Figure 1.

Large hepatocellular carcinoma of the right lobe (actual tumor not well depicted). (A) Catheter-directed CT angiogram of the right hepatic artery, proximal to the origin of the middle hepatic artery, delineates the target arterial territory. (B) Digital subtraction angiography (DSA) of the proper hepatic artery demonstrates the hepatic arterial tree. The liver is supplied by the left hepatic artery (“L”; branch of the common hepatic artery), middle hepatic artery (“M”; branch of the right hepatic artery) and right hepatic artery (“R”; continuation of the common hepatic artery). Prophylactic coil embolization of the gastroduodenal, right gastric, and accessory left gastric arteries were performed. (C) DSA of the target arterial tree with the catheter tip in the right hepatic artery, proximal to the origin of the middle hepatic artery, immediately prior to RE. (D) Moderate vascular stasis and contrast reflux into the left and proper hepatic arteries is seen on DSA immediately after RE, with no change in catheter tip position. (E,F) ⁹⁰Y PET/CT depicts in high resolution, non-target activity in a non-random distribution conforming to the anatomy of the untargeted left liver lobe (arrows). (G,H) ⁹⁰Y bremsstrahlung SPECT/CT shows concordant but subtle diffuse non-target activity in the untargeted left liver lobe (arrows).