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Peer-reviewedCC BY-NC-ND 4.0European Journal of Nuclear Medicine and Molecular Imaging

Interventional strategies for inferior phrenic artery management in yttrium‑90 selective internal radiation therapy for hepatocellular carcinoma: A single‑center retrospective study

  • Yong Liao1,2,3,4
  • Xin Huang1,2,3
  • Ziwei Liang3,5
  • Junpeng Ma1,2,3
  • Xiaobin Feng1,3
  • Wenkang Fu1
  • Bin Liang3,6
  • Shizhong Yang1
  • Guangxin Li7
  • Lei Bao8
  • Tiantian Zhang3,5
  • Linxia Zheng1
4 more authors
  • Can Liu1
  • Mulan Tang2
  • Lin Zhang1,2,3,4
  • Jiahong Dong1
8 affiliations
  1. 1Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102200 P. R. China
  2. 2Department of Hepatobiliary Intervention, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102200 P. R. China
  3. 3Yttrium-90 Precision Interventional Radiotherapy Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102200 P. R. China
  4. 4Precise Intervention-Radiotherapy Research Center, School of Clinical Medicine, Tsinghua University, Beijing, 102200 P. R. China
  5. 5Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102200 P. R. China
  6. 6Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102200 P. R. China
  7. 7Department of Radiotherapy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, 102200 P. R. China
  8. 8School of Biomedical Engineering, Tsinghua University, Beijing, 102200 P. R. China
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Abstract

Objective: Extrahepatic collateral supply from the inferior phrenic artery (IPA) is frequently observed in patients with hepatocellular carcinoma (HCC) undergoing yttrium-90 selective internal radiation therapy (90Y-SIRT). Currently, no standardized IPA management algorithm has been established. This study aimed to propose stratified interventional strategies for IPA and compare the safety and oncological outcomes between two mainstream approaches.

Methods: A retrospective analysis was performed on 290 consecutive unresectable HCC patients treated with 90Y-SIRT between October 2022 and December 2025. Patients with suspected IPA tumor perfusion on pre-treatment cross-sectional imaging were enrolled. All patients underwent superselective IPA catheterization under combined digital subtraction angiography (DSA) and cone-beam computed tomography (CBCT). According to tumor volume and anatomical characteristics of non-target vessels, patients were divided into direct Y-90 infusion group and IPA embolization group. Tumor response and treatment-related adverse events were assessed and compared.

Results: A total of 78 patients with angiographically confirmed IPA tumor supply were finally enrolled, including 45 patients in the IPA Y-90 infusion group and 33 in the IPA embolization group. The median administered radioactivity via IPA was 0.3 GBq. Based on modified Response Evaluation Criteria in Solid Tumors (mRECIST), the objective response rates (ORRs) at 1 and 3 months were 60.0% and 82.3% in the infusion group, versus 48.5% and 69.7% in the embolization group. The compensatory distribution rate of Y-90 microspheres in the original IPA-perfused regions reached approximately 88.0% after IPA embolization. Only mild, reversible thoracic adverse events were noted in both groups, with no severe treatment-related complications.

Conclusion: DSA-CBCT combined evaluation is essential for pre-procedural IPA anatomical assessment. Direct Y-90 microsphere infusion via IPA yields superior tumor control when non-target vessels are manageable and IPA-perfused tumor volume ≥ 20 mL. IPA embolization is a reliable alternative for patients with untreatable non-target branches or tumor volume < 20 mL. Both strategies demonstrate favorable safety profiles. The proposed stratified algorithm represents a preliminary approach that warrants further external validation for IPA management during 90Y-SIRT for HCC.

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Cite

BibTeXRIS
BibTeX
@article{liao2026interventional,
  title = {{Interventional strategies for inferior phrenic artery management in yttrium‑90 selective internal radiation therapy for hepatocellular carcinoma: A single‑center retrospective study}},
  author = {Yong Liao and Xin Huang and Ziwei Liang and Junpeng Ma and Xiaobin Feng and Wenkang Fu and Bin Liang and Shizhong Yang and Guangxin Li and Lei Bao and Tiantian Zhang and Linxia Zheng and Can Liu and Mulan Tang and Lin Zhang and Jiahong Dong},
  journal = {European Journal of Nuclear Medicine and Molecular Imaging},
  year = {2026},
  month = sep,
  doi = {10.1007/s00259-026-08170-0},
  url = {https://doi.org/10.1007/s00259-026-08170-0},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Interventional strategies for inferior phrenic artery management in yttrium‑90 selective internal radiation therapy for hepatocellular carcinoma: A single‑center retrospective study
AU  - Yong Liao
AU  - Xin Huang
AU  - Ziwei Liang
AU  - Junpeng Ma
AU  - Xiaobin Feng
AU  - Wenkang Fu
AU  - Bin Liang
AU  - Shizhong Yang
AU  - Guangxin Li
AU  - Lei Bao
AU  - Tiantian Zhang
AU  - Linxia Zheng
AU  - Can Liu
AU  - Mulan Tang
AU  - Lin Zhang
AU  - Jiahong Dong
PY  - 2026
DA  - 2026/09/18
JO  - European Journal of Nuclear Medicine and Molecular Imaging
DO  - 10.1007/s00259-026-08170-0
UR  - https://doi.org/10.1007/s00259-026-08170-0
AB  - Objective: Extrahepatic collateral supply from the inferior phrenic artery (IPA) is frequently observed in patients with hepatocellular carcinoma (HCC) undergoing yttrium-90 selective internal radiation therapy (90Y-SIRT). Currently, no standardized IPA management algorithm has been established. This study aimed to propose stratified interventional strategies for IPA and compare the safety and oncological outcomes between two mainstream approaches.  Methods: A retrospective analysis was performed on 290 consecutive unresectable HCC patients treated with 90Y-SIRT between October 2022 and December 2025. Patients with suspected IPA tumor perfusion on pre-treatment cross-sectional imaging were enrolled. All patients underwent superselective IPA catheterization under combined digital subtraction angiography (DSA) and cone-beam computed tomography (CBCT). According to tumor volume and anatomical characteristics of non-target vessels, patients were divided into direct Y-90 infusion group and IPA embolization group. Tumor response and treatment-related adverse events were assessed and compared.  Results: A total of 78 patients with angiographically confirmed IPA tumor supply were finally enrolled, including 45 patients in the IPA Y-90 infusion group and 33 in the IPA embolization group. The median administered radioactivity via IPA was 0.3 GBq. Based on modified Response Evaluation Criteria in Solid Tumors (mRECIST), the objective response rates (ORRs) at 1 and 3 months were 60.0% and 82.3% in the infusion group, versus 48.5% and 69.7% in the embolization group. The compensatory distribution rate of Y-90 microspheres in the original IPA-perfused regions reached approximately 88.0% after IPA embolization. Only mild, reversible thoracic adverse events were noted in both groups, with no severe treatment-related complications.  Conclusion: DSA-CBCT combined evaluation is essential for pre-procedural IPA anatomical assessment. Direct Y-90 microsphere infusion via IPA yields superior tumor control when non-target vessels are manageable and IPA-perfused tumor volume ≥ 20 mL. IPA embolization is a reliable alternative for patients with untreatable non-target branches or tumor volume < 20 mL. Both strategies demonstrate favorable safety profiles. The proposed stratified algorithm represents a preliminary approach that warrants further external validation for IPA management during 90Y-SIRT for HCC.
SN  - 1619-7070
SN  - 1619-7089
ER  -