Transarterial radioembolization (TARE) has emerged as a key treatment option for hepatocellular carcinoma (HCC) in certain medical centers. This innovative intra-arterial therapy utilizes glass or resin microspheres containing yttrium-90 (Y90), a radioactive isotope, to target liver tumors. The microspheres are delivered through the hepatic artery and occlude at the arteriolar level, acting as localized radiation sources through beta decay. TARE is a unique treatment option to preserve blood flow to the targeted liver segments while promoting radiation-induced tumor damage.

The successful treatment of HCC using TARE is established in two steps. The planning angiography with technetium-99m macroaggregated albumin (MAA) is performed to exclude patients with significant lung shunting or perfusion of the gastrointestinal tract. To exclude nontarget perfusion, a cone-beam CT with intra-arterial contrast is performed in order to avoid non-target perfusion, verify proper tumor targeting, and measure the perfused treatment volume. Moreover, cone beam CT can serve as a baseline to assess treatment radiation changes when conducting subsequent cross-sectional imaging to track tumor size and level of enhancement following TARE. Furthermore, Bremsstrahlung SPECT/CT can be utilized after TARE to correlate sites of dose administration and identify deposition of nontarget dose.