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Hepatic Metastases Therapy
Trevor Downing, MD; Paige Bennett, MD; Brian Kouri, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Yttrium-90 radioembolization for hepatic metastases therapy
            • Pure beta emitter (mean: 2.28 MeV); tissue penetration ~ 2.5 mm, t1/2 = 64.2 hrs
            • 2 radiopharmaceuticals: Yttrium-90 resin microparticles (SirSpheres) and glass microparticles (TheraSpheres)
          • Concept

            • Liver malignancies derive ~ 90% of blood supply from hepatic arteries, normal parenchyma 70% from portal vein
            • Targeted delivery of Yttrium-90 microparticles allows destruction of tumor cells while sparing normal liver

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Procedure Steps

                    POST PROCEDURE

                    • Expected Outcome

                      • Post-Therapy Imaging

                        OUTCOMES

                        • Complications

                          Selected References

                          1. Uliel L et al: From the angio suite to the γ-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization--a comprehensive pictorial review. J Nucl Med. 53(11):1736-47, 2012
                          2. Dezarn WA et al: Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys. 38(8):4824-45, 2011
                          3. Ibrahim SM et al: Radiologic findings following Y90 radioembolization for primary liver malignancies. Abdom Imaging. 34(5):566-81, 2009
                          4. Kennedy A et al: Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys. 68(1):13-23, 2007
                          5. Keppke AL et al: Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres. AJR Am J Roentgenol. 188(3):768-75, 2007
                          6. Miller FH et al: Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol. 188(3):776-83, 2007
                          7. Gulec SA et al: Dosimetric techniques in 90Y-microsphere therapy of liver cancer: The MIRD equations for dose calculations. J Nucl Med. 47(7):1209-11, 2006
                          8. Bienert M et al: 90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT. Eur J Nucl Med Mol Imaging. 32(7):778-87, 2005
                          9. Murthy R et al: Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics. 25 Suppl 1:S41-55, 2005
                          10. Covey AM et al: Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 224(2):542-7, 2002
                          11. SIR-Spheres Microspheres package insert
                          12. TheraSphere® Yttrium-90 Glass Microspheres package insert
                          13. 9. Cherry SR, Sorenson JA, Phelps ME. Physics in Nuclear Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders. 458-459, 2012
                          14. Sirspheres dose calculator
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Preprocedure

                              • Procedure

                                • Post Procedure

                                  TERMINOLOGY

                                  • Definitions

                                    • Yttrium-90 radioembolization for hepatic metastases therapy
                                    • Pure beta emitter (mean: 2.28 MeV); tissue penetration ~ 2.5 mm, t1/2 = 64.2 hrs
                                    • 2 radiopharmaceuticals: Yttrium-90 resin microparticles (SirSpheres) and glass microparticles (TheraSpheres)
                                  • Concept

                                    • Liver malignancies derive ~ 90% of blood supply from hepatic arteries, normal parenchyma 70% from portal vein
                                    • Targeted delivery of Yttrium-90 microparticles allows destruction of tumor cells while sparing normal liver

                                  PREPROCEDURE

                                  • Indications

                                    • Contraindications

                                      • Preprocedure Imaging

                                        • Getting Started

                                          PROCEDURE

                                          • Procedure Steps

                                            POST PROCEDURE

                                            • Expected Outcome

                                              • Post-Therapy Imaging

                                                OUTCOMES

                                                • Complications

                                                  Selected References

                                                  1. Uliel L et al: From the angio suite to the γ-camera: vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization--a comprehensive pictorial review. J Nucl Med. 53(11):1736-47, 2012
                                                  2. Dezarn WA et al: Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys. 38(8):4824-45, 2011
                                                  3. Ibrahim SM et al: Radiologic findings following Y90 radioembolization for primary liver malignancies. Abdom Imaging. 34(5):566-81, 2009
                                                  4. Kennedy A et al: Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys. 68(1):13-23, 2007
                                                  5. Keppke AL et al: Imaging of hepatocellular carcinoma after treatment with yttrium-90 microspheres. AJR Am J Roentgenol. 188(3):768-75, 2007
                                                  6. Miller FH et al: Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol. 188(3):776-83, 2007
                                                  7. Gulec SA et al: Dosimetric techniques in 90Y-microsphere therapy of liver cancer: The MIRD equations for dose calculations. J Nucl Med. 47(7):1209-11, 2006
                                                  8. Bienert M et al: 90Y microsphere treatment of unresectable liver metastases: changes in 18F-FDG uptake and tumour size on PET/CT. Eur J Nucl Med Mol Imaging. 32(7):778-87, 2005
                                                  9. Murthy R et al: Yttrium-90 microsphere therapy for hepatic malignancy: devices, indications, technical considerations, and potential complications. Radiographics. 25 Suppl 1:S41-55, 2005
                                                  10. Covey AM et al: Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 224(2):542-7, 2002
                                                  11. SIR-Spheres Microspheres package insert
                                                  12. TheraSphere® Yttrium-90 Glass Microspheres package insert
                                                  13. 9. Cherry SR, Sorenson JA, Phelps ME. Physics in Nuclear Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders. 458-459, 2012
                                                  14. Sirspheres dose calculator