ArticleEuropean radiology2026
Transient flow modulation with rapid-resorbable gelatin microspheres during Yttrium-90 radioembolization for liver cancer: a preliminary clinical trial.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo explore the effectiveness of rapid-resorbable gelatin microspheres (RGMs) for protecting non-tumorous liver (NTL) through flow modulation during yttrium-90 (Y-90) radioembolization for liver cancer. MATERIALS AND
methodsThis phase II trial defined the primary outcome as the protection rate of RGM-embolized vs non-embolized NTL on Y-90 PET/CT. RGMs (560-800 µm) were used to transiently diminish blood flow to the NTL, followed by Y-90 microsphere administration. The effectiveness of flow modulation and radioembolization was assessed using Y-90 PET/CT and gadoxetic acid-enhanced MRI (EOB-MRI).
resultsTwenty patients were enrolled between March 2023 and January 2025. The median protection rate was 35.8% (interquartile range [IQR], 20.2-66.7). Seven patients (35%, 7/20) demonstrated a ≥ 2-fold increase in the tumor-to-NTL uptake ratio on Y-90 PET/CT compared with pre-treatment SPECT/CT. The signal intensity (SI) ratio between protected and unprotected NTLs on the hepatobiliary phase of EOB-MRI increased significantly from baseline (median, 1.03; IQR, 0.97-1.05) to 6-month follow-up (median, 1.29; IQR, 1.18-1.54; p < 0.001). The Y-90 microsphere load to the NTL was negatively correlated with the protection rate (ρ = -0.578, p = 0.010), whereas the protection rate was positively correlated with the SI ratio at 6 months (ρ = 0.710, p = 0.001). All patients who underwent subsequent intra-arterial treatments achieved complete arterial recanalization.
conclusionRGM-mediated flow modulation was associated with reduced Y-90 microsphere deposition in the NTL, with imaging findings suggesting regional liver function preservation. This protective effect appeared greater with lower Y-90 microsphere load. KEY POINTS: Question Can flow modulation using RGMS preserve regional liver function? Findings Prior embolization with rapidly resorbable gelatin microspheres reduced the absorbed dose to the NTL by 35.8% and preserved signal intensity on EOB-MRI after radioembolization. Clinical relevance RGMs can transiently divert arterial flow away from the NTL, reducing Yttrium-90 microsphere influx and helping preserve regional liver function during Yttrium-90 radioembolization for liver cancer.
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