The Efficacy of Coil Embolization to Obtain Intrahepatic Redistribution in Radioembolization: Qualitative and Quantitati
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COMMENTARY
COMMENTARY
The Efficacy of Coil Embolization to Obtain Intrahepatic Redistribution in Radioembolization: Qualitative and Quantitative Analyses Irene Bargellini1 Roberto Cioni1
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Giulia Lorenzoni1 • Rosa Cervelli1 • Giuseppe Boni2
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Received: 26 July 2020 / Accepted: 2 August 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Arterial flow redistribution by coil embolization has become common clinical practice during the diagnostic work-up before transarterial radioembolization (RE). However, there is still limited knowledge on how redistribution occurs, and debate is ongoing regarding indications, outcomes’ evaluation and optimal time interval between embolization and treatment. The paper by Asultan provides some interesting information in the attempt to answer to some of these open questions [1].
How Should Flow Redistribution be Assessed? Compared to previous studies [2–4], Asultan et al. [1] performed qualitative and quantitative evaluation of flow redistribution, measuring the post-treatment activity distributed to the coil-embolized (dependent) segment relative to the other segments, and demonstrated that qualitative evaluation overestimates the success of redistribution (70%) compared to the quantitative measurements (57% success rated using a cut-off ratio of 0.7). Considering the importance of the tumour radiation-absorbed dose after RE [5], this overestimation may impact treatment results. Thus, qualitative assessment should be recommended and implemented.
& Irene Bargellini [email protected] 1
Department of Interventional Radiology, Pisa University Hospital, Via Paradisa 2, 56126 Pisa, Italy
2
Department of Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, 56126 Pisa, Italy
Are Results Affected by Factors Such as Vascular Anatomy, Tumour Type and Location? Flow redistribution is based on the activation of intrasegmental and interlobar liver arterial connections following arterial embolization [2]; these connections are variable, depending upon vascular anatomy and tumour type and location. Asultan et al. [1] reported a lower success rate of redistribution when embolizing parasitized arteries (success rate 0–33%), possibly due to the recruitment of other branches when proximal embolization was performed. Therefore, flow redistribution of parasitized extrahepatic arteries should be performed with caution, it requires distal embolization, as close to the tumour as possible, and it may cause exclusion from RE treatment when redistribution is considered insufficient. Highest success rate of redistribution was reported after embolization of segment IV hepatic artery [1]. As opposite, Ezponda et al. [4] pointed out that in centrally located tumours (segments IV and I), when dealing with vessels in watershed in-between right and left hepatic branches, the success of redistribution is reduced, since it is difficult to predict which collateral vessels are going to re-pe
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