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. 2022 Jun 21;45(11):1634–1645. doi: 10.1007/s00270-022-03187-y

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — On the left, the steps of the clinical workflow for ¹⁶⁶Ho liver radioembolization are depicted. On the right, images referring to an exemplary clinical case are reported. A 73 years old female patient diagnosed with hepatocellular carcinoma was referred for ¹⁶⁶Ho radioembolization. Among others, she presented a lesion in segment 6 with a maximum diameter of 71 mm, as it is possible to see from the baseline MRI reported in panel A. During the workup angiography (panel B), coil embolization of the segment 4 artery was performed to obtain intrahepatic redistribution. Consequently, activity initially planned for segment 4 was added to the activity injected in the right hepatic artery, for a total of 122 MBq. In the SPECT/CT acquired after the scout procedure and displayed in panel C, it is possible to see a clear ¹⁶⁶Ho uptake in the segment 6, where the tumor lesion was located. No extrahepatic deposition was reported, confirming a successful scout procedure. After having planned the treatment aiming at 60 Gy average absorbed dose to the whole liver (panel D), 4116 ¹⁶⁶Ho MBq was injected into the right hepatic artery (panel E). 3 days after the treatment, a SPECT/CT was acquired to visually confirm the good targeting of tumor in segment 6 (panel F). Post-treatment dosimetry revealed a good targeting of the tumor, which received a mean dose of 137 Gy, and a safe uptake by the healthy liver, which had a mean absorbed dose of 36 Gy. The MRI acquired 3 months after the treatment (panel G) showed a decrease in lesion size of segment 6 from 71 to 42 mm and complete disappearance of contrast enhancement (complete response according to mRECIST)