Der Nuklearmediziner 2019; 42(01): 21-26
DOI: 10.1055/a-0807-3605
Theranostik
© Georg Thieme Verlag KG Stuttgart · New York

Radioembolisation

Radioembolization
Philipp M. Paprottka
Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München
› Author Affiliations
Further Information

Publication History

Publication Date:
25 April 2019 (online)

Zusammenfassung

Die Radioembolisation von Lebertumoren kombiniert eine interstitielle Strahlentherapie mit Betastrahlern mit einer arteriellen Mikroembolisation durch Glas- oder Harzpartikel. Als Radionuklid wird seit einigen Jahren 90Y und seit Kurzem auch 166Ho angewandt. Im Gegensatz zu 90Y sendete 166Ho auch Gammastrahlung aus, die für die SPECT-Bildgebung eingesetzt werden kann. Holmium ist außerdem paramagnetisch, sodass die Partikel auch in der MRT sichtbar gemacht werden können. Die Radioembolisation erfordert eine sorgfältige Planung, um Nebenwirkungen durch Partikel zu verhindern. Während in der Vergangenheit v. a. Behandlungen der gesamten Leber oder eines Leberlappens durchgeführt wurden, werden jetzt zunehmend superselektive Therapien von Lebersegmenten durchgeführt, um höhere Strahlendosen unter Schonung des normalen Lebergewebes applizieren zu können.

Abstract

Radioembolization of liver tumors combines interstitial radiation therapy with beta emitters with arterial microembolization through glass or resin particles. Radionuclides for radioembolization include 90Y and more recently, 166Ho. In contrast to 90Y, 166Ho emits gamma radiation, which can be used for SPECT imaging. Holmium is also paramagnetic, so that the particles can be visualized on MRI. Radioembolization requires careful planning to prevent side effects from particles that reach the outside of the liver during injection. While in the past mainly treatments of the entire liver or a lobe of the liver were performed, now superselective therapies of liver segments are increasingly carried out in order to be able to apply higher radiation doses while sparing normal liver tissue.

 
  • Literatur

  • 1 Paprottka PM, Paprottka KJ, Walter A. et al. Safety of Radioembolization with (90)Yttrium Resin Microspheres Depending on Coiling or No-Coiling of Aberrant/High-Risk Vessels. Cardiovasc Intervent Radiol 2015; 38: 946-956
  • 2 Denecke T, Ruhl R, Hildebrandt B. et al. Planning transarterial radioembolization of colorectal liver metastases with Yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques. Eur Radiol 2008; 18: 892-902
  • 3 Hamami ME, Poeppel TD, Muller S. et al. SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer. J Nucl Med 2009; 50: 688-692
  • 4 Ilhan H, Goritschan A, Paprottka P. et al. Predictive Value of 99mTc-MAA SPECT for 90Y-Labeled Resin Microsphere Distribution in Radioembolization of Primary and Secondary Hepatic Tumors. J Nucl Med 2015; 56: 1654-1660
  • 5 Ahmadzadehfar H, Meyer C, Pieper CC. et al. Evaluation of the delivered activity of yttrium-90 resin microspheres using sterile water and 5 % glucose during administration. EJNMMI Res 2015; 5: 54
  • 6 Paprottka KJ, Lehner S, Fendler WP. et al. Reduced Periprocedural Analgesia After Replacement of Water for Injection with Glucose 5% Solution as the Infusion Medium for 90Y-Resin Microspheres. J Nucl Med 2016; 57: 1679-1684
  • 7 Paprottka PM, Jakobs TF, Reiser MF. et al. Practical vascular anatomy in the preparation of radioembolization. Cardiovasc Intervent Radiol 2012; 35: 454-462
  • 8 Sangro B, Gil-Alzugaray B, Rodriguez J. et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer 2008; 112: 1538-1546
  • 9 Kennedy AS, McNeillie P, Dezarn WA. et al. Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys 2009; 74: 1494-1500
  • 10 Seidensticker R, Seidensticker M, Damm R. et al. Hepatic toxicity after radioembolization of the liver using (90)Y-microspheres: sequential lobar versus whole liver approach. Cardiovasc Intervent Radiol 2012; 35: 1109-1118