In the pretreatment workup of patients considered for 90 Y radioembolization, what imaging procedures besides cross-sectional imaging must occur?
Prior to 90 Y radioembolization, diagnostic visceral arteriography with injection of the celiac, superior mesenteric, left gastric, gastroduodenal, proper hepatic, and right and left hepatic arteries should be performed. Embolization of the gastroduodenal artery as well as any right gastric or other gastric arteries should be considered to redistribute the flow of blood and prevent potential ulcerations from nontarget embolization. After embolization of these extrahepatic pathways, technetium-99 macroaggregated albumin is injected into the hepatic artery. Nuclear medicine scanning is performed to determine pulmonary shunt fraction and nontarget embolization. If the percentage of pulmonary shunting is high, there is a risk of radiation pneumonitis.