^99mTc-Macroaggregated Albumin Liver Lung Shunt Study with Uptake Indicative of Patent Falciform Artery

Intra-arterial injection of radioactive isotope 90-yttrium 90Y has been used for elective internal radiation therapy for the treatment of localized hepatocellular carcinoma deemed surgically unresectable. It has also been used to treat intrahepatic cholangiocarcinoma and colorectal cancer that has metastasized to the liver. To prepare for 90Y treatment, preprocedural mapping via hepatic angiography and 99mTc-macroaggregated albumin liver lung shunt study followed by postprocedural 90Y SPECT/CT is essential to ensure a targeted therapy. Therapy is contraindicated if lung shunt fraction is greater than 20% for SIR-Spheres. Anatomic variation in hepatic angiography may be present that can lead to complications if unaccounted for.