Planning Arteriography for Yttrium-90 Microsphere Radioembolization.

Yttrium-90 radioembolization (Y RE) is a contemporary transcatheter locoregional therapy for primary and secondary hepatic malignancies that is commonly utilized in modern Interventional Radiology (IR) practice.1 Unlike other targeted endovascular therapies, such as transarterial chemoembolization (TACE) and transarterial embolization (TAE), the current standard of care protocol for Y RE treatment of liver tumors involves a two-stage treatment process consisting of a planning arteriography procedure followed by the therapeutic Y RE, typically performed 1 to 2weeks later. The diagnostic planning procedure has threefold intent: (1) to delineate hepatic and tumor vascular anatomy relevant to Y microsphere dosimetry and administration; (2) to identify and possibly embolize extrahepatic vessels at risk for nontarget microsphere deposition; and (3) to quantify the degree of hepatopulmonary shunting using technetium-99mmacroaggregated albumin (Tc-MAA) scanning.2 Given the multifactorial basis for performance of mapping arteriography, and despite some literature guidelines outlining procedure methodology,3,4 this procedure is often technically challenging, labor intensive, and time consuming. This article aims to present a simple overview of a single operator’s technical approach to planning arteriography performed prior to Y RE—including tips, tricks, and pitfalls—based on experience gained in having performed hundreds of hepatic arteriography procedures. Technical details of Y RE dosimetry and microsphere administration are beyond the scope of the current topic, and will not be discussed.