Typical and Atypical MR Findings After Y90 Radiation Segmentectomy Using High Dose (> 400 Gy) for Hepatocellular Carcinoma

Monday, March 31, 2025

4:45 PM – 4:50 PM CT

Location: Music City Center, 209 ABC

Abstract Presenter(s)

Amro Saad Aldine, MD

IR/DR Resident
Interventional Radiology, UT Southwestern Medical Center, United States

Author/Co-author(s)

Seung Kwon Kim, MD, FSIR, MBA (he/him/his)

Professor
Department of Radiology, UT Southwestern Medical C, United States
JB

Jamaal Benjamin, MD

Assistant Professor
UT Southwestern, United States
Moaz M. Choudhary, MD

Assistant Professor of Radiology
University of Texas Southwestern Medical Center, United States
Anil K. Pillai, MD, MBA

Professor
University of Texas Health Science Center, United States

Learning Objectives:

To demonstrate typical MR findings after Y90 radiation segmentectomy using high doses ( > 400 Gy) for HCC.

To illustrate atypical MR findings after Y90 radiation segmentectomy using high doses ( > 400 Gy).

To showcase the correlation between cone beam CT, post-Y90 SPECT, and post-Y90 MR findings.

Background: The target-absorbed dose to the perfused treatment volume for hepatocellular carcinoma (HCC) should be at least 400 Gy to the angiosome, with no established upper limit. A median dose of 400 Gy has led to 100% of patients achieving complete pathologic necrosis in tumor explants. Recent studies indicate that higher doses (≥400 Gy) correlate with improved pathologic and clinical outcomes. However, MR findings following doses greater than 400 Gy have not been previously reported. This study presents both typical and atypical MR findings, including non-tumoral necrosis, periportal edema, changes in blood vessels (hepatic and portal veins), and bile duct alterations.

Clinical Findings/Procedure Details:

Typical MR Findings: Size changes/tumor necrosis, rim enhancement/nodular enhancement, and radiation effects (edema and inflammation).

Atypical MR Findings: Non-tumoral necrosis, periportal edema, changes in blood vessels (hepatic and portal veins), and bile duct alterations.

Correlation between cone beam CT, post-Y90 SPECT, and post-Y90 MR findings

Conclusion and/or Teaching Points: Understanding both typical and atypical MR findings—such as non-tumoral necrosis, periportal edema, changes in blood vessels (hepatic and portal veins), and bile duct alterations—is crucial for accurate interpretation and management following Y90 radiation segmentectomy.