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Review
. 2021 Oct;38(4):397-404.
doi: 10.1055/s-0041-1735616. Epub 2021 Oct 7.

Current Approach to Planning Angiography and MAA Administration

Clayton W Commander  1 , David M Mauro  1
Affiliations
Review

Current Approach to Planning Angiography and MAA Administration

Clayton W Commander et al. Semin Intervent Radiol. 2021 Oct.

Abstract

Transarterial radioembolization of primary and secondary hepatic malignancies utilizing yttrium-90 microspheres is a commonly performed treatment by interventional radiologists. Traditionally performed as a two-part procedure, a diagnostic angiography is performed 1 to 3 weeks prior to treatment with the injection of technetium-99m-macroaggregated albumin followed by planar scintigraphy in the nuclear medicine department. Careful attention must be paid to the details during the diagnostic angiography to ensure the delivery of a safe and optimal dose to the diseased liver and to minimize radiation-induced damage to both unaffected liver and adjacent structures. In this article, we will review the steps and considerations that must be made during the angiography planning and discuss current and future areas of research.

Keywords: diagnostic angiography; interventional radiology; liver cancer; radioembolization; yttrium-90.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Arterioportal shunting. Right hepatic artery injection via a microcatheter demonstrating a prominent arterioportal shunt and brisk opacification of the portal system. Arrowhead—hepatic artery; arrow—portal vein.
Fig. 2
Fig. 2
Magnetic resonance imaging (MRI), angiography, cone-beam, SPECT/CT correlation. ( a ) Postcontrast T1 MRI with a LI-RADS 5 lesion in segment 5 demonstrating washout and pseudocapsule. ( b ) Right hepatic artery angiography showing angiographic correlate. Arrow—hypervascular lesion. ( c ) Selective cone-beam CT demonstrating coverage of the entire tumor and enhancing the surrounding background parenchyma that will fall in the treatment zone. ( d ) SPECT/CT confirming coverage of the lesion and treatment zone.
Fig. 3
Fig. 3
Falciform artery embolization. ( a ) Selective middle hepatic angiography with prominent falciform artery coursing medially (arrows). ( b ) Selective left hepatic artery angiography following proximal coil embolization (arrow) of the falciform artery.
Fig. 4
Fig. 4
Right gastric artery embolization. ( a ) Following failure to catheterize the right gastric artery directly, the left gastric artery was catheterized (arrow) with subsequent microcatherization of the right gastric artery (arrowhead). ( b ) Successful coil embolization of the right gastric artery (arrow).
Fig. 5
Fig. 5
Complication following gastroduodenal artery embolization. ( a ) Initial celiac imaging demonstrating conventional anatomy. ( b ) Celiac imaging following coil embolization with coil prolapse into the proper hepatic artery (arrowhead) and thrombosis of the proper and common hepatic artery (arrow).
See this image and copyright information in PMC

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