Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
Eur J Nucl Med Mol Imaging. 2011 Aug;38(8):1477-84. doi: 10.1007/s00259-011-1807-z. Epub 2011 Apr 15.
While influx of chemoembolic agents into the hepatic falciform artery (HFA) from the hepatic artery can cause supraumbilical skin rash, epigastric pain and even skin necrosis, the significance of a patent HFA in patients undergoing radioembolization is not completely clear. Furthermore, the presence of tracer in the anterior abdominal wall seen in (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) images, which is generally performed prior to radioembolization, has been described as a sign of a patent HFA. The aim of this retrospective study was to evaluate the incidence and consequences of (99m)Tc-MAA accumulation in the anterior abdominal wall, indicating a patent HFA, in patients undergoing radioembolization of liver tumours.
A total of 224 diagnostic hepatic angiograms combined with (99m)Tc-MAA SPECT/CT were acquired in 192 patients with different types of cancer, of whom 142 were treated with a total of 214 radioembolization procedures. All patients received a whole-body scan, and planar and SPECT/CT scans of the abdomen. Only patients with extrahepatic (99m)Tc-MAA accumulation in the anterior abdominal wall were included in this study. Posttreatment bremsstrahlung SPECT/CT and follow-up results for at least 3 months served as reference standards.
Tracer accumulation in the anterior abdominal wall was present in pretreatment (99m)Tc-MAA SPECT/CT images of 18 patients (9.3%). The HFA was found and embolized by radiologists before treatment in one patient. In the remaining patients radioembolization was performed without any modification in the treatment plan despite the previously mentioned extrahepatic accumulation. Only one patient experienced abdominal muscle pain above the navel, which started 24 h after treatment and lasted for 48 h without any skin changes. The remaining patients did not experience any relevant side effects during the follow-up period.
Side effects after radioembolization in patients with tracer accumulation in the anterior abdominal wall on (99m)Tc-MAA scans indicating a patent HFA are neither common nor severe. Thus, there is no absolute need for prophylactic embolization of the HFA or modification of the treatment plan if the HFA is not detectable on angiography.
虽然经肝动脉流入肝镰状韧带动脉（HFA）的化疗栓塞剂会导致脐上皮疹、上腹痛甚至皮肤坏死，但在接受放射性栓塞治疗的患者中，HFA 通畅的意义尚不完全清楚。此外，在放射性栓塞治疗前通常进行的（99m）Tc-聚合白蛋白（（99m）Tc-MAA）扫描中，在前腹壁可见示踪剂，这被描述为 HFA 通畅的标志。本回顾性研究的目的是评估在接受肝肿瘤放射性栓塞治疗的患者中，（99m）Tc-MAA 在前腹壁积聚表明 HFA 通畅的发生率和后果。
共对 192 例不同类型癌症患者进行了 224 次诊断性肝血管造影术和（99m）Tc-MAA SPECT/CT 检查，其中 142 例患者共进行了 214 次放射性栓塞治疗。所有患者均接受了全身扫描以及腹部平面和 SPECT/CT 扫描。本研究仅纳入了在前腹壁有肝外（99m）Tc-MAA 积聚的患者。治疗后韧致辐射 SPECT/CT 和至少 3 个月的随访结果作为参考标准。
18 例患者（9.3%）在治疗前的（99m）Tc-MAA SPECT/CT 图像中存在前腹壁示踪剂积聚。在 1 例患者中，放射科医生在治疗前发现并栓塞了 HFA。在其余患者中，尽管存在上述肝外积聚，仍未修改治疗计划而进行了放射性栓塞治疗。只有 1 例患者在治疗后 24 小时出现脐上腹部肌肉疼痛，持续 48 小时，无皮肤改变。在随访期间，其余患者均未出现任何相关的不良反应。
在（99m）Tc-MAA 扫描中，在前腹壁示踪剂积聚的患者中进行放射性栓塞治疗后，出现副作用的情况并不常见，也不严重。因此，如果血管造影无法检测到 HFA，则无需预防性栓塞 HFA 或修改治疗计划。
