Letter to the Editor on "Radiologic serosal invasion sign as a new criterion of T4a gastric cancer on computed tomography: diagnostic performance and prognostic significance in patients with advanced gastric cancer".

We provide commentary on the paper by You et al., which proposed the 'serosal invasion sign' as a new criterion for T4a gastric cancer on CT. We clarify the anatomical relationship between the perigastric vessels and the serosa, correcting for an anatomical oversight in the original figures.

Lung Mean Dose Prediction in Transarterial Radioembolization (TARE): Superiority of [Ho]-Scout Over [Tc]MAA in a Prospective Cohort Study.

Purpose: Radiation pneumonitis is a serious complication of radioembolization. In holmium-166 ([Ho]) radioembolization, the lung mean dose (LMD) can be estimated (eLMD) using a scout dose with either technetium-99 m-macroaggregated albumin ([Tc]MAA) or [Ho]-microspheres. The accuracy of eLMD based on [Tc]MAA (eLMD) was compared to eLMD based on [Ho]-scout dose (eLMD) in two prospective clinical studies.

Evaluation of the Safety and Feasibility of Same-Day Holmium-166 -Radioembolization Simulation and Treatment of Hepatic Metastases.

Purpose: To evaluate the safety and feasibility of same-day treatment, including the simulation procedure for assessment of intrahepatic and extrahepatic distribution of the microspheres, with holmium-166 (Ho)-radioembolization.

Materials And Methods: This was a secondary analysis of patients included in the 4 prospective studies (HEPAR I, HEPAR II, HEPAR PLuS, and SIM) on Ho-radioembolization. The technical success rate of the same-day treatment protocol, defined as the number of patients who completed the same-day treatment, was measured.

Quality of life in patients with liver tumors treated with holmium-166 radioembolization.

Holmium-166 radioembolization is a palliative treatment option for patients with unresectable hepatic malignancies. Its influence on quality of life has not been evaluated yet. Since quality of life is very important in the final stages of disease, the aim of this study was to evaluate the effect of holmium-166 radioembolization on quality of life.

First Evidence for a Dose-Response Relationship in Patients Treated with Ho Radioembolization: A Prospective Study.

Ho-microspheres have recently been approved for clinical use for hepatic radioembolization in the European Union. The aim of this study was to investigate the absorbed dose-response relationship and its association with overall survival for Ho radioembolization in patients with liver metastases. Patients treated in the HEPAR I and II studies who underwent an F-FDG PET/CT scan at baseline, a posttreatment Ho SPECT/CT scan, and another F-FDG PET/CT scan at the 3-mo follow-up were included for analysis.

The superior predictive value of Ho-scout compared with Tc-macroaggregated albumin prior to Ho-microspheres radioembolization in patients with liver metastases.

Purpose: As an alternative to technetium-99m-macroaggregated albumin (Tc-MAA), a scout dose of holmium-166 (Ho) microspheres can be used prior to Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between Ho-scout and Ho-therapeutic dose in comparison with the agreement between Tc-MAA and Ho-therapeutic dose.

Accuracy of SPECT/CT-based lung dose calculation for Holmium-166 hepatic radioembolization before OSEM convergence.

Purpose: In intra-arterial hepatic radioembolization using Holmium-166 ( Ho) microspheres, a predicted lung-absorbed dose of more than 30 Gy is a contraindication for therapy. Therefore, scout imaging by means of quantitative SPECT of the lungs after a low-dose pretreatment session is essential. Earlier we showed the superiority of Monte Carlo-based iterative SPECT reconstructions over conventional reconstructions due to its quantitative nature, required for dosimetry, at the cost of substantial computation times.

Efficacy of Radioembolization with Ho-Microspheres in Salvage Patients with Liver Metastases: A Phase 2 Study.

Radioembolization of liver malignancies with Ho-microspheres has been shown to be safe in a phase 1 dose-escalation study. The purpose of this study was to investigate the efficacy of Ho radioembolization. In this prospective single-arm study, 56 patients were enrolled, all with liver metastases refractory to systemic therapy and ineligible for surgical resection.

Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up: A cohort study.

Objective: Radioembolisation is generally preceded by a scout dose of technetium-99m-macroaggregated albumin to estimate extrahepatic shunting of activity. Holmium-166 microspheres can be used as a scout dose (±250 MBq) and as a therapeutic dose. The general toxicity of a holmium-166 scout dose (Ho-SD) and safety concerns of an accidental extrahepatic deposition of Ho-SD were investigated.

Surefire infusion system versus standard microcatheter use during holmium-166 radioembolization: study protocol for a randomized controlled trial.

Background: An anti-reflux catheter (ARC) may increase the tumor absorbed dose during radioembolization (RE) by elimination of particle reflux and its effects on hemodynamics. Since the catheter is fixed in a centro-luminal position, it may also increase the predictive accuracy of a scout dose administration before treatment. The purpose of the SIM trial is to compare the effects of ARC use during RE with holmium-166 (Ho) microspheres in patients with colorectal liver metastases (CRLM), with the use of a standard end-hole microcatheter.

Liver CT for vascular mapping during radioembolisation workup: comparison of an early and late arterial phase protocol.

Objectives: To compare right gastric (RGA) and segment 4 artery (A4) origin detection rates during radioembolisation workup between early and late arterial phase liver CT protocols.

Methods: 100 consecutive patients who underwent liver CT between May 2012-January 2015 with early or late arterial phase protocol (n = 50 each, 10- vs. 20-s post-threshold delay) were included.

Radioembolization: Is Prophylactic Embolization of Hepaticoenteric Arteries Necessary? A Systematic Review.

Purpose: To study the effectiveness of prophylactic embolization of hepaticoenteric arteries to prevent gastrointestinal complications during radioembolization.

Methods: A PubMed, Embase and Cochrane literature search was performed. We included studies assessing both a group of patients with and without embolization.

Use of C-Arm Cone Beam CT During Hepatic Radioembolization: Protocol Optimization for Extrahepatic Shunting and Parenchymal Enhancement.

Purpose: To optimize a C-arm computed tomography (CT) protocol for radioembolization (RE), specifically for extrahepatic shunting and parenchymal enhancement.

Materials And Methods: A prospective development study was performed per IDEAL recommendations. A literature-based protocol was applied in patients with unresectable and chemorefractory liver malignancies undergoing an angiography before radioembolization.

⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments.

Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization.

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres.

Unlabelled: Before (166)Ho radioembolization, a small batch of the same type of microspheres is administered as a scout dose instead of the conventional (99m)Tc-macroaggregated albumin ((99m)Tc-MAA). The (166)Ho scout dose provides a more accurate and precise lung shunt assessment. However, in contrast to (99m)Tc-MAA, an unintended extrahepatic deposition of this β-emitting scout dose could inflict radiation damage, the extent of which we aimed to quantify in this study.

Radiation-induced cholecystitis after hepatic radioembolization: do we need to take precautionary measures?

Controversy exists over the need to take precautionary measures during hepatic radioembolization to minimize the risk of radiation-induced cholecystitis. Strategies for a variety of clinical scenarios are discussed on the basis of a literature review. Precautionary measures are unnecessary in the majority of patients and should be taken only when single photon-emission computed tomography (CT; SPECT)/CT shows a significant concentration of technetium-99m macroaggregated albumin in the gallbladder wall.

Radiation emission from patients treated with holmium-166 radioembolization.

Purpose: To assess the radiation exposure to individuals coming from patients after treatment with holmium-166 ((166)Ho) microspheres.

Materials And Methods: Holmium-166 radioembolization (RE) with escalating whole-liver doses of 20 Gy, 40 Gy, 60 Gy, and 80 Gy was administered to 15 patients. Exposure rates (μSv/h) from patients were measured at 1.

(⁹⁹m)Tc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with ¹⁶⁶Ho-microspheres.

Purpose: Radiation pneumonitis is a rare but serious complication of radioembolic therapy of liver tumours. Estimation of the mean absorbed dose to the lungs based on pretreatment diagnostic (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) imaging should prevent this, with administered activities adjusted accordingly. The accuracy of (99m)Tc-MAA-based lung absorbed dose estimates was evaluated and compared to absorbed dose estimates based on pretreatment diagnostic (166)Ho-microsphere imaging and to the actual lung absorbed doses after (166)Ho radioembolization.

Endovascular treatment of internal iliac artery stenosis in patients with buttock claudication.

Aim: To assess the technical feasibility and clinical outcome of percutaneous transluminal angioplasty (PTA) with and without stent placement for treatment of buttock claudication caused by internal iliac artery (IIA) stenosis.

Methods: Between September 2001 and July 2011, thirty-four patients with buttock claudication underwent endovascular treatment. After angiographic lesion evaluation PTA with or without stent placement was performed.

Posttreatment PET-CT-confirmed intrahepatic radioembolization performed without coil embolization, by using the antireflux Surefire Infusion System.

Intra-arterial radioembolization with yttrium-90 microspheres is a safe and effective treatment option for patients with unresectable liver tumors. Pretreatment coil embolization of extrahepatic vessels is recommended to avoid extrahepatic deposition of radioactive microspheres. A novel infusion system with an expandable tip, the Surefire Infusion System (SIS), has recently been developed to minimize reflux.