Numerical investigation of liver radioembolization via computational particle-hemodynamics: The role of the microcatheter distal direction and microsphere injection point and velocity.

Liver radioembolization is a treatment option for patients with primary and secondary liver cancer. The procedure consists of injecting radiation-emitting microspheres via an intra-arterially placed microcatheter, enabling the deposition of the microspheres in the tumoral bed. The microcatheter location and the particle injection rate are determined during a pretreatment work-up. The purpose of this study was to numerically study the effects of the injection characteristics during the first stage of microsphere travel through the bloodstream in a patient-specific hepatic artery (i.e., the near-tip particle-hemodynamics and the segment-to-segment particle distribution). Specifically, the influence of the distal direction of an end-hole microcatheter and particle injection point and velocity were analyzed. Results showed that the procedure targeted the right lobe when injecting from two of the three injection points under study and the remaining injection point primarily targeted the left lobe. Changes in microcatheter direction and injection velocity resulted in an absolute difference in exiting particle percentage for a given liver segment of up to 20% and 30%, respectively. It can be concluded that even though microcatheter placement is presumably reproduced in the treatment session relative to the pretreatment angiography, the treatment may result in undesired segment-to-segment particle distribution and therefore undesired treatment outcomes due to modifications of any of the parameters studied, i.e., microcatheter direction and particle injection point and velocity.