Saudi Journal of Gastroenterology
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Year : 2012  |  Volume : 18  |  Issue : 6  |  Page : 384-387

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


1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
2 Department of Diagnostic Radiology, Singapore General Hospital, Singapore
3 Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore

Correspondence Address:
Terence K. B. Teo
Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore - 169608
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.103431

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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.


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