Assessment of the parenchymal blood volume by C-arm computed tomography for radioembolization dosimetry

Grözinger, Gerd; Kupferschläger, Jürgen; Dittmann, Helmut; Maurer, Michael; Grosse, Ulrich; Fougère, Christian la; Nikolaou, Konstantin; Syha, Roland; Ketelsen, Dominik

doi:10.1016/j.ejrad.2016.06.005

“…Due to the described limitation of 99m Tc-MAA-SPET/CT for predicting intrahepatic 90 Yspheres distribution [6], new approaches for a better prediction of tumor perfusion and thus PBV has been shown to correlate with other parameters of perfusion measurement like volume perfusion CT [14] and to enable the visual and quantitative assessment of tumor-perfusion directly during the angiographic work-up procedure. Furthermore, the acquisition of 3D C-arm CTs improve the detection of aberrant vessels and identification of vascular territory supply compared to regular digital subtraction angiography images and has become part of the routine work-up in various centers [15][16][17]. Additionally, the benefit for the characterization of tumors and subsequent image-guided transarterial therapies has already been shown in several studies [16,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the acquisition of 3D C-arm CTs improve the detection of aberrant vessels and identification of vascular territory supply compared to regular digital subtraction angiography images and has become part of the routine work-up in various centers [15][16][17]. Additionally, the benefit for the characterization of tumors and subsequent image-guided transarterial therapies has already been shown in several studies [16,18,19].…”

Section: Introductionmentioning

confidence: 99%

Correlation of C-arm CT acquired parenchymal blood volume (PBV) with 99mTc-macroaggregated albumin (MAA) SPECT/CT for radioembolization work-up

Weissinger

¹

,

Vogel

²

,

Kupferschläger

³

et al. 2020

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Objective SPECT/CT with 99mTc-macroaggregated albumin (MAA) is generally used for diagnostic work-up prior to transarterial radioembolization (TARE) to exclude shunts and to provide additional information for treatment stratification and dose calculation. C-arm CT is used for determination of lobular vascular supply and assessment of parenchymal blood volume (PBV). Aim of this study was to correlate MAA-uptake and PBV-maps in hepatocellular carcinoma (HCC) and hepatic metastases of the colorectal carcinoma (CRC). Materials and methods 34 patients underwent a PBV C-arm CT immediately followed by 99mTc-MAA injection and a SPECT/CT acquisition after 1 h uptake. MAA-uptake and PBV-maps were visually assessed and semi-quantitatively analyzed (MAA-tumor/liver-parenchyma = MAA-TBR or PBV in ml/100ml). In case of a poor match, tumors were additionally correlated with post-TARE 90Y-Bremsstrahlung-SPECT/CT as a reference. Results 102 HCC or CRC metastases were analyzed. HCC presented with significantly higher MAA-TBR (7.6 vs. 3.9, p<0.05) compared to CRC. Tumors showed strong intra- and inter-individual dissimilarities between TBR and PBV with a weak correlations for capsular HCCs (r = 0.45, p<0.05) and no correlation for CRC. The demarcation of lesions was slightly better for both HCC and CRC in PBV-maps compared to MAA-SPECT/CT (exact match: 52%/50%; same intensity/homogeneity: 38%/39%; insufficient 10%/11%). MAA-SPECT/CT revealed a better visual correlation with post-therapeutic 90Y-Bremsstrahlung-SPECT/CT. Conclusion The acquisition of PBV can improve the detectability of small intrahepatic tumors and correlates with the MAA-Uptake in HCC. The results indicate that 99mTc-MAA-SPECT/CT remains to be the superior method for the prediction of post-therapeutic 90Y-particle distribution, especially in CRC. However, intra-procedural PBV acquisition has the potential to become an additional factor for TARE planning, in addition to improving the determination of segment and tumor blood supply, which has been demonstrated previously.

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“…Due to the described limitation of 99m Tc-MAA-SPET/CT for predicting intrahepatic 90 Yspheres distribution [6], new approaches for a better prediction of tumor perfusion and thus PBV has been shown to correlate with other parameters of perfusion measurement like volume perfusion CT [14] and to enable the visual and quantitative assessment of tumor-perfusion directly during the angiographic work-up procedure. Furthermore, the acquisition of 3D C-arm CTs improve the detection of aberrant vessels and identification of vascular territory supply compared to regular digital subtraction angiography images and has become part of the routine work-up in various centers [15][16][17]. Additionally, the benefit for the characterization of tumors and subsequent image-guided transarterial therapies has already been shown in several studies [16,18,19].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the acquisition of 3D C-arm CTs improve the detection of aberrant vessels and identification of vascular territory supply compared to regular digital subtraction angiography images and has become part of the routine work-up in various centers [15][16][17]. Additionally, the benefit for the characterization of tumors and subsequent image-guided transarterial therapies has already been shown in several studies [16,18,19].…”

Section: Introductionmentioning

confidence: 99%