OBJECTIVES To determine the rate of prophylactic embolization of extrahepatic vessels in patients undergoing yttrium-90 selective internal radiotherapy (90Y SIRT) for hepatocellular carcinoma (HCC) with the use of catheter-directed computed tomography hepatic angiography (CD-CTHA). MATERIALS AND METHODS This retrospective study included 186 HCC patients who received 90Y SIRT from May 2010 to June 2015 in a single institution. All procedures were performed in a hybrid angiography-CT suite equipped with digital subtraction angiography (DSA) and CD-CTHA capabilities. CD-CTHA was performed during pre-treatment hepatic angiography. 90Y SIRT was administered approximately 2 weeks later. Selective prophylactic embolization of extrahepatic vessels was performed if extrahepatic enhancement was seen on CD-CTHA or if an extrahepatic vessel opacified on DSA/CD-CTHA despite the final microcatheter position for 90Y microsphere delivery being beyond the origin of this vessel. RESULTS Thirty-five patients (18.8%) required selective embolization of extrahepatic vessels. Technical success of 90Y SIRT was 99.5%. Two patients (1.1%) developed radiation-induced gastrointestinal ulceration, and one (0.54%) developed radiation-induced pneumonitis. Extrahepatic uptake of 90Y microspheres was seen in the gallbladder of one patient without significant complications. CONCLUSION The use of CD-CTHA in 90Y SIRT of HCC was associated with a low rate of prophylactic embolization of extrahepatic vessels while maintaining a high technical success rate of treatment and low rate of complications. LEVEL OF EVIDENCE Level 4, case series.

中文翻译：

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用于肝细胞癌的Yttrium-90选择性内部放射治疗的导管导向计算机断层扫描肝脏血管造影术可减少肝外血管的预防性栓塞。

目的通过导管定向计算机断层扫描肝血管造影术（CD-CTHA），确定接受钇90选择性内部放疗（90Y SIRT）治疗肝细胞癌（HCC）的患者肝外血管的预防栓塞率。材料与方法这项回顾性研究纳入了186例从2010年5月至2015年6月在同一机构接受90Y SIRT的HCC患者。所有程序均在配备数字减影血管造影（DSA）和CD-CTHA功能的混合血管造影CT套件中进行。CD-CTHA在治疗前的肝血管造影过程中进行。约2周后给予90Y SIRT。如果在CD-CTHA上看到肝外增强或在DSA / CD-CTHA上有肝外血管混浊，尽管90Y微球递送的最终微导管位置超出了该血管的起点，则进行肝外血管的选择性预防栓塞。结果35例患者（18.8％）需要选择性栓塞肝外血管。90Y SIRT的技术成功率为99.5％。两名患者（1.1％）发生了辐射诱发的胃肠道溃疡，一名患者（0.54％）发生了辐射诱发的肺炎。在一名患者的胆囊中观察到肝外摄取90Y微球，无明显并发症。结论CD-CTHA在肝癌90Y SIRT中的使用与肝外血管的预防性栓塞率低，同时维持较高的治疗技术成功率和较低的并发症发生率有关。证据级别4级，案例系列。