Hepatobiliary scintigraphy and liver function changes in patients with hepatocellular carcinoma treated with Ho-radioembolization : HBS in HCC treated with holmium-166.

Background: To study the feasibility of hepatobiliary scintigraphy (HBS) to improve selection and planning of patients with hepatocellular carcinoma (HCC) treated with holmium-166 (Ho)-microspheres radioembolization.

Results: Thirty-one patients with HCC were included and treated with Ho- radioembolization as part of a prospective phase 2 study. Twenty-seven patients were eligible for analysis, 67% had a cirrhotic liver morphology on imaging, 70% had multifocal disease and 51% had bilobar disease.

An Evaluation of 90Y Bremsstrahlung SPECT Image Quality in the Presence of 99mTc: A Technical Perspective on Same-Day Radioembolization.

In same-day radioembolization, 99mTc-MAA SPECT/CT, 90Y radioembolization, and post-treatment 90Y SPECT/CT procedures are conducted on the same-day, resulting in a dual-isotope environment of 90Y and 99mTc during post-treatment imaging. This study aimed to quantify the impact of 99mTc on 90Y bremsstrahlung-SPECT/CT image quality and to establish an optimised imaging protocol for both clinical practice, and with advanced reconstruction techniques. Utilising a NEMA IQ phantom, contrast recovery coefficients (CRCs) were measured to evaluate the 90Y image quality degradation caused by 99mTc.

Safety and Feasibility of Interventional Hybrid Fluoroscopy and Nuclear Imaging in the Work-up Procedure of Hepatic Radioembolization.

Purpose To evaluate the safety and feasibility of a novel hybrid nuclear and fluoroscopy C-arm scanner to be used during the work-up procedure of hepatic radioembolization. Materials and Methods In this prospective first-in-human clinical study, 12 participants (median age, 67 years [range: 37-78 years]; nine [75%] male, three [25%] female) with liver tumors undergoing work-up for yttrium 90 radioembolization were included (ClinicalTrials.gov NCT06013774).

Holmium-166 radioembolisation dosimetry in HCC.

Purpose: To evaluate dosimetry, dose-response and dose-toxicity relationships for holmium-166 (Ho) radioembolisation in patients with hepatocellular carcinoma (HCC).

Methods: Thirty-one patients with hepatocellular carcinoma were included in the HEPAR Primary study (NCT03379844, registered on December 20th, 2017) and underwent Ho-microspheres radioembolisation. Linear mixed models assessed the association between tumour absorbed doses and response based on mRECIST both on tumour and patient level.

The Paradox of Modern Technology in Standardizing Thermal Liver Ablation: Fostering Uniformity or Diversity?

Purpose: Currently, significant medical practice variation exists in thermal ablation (TA) of malignant liver tumors with associated differences in outcomes. The IMaging and Advanced Guidance for workflow optimization in Interventional Oncology (IMAGIO) consortium aims to integrate interventional oncology into the standard clinical pathway for cancer treatment in Europe by 2030, by development of a standardized low-complex-high-precision workflow for TA of malignant liver tumors. This study was conducted at the start of the IMAGIO project with the aim to explore the current state and future role of modern technology in TA of malignant liver tumors.

Subtraction of single-photon emission computed tomography (SPECT) in radioembolization: a comparison of four methods.

Background: Subtraction of single-photon emission computed tomography (SPECT) images has a number of clinical applications in e.g. foci localization in ictal/inter-ictal SPECT and defect detection in rest/stress cardiac SPECT.

Ablation of Small Liver Metastases Presenting as Foci of Diffusion Restriction on MRI-Results from the Prospective Minimally Invasive Thermal Ablation (MITA) Study.

Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver metastases (≤10 mm) detected on DWI can be successfully localized and ablated with the Hepatic Arteriography and C-Arm CT-Guided Ablation technique (HepACAGA).

Transarterial Radioembolization (TARE) Global Practice Patterns: An International Survey by the Cardiovascular and Interventional Radiology Society of Europe (CIRSE).

Purpose: An international survey was conducted by the Cardiovascular Interventional Radiological Society of Europe (CIRSE) to evaluate radioembolization practice and capture opinions on real-world clinical and technical aspects of this therapy.

Materials And Methods: A survey with 32 multiple choice questions was sent as an email to CIRSE members between November and December 2022. CIRSE group member and sister societies promoted the survey to their local members.

[A young woman with hydronephrosis and ureteritis cystica].

A 38-year-old woman with urosepsis and persistent unilateral hydronephrosis after antibiotic treatment. Antegrade pyelogram shows urine flow obstruction to the bladder. The whole ureter shows multiple small smooth-walled round lucent filling defects projecting into the lumen.

Hepatic Radioembolization: A Multistep Theragnostic Procedure.

This article provides a thorough overview of the practice and multistep approach of hepatic radioembolization. The current literature on hepatic radioembolization in primary or metastatic liver tumors as well as future perspectives are discussed.

Conventional versus Hepatic Arteriography and C-Arm CT-Guided Ablation of Liver Tumors (HepACAGA): A Comparative Analysis.

Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic-arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation.

Materials And Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included.

Impact of intraoperative imaging on decision-making during spine surgery: a survey among spine surgeons using simulated intraoperative images.

Purpose: To assess whether the intention to intraoperatively reposition pedicle screws differs when spine surgeons evaluate the same screws with 2D imaging or 3D imaging.

Methods: In this online survey study, 21 spine surgeons evaluated eight pedicle screws from patients who had undergone posterior spinal fixation. In a simulated intraoperative setting, surgeons had to decide if they would reposition a marked pedicle screw based on its position in the provided radiologic imaging.

The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts' Opinion Pictorial Essay.

With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures.

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.

Current status of yttrium-90 microspheres radioembolization in primary and metastatic liver cancer.

Liver malignancy, including primary liver cancer and metastatic liver cancer, has become one of the most common causes of cancer-related death worldwide due to the high malignant degree and limited systematic treatment strategy. Radioembolization with yttrium-90 (Y)-loaded microspheres is a relatively novel technology that has made significant progress in the local treatment of liver malignancy. The different steps in the extensive work-up of radioembolization for patients with an indication for treatment with Y microspheres, from patient selection to follow up, both technically and clinically, are discussed in this paper.

Comparison of 3 Different Therapeutic Particles in Radioembolization of Locally Advanced Intrahepatic Cholangiocarcinoma.

Our objective was to compare 3 different therapeutic particles used for radioembolization in locally advanced intrahepatic cholangiocarcinoma. Y-glass, Y-resin, and Ho-labeled poly(l-lactic acid) microsphere prescribed activity was calculated as per manufacturer recommendations. Posttreatment quantitative Y PET/CT and quantitative Ho SPECT/CT were used to determine tumor-absorbed dose, whole-normal-liver-absorbed dose, treated-normal-liver-absorbed dose, tumor-to-nontumor ratio, lung-absorbed dose, and lung shunt fraction.

Prophylactic Medication during Radioembolization in Metastatic Liver Disease: Is It Really Necessary? A Retrospective Cohort Study and Systematic Review of the Literature.

Purpose: Trans-arterial radioembolization is a well-studied tumoricidal treatment for liver malignancies; however, consensus and evidence regarding periprocedural prophylactic medication (PPM) are lacking.

Methods: A single-center retrospective analysis from 2014 to 2020 was performed in patients treated with Y-glass microspheres for neuroendocrine or colorectal liver metastases. Inclusion criteria were the availability of at least 3 months of clinical, biochemical, and imaging follow-up and post-treatment Y-PET/CT imaging for the determination of the whole non-tumorous liver absorbed dose (D).

Hepatic Arteriography and C-Arm CT-Guided Ablation (HepACAGA) to Improve Tumor Visualization, Navigation and Margin Confirmation in Percutaneous Liver Tumor Ablation.

Purpose: We present a technique that combines Hepatic Arteriography with C-arm CT-Guided Ablation (HepACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of liver tumors.

Materials And Methods: All consecutive patients scheduled for HepACAGA between April 20th, 2021, and November 2nd, 2021, were included in this retrospective, cohort study. HepACAGA was performed in an angiography-suite under general anesthesia.

Combining Selective Internal Radiation Therapy with Immunotherapy in Treating Hepatocellular Carcinoma and Hepatic Colorectal Metastases: A Systematic Review.

Immunotherapy in the form of checkpoint inhibitors has changed the treatment paradigm in oncology. Combining selective internal radiation therapy (SIRT) with immunotherapy has been suggested to potentially improve outcomes in hepatocellular carcinoma (HCC) and metastatic colorectal carcinoma (mCRC). In this systematic review, the authors discuss the current developments and available clinical data regarding the combination of immunotherapy and SIRT in treating hepatic malignancies.

Assessing the accuracy of a new 3D2D registration algorithm based on a non-invasive skin marker model for navigated spine surgery.

Purpose: We assessed the accuracy of a new 3D2D registration algorithm to be used for navigated spine surgery and explored anatomical and radiologic parameters affecting the registration accuracy. Compared to existing 3D2D registration algorithms, the algorithm does not need bone-mounted or table-mounted instruments for registration. Neither does the intraoperative imaging device have to be tracked or calibrated.

Safety and Efficacy of Ho Radioembolization in Hepatocellular Carcinoma: The HEPAR Primary Study.

The safety and efficacy of Ho radioembolization was first determined in the HEPAR and HEPAR II studies, which, however, excluded patients with hepatocellular carcinoma (HCC). The aim of this prospective clinical early phase II study was to establish the toxicity profile of Ho radioembolization in patients with measurable, liver-dominant HCC; Barcelona clinic liver cancer stage B or C; a Child-Pugh score of no more than B7; and an Eastern Cooperative Oncology Group performance status of 0-1 without curative treatment options. The primary endpoint was a rate of unacceptable toxicity defined as grade 3 hyperbilirubinemia (Common Terminology Cancer Adverse Events, version 4.