Intra-arterial CT angiography visualization of arterial supply to inferior vena cava tumor thrombus prior to radioembolization of hepatocellular carcinoma

• Main Authors: Glen Roche, Terence K. B. Teo, Andrew E. H. Tan, Farah G Irani
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2012-01-01
• Series: The Saudi Journal of Gastroenterology
• Subjects: Intra-arterial computed tomographic angiography; radioembolization; tumor thrombus
• Online Access: http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2012;volume=18;issue=6;spage=384;epage=387;aulast=Roche
• ISSN: 1319-3767; 1998-4049

Unresectable hepatocellular carcinoma has a high frequency of vascular invasion and arterial parasitization. Trans-arterial radioembolization using yttrium-90 (Y90) microspheres is a possible treatment option. Paramount to its success is the meticulous angiographic interrogation of tumor feeding arteries and extra-hepatic supply. We describe a patient with tumor invasion of the inferior vena cava with arterial supply from the right inferior phrenic artery, which was exquisitely visualized using intra-arterial computed tomographic angiography (IACTA) during the planning technetium-99m macro aggregated albumin phase. This technique was useful in planning which artery to administer Y90 microspheres into for maximal brachytherapy. Although patient outcome was poor due to significant arterio-portal shunting, we believe that IACTA is a useful adjunct to conventional digital subtraction angiography in planning radioembolization therapy.