Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
Radiology Practice, Dessau-Roßlau, Germany.
Acta Radiol. 2023 Oct;64(10):2783-2790. doi: 10.1177/02841851231189490. Epub 2023 Jul 31.
Cholecystitis is a rare but dolorous complication after Y90-radioembolization of liver malignancies.
To decide the occlusion of the cystic artery (CA) to prevent cholecystitis after Y90 radioembolization using an algorithm.
In 130 patients, the gallbladder was at risk of embolization as the right liver lobe was targeted. Precautionary measures (e.g. coil occlusion of the cystic artery) were decided by enhancement of the gallbladder in pre-treatment Tc99m-MAA SPECT/CT and performed directly before Y90 radioembolization. In non-enhancing cases, the CA was left open. The outcome was determined by clinical symptoms of acute or chronic cholecystitis as well as imaging and laboratory parameters. Findings were additionally classified according to the Tokyo Guidelines of acute cholecystitis.
Only 16 patients demonstrated enhancement of the gallbladder in Tc99m-MAA SPECT/CT. Including additional indications from angiographic findings, prophylactic measures were scheduled in 22 patients (standard of care). Thus, 121 patients were at risk of non-target embolization to the gallbladder during Y90 microsphere administration (investigative arm). Four cases (3.0%) of cholecystitis occurred by clinical presentation: two patients with onset of acute symptoms within 48 h after Y90 radioembolization ("embolic cholecystitis") and two patients with late onset of symptoms ("radiogenic cholecystitis"). The incidence of cholecystitis was not significantly more frequent without indication of precautionary measures (investigative cohort 2.9% vs. standard of care 4.7%; = 0.53).
The overall incidence of cholecystitis after Y90 radioembolization is low. Determination of cystic artery intervention using Tc99m-MAA SPECT/CT successfully balances the incidence of symptomatic cholecystitis with unnecessary vessel occlusion.
胆囊炎症是肝脏恶性肿瘤 Y90 放射性栓塞后罕见但严重的并发症。
使用算法确定胆囊动脉（CA）闭塞以预防 Y90 放射性栓塞后发生胆囊炎。
在 130 例患者中，由于靶向右肝叶，胆囊存在栓塞风险。在治疗前 Tc99m-MAA SPECT/CT 中增强胆囊，并在 Y90 放射性栓塞前直接进行预防性措施（例如，CA 线圈闭塞）。在非增强的情况下，CA 保持开放。通过急性或慢性胆囊炎的临床症状以及影像学和实验室参数来确定结果。根据东京急性胆囊炎指南对发现进行分类。
只有 16 例患者在 Tc99m-MAA SPECT/CT 中显示胆囊增强。包括血管造影发现的其他指征，22 例患者（标准治疗）计划进行预防性措施。因此，在 Y90 微球给药期间，121 例患者有胆囊非目标栓塞的风险（研究组）。4 例（3.0%）胆囊炎通过临床表现发生：2 例患者在 Y90 放射性栓塞后 48 小时内出现急性症状（“栓塞性胆囊炎”），2 例患者出现迟发性症状（“放射性胆囊炎”）。无预防性措施指征的胆囊炎发生率无显著增加（研究组 2.9%比标准治疗组 4.7%； = 0.53）。
Y90 放射性栓塞后胆囊炎的总发生率较低。使用 Tc99m-MAA SPECT/CT 确定胆囊动脉干预可成功平衡有症状胆囊炎的发生率与不必要的血管闭塞。
