Planning transarterial radioembolization of colorectal liver metastases with Yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques

Abstract

The purpose of the study was to establish a diagnostic approach to the preparation of patients with colorectal liver metastases considered for transarterial radioembolization (RE). Twenty-two patients sequentially underwent computed tomography (CT; thorax/abdomen), magnetic resonance imaging (MRI; liver; hepatocyte-specific contrast), positron emission tomography (PET/PET-CT; F18-fluoro-desoxy-glucose), and angiography with perfusion scintigraphy [planar imaging; tomography with integrated CT (SPECT-CT)]. The algorithm was continued when no contraindication or alternative treatment option was found. The impact of each test on the therapy decision and RE management was recorded. Patient evaluation using CT revealed contraindications for RE in 4/22 patients (18%). Of the remaining 18 patients, 2 were excluded and 3 were assigned to locally ablative treatment based on MRI and PET results (28%). The remaining 13 patients entered the planning algorithm: SPECT-CT revealed gastrointestinal tracer accumulations in 4 (31%) patients [SPECT, 2 (15%)], making a modified application necessary. In five patients (38%), planar scintigraphy revealed relevant hepatopulmonary shunting. Therapy was finally administered to all 13 patients without therapy-related pulmonary or gastrointestinal morbidity. Each part of the diagnostic algorithm showed a relevant impact on patient management. The sequential approach appears to be suitable and keeps the number of unnecessary treatments and therapy risks to a minimum.

The Significance of 99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for 90Y-Microsphere Selective Internal Radiation Treatment

“…Although SPECT or planar scanning is widely used before SIRT (2,5,27,28), the value of preradioembolization SPECT/CT has been investigated only in patients with colorectal cancer and hepatocellular carcinoma (28,29).…”

“…Denecke et al (28) performed SPECT/CT on a small group of patients (n 5 13) with colorectal cancer and found more gastrointestinal 99m Tc-MAA uptake in SPECT/CT (31%) than in SPECT alone (15%). In a recently published prospective study, Hamami et al (29) showed a sensitivity of 100% for SPECT/CT.…”

Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases

“…In patients with colorectal cancer, accurate assessment of the size, location and segmental distribution of liver metastases on a per-lesion basis is critical for treatment planning [1]. Accurate depiction of the size and distribution of liver metastases helps the selection of patients to undergo radical surgery [2,3] or minimally invasive therapy, such as radiofrequency ablation (RFA) [4], chemoembolisation or radio-embolisation [5].The image contrast in diffusion-weighted MRI (DW-MRI) is based on differences in the mobility of water between tissues [6]. In tumour tissues, such as liver metastases, water mobility is often more impeded compared with normal parenchyma.…”

“…Accurate depiction of the size and distribution of liver metastases helps the selection of patients to undergo radical surgery [2,3] or minimally invasive therapy, such as radiofrequency ablation (RFA) [4], chemoembolisation or radio-embolisation [5].…”

Intraarterial Hepatic SPECT/CT Imaging Using 99mTc-Macroaggregated Albumin in Preparation for Radioembolization

“…Radioembolization has evolved for the palliative treatment of patients with primary and secondary malignancies. Meticulous pretreatment planning with angiography and 99m Tc-MAA scintigraphy allows for a low-toxicity profile, increased response rates, and low incidence of posttreatment complications for patients (9). The purpose of this paper was to demonstrate the typical and atypical findings of 99m Tc-MAA distribution obtained as part of pretherapeutic planning for radioembolization with 90 Y-microspheres.…”