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DOI: 10.1148/rg.281065721
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RadioGraphics 2008;28:81-99
© RSNA, 2008

EDUCATION EXHIBIT

Multimodality Imaging Following 90Y Radioembolization: A Comprehensive Review and Pictorial Essay1

Bassel Atassi, MD, Affaan K. Bangash, DO, Ammar Bahrani, BS, Giuseppi Pizzi, MD, Robert J. Lewandowski, MD, Robert K. Ryu, MD, Kent T. Sato, MD, Vanessa L. Gates, MS, Mary F. Mulcahy, MD, Laura Kulik, MD, Frank Miller, MD, Vahid Yaghmai, MD, Ravi Murthy, MD, Andrew Larson, PhD, Reed A. Omary, MD, MS, and Riad Salem, MD, MBA

1 From the Department of Radiology, Section of Interventional Radiology (B.A., A.K.B., A.B., R.J.L., R.K.R., K.T.S., V.L.G., F.M., V.Y., A.L., R.A.O., R.S.), and the Department of Medicine (L.K.), Division of Hematology and Oncology (M.F.M.), Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611; Department of Diagnostic and Interventional Radiology, Istituto Regina Elena, National Cancer Institute, Rome, Italy (G.P.); and Division of Diagnostic Imaging, Section of Interventional Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Tex (R.M.). Received July 14, 2006; revision requested August 31; final revision received July 31, 2007; accepted July 31. M.F.M. received a research grant from MDS Nordion; R.M. received a research grant from Sirtex Medical; R.S. received a research grant from and is a consultant with MDS Nordion; all other authors have no financial relationships to disclose. Address correspondence to R.S. (e-mail: r-salem{at}northwestern.edu).

Radioembolization with yttrium 90 (90Y) microspheres represents an emerging transarterial therapy for the treatment of liver malignancies that continues to generate interest in the medical community. The classic indication of treatment response is a reduction in tumor size; however, parenchymal changes (eg, necrosis, lack of enhancement, specific findings at positron emission tomography and functional magnetic resonance imaging) and other benign findings (pleural effusions, perivascular edema, contralateral hypertrophy, ring enhancement, perihepatic fluid, fibrosis) may occur following treatment, requiring proper image interpretation. With classic imaging findings and surrogates (time to progression, duration of response, disease-free interval), response rates range from 20% to 80% in patients treated for hepatocellular carcinoma or metastatic disease to the liver. Complications of 90Y radioembolization include cholecystitis, abscess, and bilomas and should be recognized early in the imaging follow-up of these patients. Radiologists who are involved in the posttreatment assessment of patients undergoing 90Y radioembolization should be familiar with the imaging findings and potential imaging pitfalls associated with this therapy.

© RSNA, 2008






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