90Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target Therapy Delivery
90Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target Therapy Delivery
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DOI：
10.1148/rg.2015140314
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发表时间：
2015-09-01
期刊：
影响因子：
5.5
通讯作者：
Schuster, David M.
中科院分区：
文献类型：
--
作者：
Camacho, Juan C.;Moncayo, Valeria;Schuster, David M.
原发性和转移性肝癌是相当高的发病率和死亡率的原因，许多患者在就诊时无法治愈。因此，钇90（Y-90）标记微球的放射性栓塞等新疗法是治疗不可切除的原发性或继发性肝肿瘤患者的替代方法。患者选择、治疗技术和早期识别潜在并发症是患者成功结局的关键。给予的Y-90微球的活性取决于多个变量，包括肿瘤负荷、待治疗的肝叶体积、Y-90微球的类型和肝动脉分流分数。术前计划依赖于横断面成像的结果，以确定疾病的程度，肿瘤和非肿瘤肝脏体积，门静脉通畅性和肝外疾病的程度。结合横断面成像、核医学和血流动力学专业知识的多学科方法对于充分靶向恶性组织至关重要。术前多模态成像，特别是组合的单光子发射计算机断层扫描（SPECT）和计算机断层扫描（CT）成像（SPECT/CT），可用于识别非目标成像模式，如果识别出这些模式，则可以通过分支血管栓塞或导管重新定位进行校正。术后多模态成像也有助于确认Y-90微球的适当递送，从而能够早期识别潜在的并发症和微球分布的充分性，从而优化后续治疗的计划。(C)RSNA，2015年
Primary and metastatic liver cancers are responsible for considerable morbidity and mortality, and many patients are not curable at presentation. Therefore, new therapies such as radioembolization with yttrium 90 (Y-90)-labeled microspheres are an alternative method to treat patients with unresectable primary or secondary liver tumors. Patient selection, treatment technique, and early recognition of potential complications are the keys for successful patient outcomes. The activity of administered Y-90 microspheres depends on multiple variables, including the tumor burden, the volume of the liver lobe to be treated, the type of Y-90 microspheres, and the hepatopulmonary shunt fraction. Preprocedural planning relies on the results of cross-sectional imaging to determine the extent of disease, tumoral and nontumoral liver volumes, patency of the portal vein, and the degree of extrahepatic disease. A multidisciplinary approach that combines expertise in cross-sectional imaging, nuclear medicine, and flow dynamics is critical to adequately target malignant tissue. Preprocedural multimodality imaging, particularly combined single photon emission computed tomography (SPECT) and computed tomography (CT) imaging (SPECT/CT), may be used to identify nontarget imaging patterns that, if recognized, can potentially be corrected with either branch vessel embolization or catheter repositioning. Postprocedural multimodality imaging is also useful to confirm the appropriate delivery of Y-90 microspheres, enabling early identification of potential complications and the adequacy of microsphere distribution, thereby optimizing planning for subsequent therapies. (C) RSNA, 2015