Bart de Keizer
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  4. Maarten S. van Leeuwen
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  5. Maurice A. A. J. van den Bosch
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  6. Marnix G. E. H. Lam
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Correspondence to Andor F. van den Hoven.

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van den Hoven, A.F., Smits, M.L.J., de Keizer, B. et al. Identifying Aberrant Hepatic Arteries Prior to Intra-arterial Radioembolization. Cardiovasc Intervent Radiol 37, 1482–1493 (2014). https://doi.org/10.1007/s00270-014-0845-x

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  • DOI: https://doi.org/10.1007/s00270-014-0845-x

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