Figure 2.

(A) Multifocal hepatocellular carcinoma with predominantly left lobe disease seen on non-contrast-enhanced CT. The patient was recently treated with sorafenib, a multi-kinase inhibitor with anti-angiogenic properties. RE was performed in two injections via the left and right hepatic arteries. Prophylactic coil embolization of the gastroduodenal artery was not performed at the discretion of the interventional radiologist. (B) Digital subtraction angiogram immediately after completion of right hepatic artery RE with the catheter tip (“C”) in the right hepatic artery demonstrates significant vascular stasis and reflux of contrast into the left hepatic (“LHA”), proper hepatic, gastroduodenal (“GDA”), right gastroepiploic (“RGE”), common hepatic and splenic (“S”) arteries. (C,D) ⁹⁰Y PET/CT depicts in high resolution, non-target activity in a non-random distribution conforming to the anatomy of the lower anterior gastric wall. (E,F) ⁹⁰Y bremsstrahlung SPECT/CT shows concordant but subtle diffuse bremsstrahlung activity along the lower anterior gastric wall. The unexpected vascular stasis was attributed to reduced vascular capacitance due to the anti-angiogenic effects of recent sorafenib therapy.