The Significance of <sup>99m</sup>Tc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for <sup>90</sup>Y-Microsphere Selective Internal Radiation Treatment

Ahmadzadehfar, Hojjat; Sabet, Amir; Biermann, Kim; Muckle, Marianne; Brockmann, Holger; Kuhl, Christiane K.; Wilhelm, Kai; Biersack, Hans‐Jürgen; Ezziddin, Samer

doi:10.2967/jnumed.109.074559

Cited by 114 publications

(75 citation statements)

References 28 publications

(41 reference statements)

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“…SPECT/CT more accurately identifies sites of extrahepatic activity than does SPECT or planar imaging only. Ahmadzadehfar and colleagues [26] reported that extrahepatic accumulation was detected by planar imaging, SPECT and SPECT/CT in 12, 17 and 42 % of examinations, respectively. The SPECT/CT findings affected management in 29 % of patients.…”

Section: Hepatic Perfusion Imagingmentioning

confidence: 99%

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

Maccauro¹,

Lorenzoni²,

Boni

et al. 2013

Clin Transl Imaging

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Intra-arterial radioembolization using microspheres labeled with the high-energy beta-emitter yttrium-90 ( 90 Y) is an innovative therapeutic strategy for primary and secondary hepatic malignancies. An accurate imaging workup plays a pivotal role in correctly selecting patients for treatment, to avoid severe complications and in assessment of the post-administration microsphere distribution. Nuclear medicine imaging modalities are an integral part of a complex multidisciplinary approach. In particular, hepatic perfusion imaging with 99m Tc-macroaggregated albumin particles ( 99m Tc-MAA), which identifies extrahepatic accumulation of radiopharmaceutical and lung shunt, is necessary to correctly select patients who may benefit from the treatment. Furthermore, 99m Tc MAA SPECT-based dose planning may optimize RE efficacy, overcoming the limitations of empirical methods to determine the activity to be administered. Quantitative assessment of the post-administration intrahepatic microsphere distribution with SPECT or PET is important for evaluation of toxicity and efficacy and can be used for the prediction of patient response and for patient-specific therapeutic dose optimization. Finally, [ 18 F]FDG PET/CT imaging is important in the assessment of early response after RE and in predicting patient outcome. This review provides a comprehensive overview of multimodality imaging in the complex management of patients undergoing RE for liver tumors.

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Section: Hepatic Perfusion Imagingmentioning

confidence: 99%

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

Maccauro¹,

Lorenzoni²,

Boni

et al. 2013

Clin Transl Imaging

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show abstract

“…Other studies have identified extrahepatic uptake on SPECT-CT not discernable on planar or SPECT only, leading to treatment adjustments such as additional surgical embolization [18,22]. Other work shows a sensitivity of 100% of using SPECT-CT to detect extrahepatic uptake compared to 41% for non attenuation corrected SPECT and 32% for planar imaging respectively [22]. Recently evaluated also is the discordance between hepatic angiography and MAA SPECT, noting severe discordance in only 3 of 74 cases of patients with HCC [23].…”

Section: Methodsmentioning

confidence: 99%

“…Clinical reporting issues also exist relating to dissociation; in a recent study, uptake in the stomach could not be attributed either to pertechnetate or true MAA uptake [61]. In certain clinics, patients undergoing RMS treatment are pretreated with sodium perchlorate before angiography, which aids in preventing unspecific uptake of MAA in the stomach and thyroid [22,62].…”

Section: Determination Of Lung Shunt Fraction (Lsf)mentioning

confidence: 99%

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

Doherty¹

2015

J Diagn Imaging Ther

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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.

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“…Transaxial and sagittal reconstructed SPECT/CT image shows 99m Tc-MAA uptake within anterior abdominal wall due to flow from falciform artery, which originated from middle hepatic artery. (10,(12)(13)(14)(15)(16). This study reports our experience in treatment planning for 174 patients.…”

Section: Figurementioning

confidence: 99%

“…Technical details for radioembolization have been discussed in detail elsewhere (10,11). Ninety-one patients were being treated for metastatic disease of the liver (colorectal cancer [40], neuroendocrine disease [20], cholangiocarcinoma [15], and miscellaneous origin [16]). Eighty-three patients were being treated for primary hepatocellular carcinoma (HCC).…”

Section: Patientsmentioning

confidence: 99%

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

et al. 2015

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Current standard practice for radioembolization treatment planning makes use of nuclear medicine imaging (NMI) of 99m Tc-macroaggregated albumin ( 99m Tc-MAA) arterial distributions for the assessment of lung shunting and extrahepatic uptake. Our aim was to retrospectively compare NMI with mapping angiography in the detection and localization of extrahepatic 99m Tc-MAA and to evaluate the typical and atypical findings of NMI in association with catheter placement. Methods: One hundred seventy-four patients underwent diagnostic angiography in preparation for radioembolization. 99m Tc-MAA was administered to the liver via a microcatheter positioned in the desired hepatic artery. Planar scintigraphy imaging followed by SPECT/CT imaging was obtained within 2 h. All images were reviewed for hepatic and extrahepatic 99m Tc-MAA deposition and compared with the mapping angiogram. Results: Intrahepatic lobe shunting was present on NMI in only 2.9% of the cases but was present in 62.5% of the patients with portal vein thrombosis. Extrahepatic distributions included lungs (100%), the gallbladder (49%) if present, and locations involving hepaticoenteric arterial anatomy recognized on angiograms (16%). Free pertechnetate was identified on 38% of the nuclear medicine images. Three percent of nuclear medicine images showed alternative findings such as a thyroid nodule or metallic artifact. Conclusion: Patients being considered for radioembolization should undergo both angiography and scintigraphy for the assessment of hepaticoenteric arterial anatomy, hepatopulmonary shunting, and appropriate dosimetry considerations. Knowledge of the expected distribution of 99m Tc-MAA with normal variants and potential nontarget delivery to adjacent structures is critical in improving clinical outcomes. Cur rently, nuclear medicine imaging (NMI) of 99m Tc-labeled macroaggregated albumin ( 99m Tc-MAA) is performed routinely before radioembolization for the assessment of lung shunting and extrahepatic uptake. NMI is widely recognized to be important for minimizing the risk of potentially debilitating adverse events such as radiation-induced pneumonitis or radiation gastritis/duodenitis after radioembolization using 90 Y-microspheres for inoperable hepatic tumors (1,2). The seminal work in a canine liver model demonstrating the safety and feasibility of using 90 Y-microsphere therapy for hepatic malignancies was reported in the late 1980s. Human studies of 90 Y-microsphere therapy in liver applications followed from the late 1980s through the 1990s. These investigations established the safety of 90 Y for intrahepatic applications and the optimal dosimetry for tumor radiation kill, while minimizing exposure to normal liver tissue (3-8).Given the similarities in sizes of 90 Y-microspheres (20-40 mm) and 99m Tc-MAA (20-50 mm), the pattern of 99m Tc-MAA deposition as determined from a high-resolution SPECT/CT acquisition serves as a surrogate to demonstrate how 90 Y-microspheres will localize during treatment. Radioembolization has evolved for the ...

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

Cited by 114 publications

References 28 publications

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

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

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

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

Cited by 114 publications

References 28 publications

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

Multiagent imaging of liver tumors with reference to intra-arterial radioembolization

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

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

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

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