Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

Kao, Yung Hsiang; Steinberg, J.; Tay, Young-Soon; Lim, Gina; Yan, Jianhua; Townsend, David W.; Takano, Angela; Burgmans, Mark C.; Irani, Farah Gillan; Teo, Terence Kb; Yeow, T.; Apoorva, Gogna; Lo, R.; Tay, Kiang-Hiong; Tan, Bien-Soo; Chow, Pierce K. H.; Satchithanantham, Somanesan; Tan, Andrew Hwee Chye; Ng, David; Goh, Anthony

doi:10.1186/2191-219x-3-56

Cited by 93 publications

(108 citation statements)

References 34 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…In their study, Kao et al found complications to occur from 49 Gy and upward (16,17). Of 160 patients, 34 cases with extrahepatic deposition were found.…”

Section: Discussionmentioning

confidence: 99%

“…A safety boundary for the absorbed dose in extrahepatic tissue was reported in the literature by Kao et al (16,17). After radioembolization with yttrium resin microspheres, the authors quantified the absorbed dose to extrahepatic tissue using PET.…”

Section: Absorbed Dosementioning

confidence: 99%

“…The patient developed gastritis (stomach), ulceration (stomach), and duodenitis (duodenum) after a mean absorbed dose of 49, 65, and 53 Gy, respectively. For the current study, a 49-Gy boundary was chosen from which toxicity was expected to occur (16,17).…”

Section: Absorbed Dosementioning

confidence: 99%

See 2 more Smart Citations

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

et al. 2015

View full text Add to dashboard Cite

Before 166 Ho radioembolization, a small batch of the same type of microspheres is administered as a scout dose instead of the conventional 99m Tc-macroaggregated albumin ( 99m Tc-MAA). The 166 Ho scout dose provides a more accurate and precise lung shunt assessment. However, in contrast to 99m Tc-MAA, an unintended extrahepatic deposition of this β-emitting scout dose could inflict radiation damage, the extent of which we aimed to quantify in this study. Methods: All patients eligible for radioembolization in our institute between January 2011 and March 2014 were reviewed. Of the extrahepatic depositions of 99m Tc-MAA on SPECT, the amount and volume were measured. These were used to calculate the theoretic absorbed dose in the case a 166 Ho scout dose had been used. The extrahepatic activity was measured as the sum of all voxels of the deposition. Volumes were measured using a threshold technique including all voxels from the maximum voxel intensity up to a certain percentage. The threshold needed to obtain the true volume was studied in a phantom study. Results: In the phantom study, a threshold of 40% was found to overestimate the volume, with the consequence of underestimating the absorbed dose. Of 160 patients, 32 patients (34 cases) of extrahepatic deposition were identified. The depositions contained a median of 1.3% (range, 0.1%-19.5%) of the administered activity in a median volume of 6.8 mL (range, 1.1-42 mL). The use of a scout dose of 250 MBq of 166 Ho microspheres in these cases would theoretically have resulted in a median absorbed dose of 6.0 Gy (range, 0.9-374 Gy). The dose exceeded a limit of 49 Gy (reported in 2013) in 2 of 34 cases (5.9%; 95% confidence interval, 0.7%-20.1%) or 2 of 160 (1.3%; 95% confidence interval, 0.1%-4.7%) of all patients. In these 2 patients with a large absorbed dose (112 and 374 Gy), the culprit vessel was identified in 1 case. Conclusion: Extrahepatic deposition of a 166 Ho scout dose seems to be theoretically safe in most patients. Its safety in clinical practice is being evaluated in ongoing clinical trials. Radi oembolization is a minimally invasive treatment for hepatic malignancies. Millions of radioactive microspheres are injected in the hepatic artery to radiate and embolize malignancies (1). Deposition of microspheres in gastrointestinal organs can result in ulceration or inflammation of tissue by a combination of embolization and radiation damage (2-4). To prevent this, vessels leading to gastrointestinal organs may be coil-embolized in patients scheduled for radioembolization treatment, during a pretreatment session using contrastenhanced images (i.e., digital subtraction angiography complemented by C-arm CT) to identify the culprit vessel (5). 99m Tc-macroaggregated albumin ( 99m Tc-MAA) is administered in this pretreatment session to simulate intrahepatic treatment biodistribution and to assess lung shunting and the possibility of extrahepatic deposition of the microspheres (6). This procedure is safe because 99m Tc-MAA emits 140-keV g photons (detecta...

show abstract

“…In their study, Kao et al found complications to occur from 49 Gy and upward (16,17). Of 160 patients, 34 cases with extrahepatic deposition were found.…”

Section: Discussionmentioning

confidence: 99%

Section: Absorbed Dosementioning

confidence: 99%

See 1 more Smart Citation

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In a recent diagnostic image reporting study of target to non-target activity, 90 Y PET consistently outperformed 90 Y Bremsstrahlung [118].…”

Section: Y Pet Imagingmentioning

confidence: 99%

“…Adequate visualisation can be achieved with a 20 minute per bed scan [117,118] and sensitivities of 0.11 cps/MBq in patients [119], 0.577 and 1 cps/MBq in phantom [117,120] have been reported. In a recent study, the optimal contrast for hot and cold spheres in a phantom was obtained with LYSO crystals and TOF technology [121].…”

Section: Y Pet Imagingmentioning

confidence: 99%

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Doherty¹

2015

J Diagn Imaging Ther

View full text Add to dashboard Cite

Yttrium-90 radioembolization ( 90 Y-RE) is a well-established therapy for the treatment of hepatocellular carcinoma (HCC) and also of metastatic liver deposits from other malignancies. Nuclear Medicine and Cath Lab diagnostic imaging takes a pivotal role in the success of the treatment, and in order to fully exploit the efficacy of the technique and provide reliable quantitative dosimetry that are related to clinical endpoints in the era of personalized medicine, technical challenges in imaging need to be overcome. In this paper, the extensive literature of current 90 Y-RE techniques and challenges facing it in terms of quantification and dosimetry are reviewed, with a focus on the current generation of 3D dosimetry techniques. Finally, new emerging techniques are reviewed which seek to overcome these challenges, such as highresolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.

show abstract

Radioactive Microspheres for Selective Internal Radiation Therapy of Hepatocellular Carcinoma

Zhou

Gao

Duan

et al. 2023

Advanced NanoBiomed Research

View full text Add to dashboard Cite

Selective internal radiation therapy (SIRT) as one of the radiotherapeutic techniques has been widely used in the treatment of primary and metastatic liver cancer, for better avoiding radiation damage to normal tissues from external exposure. The radioactive microspheres used in SIRT should meet some special requirements closely associated with the type of radionuclides and the size and the property of the microsphere. This review focuses on the radioactive microspheres to elaborate the current challenges in the related fields, including simplification of the preparation of microspheres formed by different materials, visualization of the biodistribution of microspheres, and the suitability of different types of microspheres for repeated treatment. In this context, the major characteristics of three kinds of commercialized radioactive microspheres are compared, the advances in the radioactive microspheres achieved in recent years are summarized, and the future prospects of radioactive microspheres are discussed.

show abstract

Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

Cited by 93 publications

References 34 publications

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Radioactive Microspheres for Selective Internal Radiation Therapy of Hepatocellular Carcinoma

Contact Info

Product

Resources

About

Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

Cited by 93 publications

References 34 publications

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

A review of 3D image-based dosimetry, technical considerations and emerging perspectives in 90Y microsphere therapy

Radioactive Microspheres for Selective Internal Radiation Therapy of Hepatocellular Carcinoma

Contact Info

Product

Resources

About

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres

Safety of a Scout Dose Preceding Hepatic Radioembolization with ¹⁶⁶Ho Microspheres