Bile-Duct-Sparing Yttrium-90 Radiation Segmentectomy for a Caudate Lobe Neuroendocrine Tumor Metastasis Using Arterial Flow Redirection: A Case Report
Abstract
Introduction Radiation segmentectomy delivers ablative yttrium-90 (Y-90) activity to a limited hepatic angiosome for selected neuroendocrine tumor liver metastases. Caudate lobe treatment is technically distinctive because its variable arterial supply may communicate with branches supplying the central biliary tree. Failure to recognize such perfusion can expose the bile duct to nontarget radiation and microsphere deposition. Case Presentation A 46-year-old man with a small-bowel neuroendocrine tumor metastatic to the liver, previously treated with right hepatectomy, developed a new 0.8 × 0.8-cm caudate lesion on surveillance imaging. His Eastern Cooperative Oncology Group (ECOG) performance status was 0, and his Albumin-Bilirubin (ALBI) grade was 1. During Y-90 mapping, angiography and cone-beam computed tomography demonstrated a small tumor-feeding branch arising from the proximal caudate artery; the more distal caudate artery also supplied the common bile duct. Technetium-99m macroaggregated albumin (MAA) SPECT/CT demonstrated activity in the intended treatment territory and adjacent common bile duct. Because the tumor-feeding branch could not be catheterized ultraselectively, the distal caudate artery beyond the tumor-feeder origin was coil embolized to redirect flow away from the biliary supply while preserving access to the tumor-feeding branch. Y-90 glass microspheres were administered, and post-treatment SPECT/CT demonstrated activity confined to the targeted caudate territory without detectable activity in the common bile duct. Voxel-based dosimetry demonstrated a D95 of 670 Gy and V400 of 100%. MRI at 1 and 10 months and DOTATATE PET/CT at 14 months demonstrated sustained complete response without biliary stricture or obstruction. Conclusion Mapping angiography, cone-beam CT, MAA SPECT/CT, and selective arterial flow redirection can be integrated when caudate tumor perfusion overlaps with central biliary arterial supply. Recognizing shared perfusion before Y-90 delivery may permit modification of the treatment angiosome and reduce unintended biliary irradiation in appropriately selected anatomy.
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BibTeX
@article{moody2026bileductsparing,
title = {{Bile-Duct-Sparing Yttrium-90 Radiation Segmentectomy for a Caudate Lobe Neuroendocrine Tumor Metastasis Using Arterial Flow Redirection: A Case Report}},
author = {John P. Moody BS and R. Ethan Evans BS and Vansh Varma MBBS and Tweheyo Ronald MBBS and Ranjana Sah MD and Amogh Verma MBBS and Kiyon Naser-Tavakolian MD and Abin Sajan MD and Junaid Raja MD, MSPH, FACP, FAAP and Venkatesh P. Krishnasamy MD, FCIRSE},
journal = {Clinical Medicine Insights: Case Reports},
year = {2026},
month = oct,
doi = {10.1177/11795476261500959},
url = {https://doi.org/10.1177/11795476261500959},
note = {CC BY},
}
RIS
TY - JOUR
TI - Bile-Duct-Sparing Yttrium-90 Radiation Segmentectomy for a Caudate Lobe Neuroendocrine Tumor Metastasis Using Arterial Flow Redirection: A Case Report
AU - John P. Moody BS
AU - R. Ethan Evans BS
AU - Vansh Varma MBBS
AU - Tweheyo Ronald MBBS
AU - Ranjana Sah MD
AU - Amogh Verma MBBS
AU - Kiyon Naser-Tavakolian MD
AU - Abin Sajan MD
AU - Junaid Raja MD, MSPH, FACP, FAAP
AU - Venkatesh P. Krishnasamy MD, FCIRSE
PY - 2026
DA - 2026/10/23
JO - Clinical Medicine Insights: Case Reports
DO - 10.1177/11795476261500959
UR - https://doi.org/10.1177/11795476261500959
AB - Introduction Radiation segmentectomy delivers ablative yttrium-90 (Y-90) activity to a limited hepatic angiosome for selected neuroendocrine tumor liver metastases. Caudate lobe treatment is technically distinctive because its variable arterial supply may communicate with branches supplying the central biliary tree. Failure to recognize such perfusion can expose the bile duct to nontarget radiation and microsphere deposition. Case Presentation A 46-year-old man with a small-bowel neuroendocrine tumor metastatic to the liver, previously treated with right hepatectomy, developed a new 0.8 × 0.8-cm caudate lesion on surveillance imaging. His Eastern Cooperative Oncology Group (ECOG) performance status was 0, and his Albumin-Bilirubin (ALBI) grade was 1. During Y-90 mapping, angiography and cone-beam computed tomography demonstrated a small tumor-feeding branch arising from the proximal caudate artery; the more distal caudate artery also supplied the common bile duct. Technetium-99m macroaggregated albumin (MAA) SPECT/CT demonstrated activity in the intended treatment territory and adjacent common bile duct. Because the tumor-feeding branch could not be catheterized ultraselectively, the distal caudate artery beyond the tumor-feeder origin was coil embolized to redirect flow away from the biliary supply while preserving access to the tumor-feeding branch. Y-90 glass microspheres were administered, and post-treatment SPECT/CT demonstrated activity confined to the targeted caudate territory without detectable activity in the common bile duct. Voxel-based dosimetry demonstrated a D95 of 670 Gy and V400 of 100%. MRI at 1 and 10 months and DOTATATE PET/CT at 14 months demonstrated sustained complete response without biliary stricture or obstruction. Conclusion Mapping angiography, cone-beam CT, MAA SPECT/CT, and selective arterial flow redirection can be integrated when caudate tumor perfusion overlaps with central biliary arterial supply. Recognizing shared perfusion before Y-90 delivery may permit modification of the treatment angiosome and reduce unintended biliary irradiation in appropriately selected anatomy.
SN - 1179-5476
ER -