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Coskun N, Kartal MO, Kartal AS, Cayhan V, Ozdemir M, Canyigit M, Ozdemir E. Use of dose-volume histograms for metabolic response prediction in hepatocellular carcinoma patients undergoing transarterial radioembolization with Y-90 resin microspheres. Ann Nucl Med 2024:10.1007/s12149-024-01926-4. [PMID: 38647875 DOI: 10.1007/s12149-024-01926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Voxel-based dosimetry offers improved outcomes in the treatment of hepatocellular carcinoma (HCC) with transarterial radioembolization (TARE) using glass microspheres. However, the adaptation of voxel-based dosimetry to resin-based microspheres has been poorly studied, and the prognostic relevance of heterogeneous dose distribution remains unclear. This study aims to explore the use of dose-volume histograms for resin microspheres and to determine thresholds for objective metabolic response in HCC patients treated with resin-based TARE. METHODS We retrospectively reviewed HCC patients who underwent TARE with Y-90-loaded resin microspheres in our institution between January 2021 and December 2022. Voxel-based dosimetry was performed on post-treatment Y-90 PET/CT images to extract parameters including mean dose absorbed by the tumor (mTD), the percentage of the targeted tumor volume (pTV), and the minimum doses absorbed by consecutive percentages within the tumor volume (D10, D25, D50, D75, D90). Assessment of metabolic response was done according to PERCIST criteria with F-18 FDG PET/CT imaging at 8-12 weeks after the treatment. RESULTS This study included 35 lesions targeted with 22 TARE sessions in 19 patients (15 males, 4 females, mean age 60 ± 13 years). Objective metabolic response was achieved in 43% of the lesions (n = 15). Responsive lesions had significantly higher mTD, pTV, and D25-D90 values (all p < 0.05). Optimal cut-off values for mTD, pTV, and D50 were 94.6 Gy (sensitivity 73%, specificity 70%, AUC 0.72), 94% (sensitivity 73%, specificity 55%, AUC 0.64), and 91 Gy (sensitivity 80%, specificity 80%, AUC 0.80), respectively. CONCLUSION Parameters derived from dose-volume histograms could offer valuable insights for predicting objective metabolic response in HCC patients treated with resin-based TARE. If verified with larger prospective cohorts, these parameters could enhance the precision of dose distribution and potentially optimize treatment outcomes.
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Affiliation(s)
- Nazim Coskun
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey.
| | - Mehmet Oguz Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Aysenur Sinem Kartal
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
| | - Velihan Cayhan
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Mustafa Ozdemir
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, University of Health Sciences, Ankara, Turkey
| | - Murat Canyigit
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
- Department of Interventional Radiology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Elif Ozdemir
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey
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Kovan B, Denizmen D, Civan C, Kuyumcu S, Isik EG, Has Simsek D, Ozkan ZG, Poyanli A, Demir B, Sanli Y. Influence of Early Versus Delayed Hepatic Artery Perfusion Scan on 90Y Selective Internal Radiation Therapy Planning. Cancer Biother Radiopharm 2024. [PMID: 38265813 DOI: 10.1089/cbr.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Purpose: The aim of this study was to evaluate the effect of an increase in the time interval between hepatic intra-arterial injection of 99mTc-macroaggregated albumin (MAA) and hepatic artery perfusion scintigraphy (HAPS) on the lung shunt fraction (LSF) and perfused volume (PV) calculations in the treatment planning of selective internal radiation therapy (SIRT). Methods: The authors enrolled 51 HAPS sessions from 40 patients diagnosed with primary or metastatic liver malignancy. All patients underwent scan at the first and fourth hour after hepatic arterial injection of 99mTc-MAA. Based on single-photon emission computed tomography images, LSF values were measured from each patient's first and fourth hour images. PV1 and PV4 were also calculated based on three-dimensional images using 5% and 10% cutoff threshold values and compared with each other. Results: The authors found that the median of LSF4 was statistically significantly higher than LSF1 (3.05 vs. 4.14, p ≤ 0.01). There was no statistically significant difference between PV1 and PV4 on the 10% (p = 0.72) thresholds. Conclusions: LSF values can be overestimated in case of delayed HAPS, potentially leading to treatment cancellation due to incorrectly high results in patients who could benefit from SIRT. Threshold-based PV values do not significantly change over time; nevertheless, keeping the short interval time would be safer.
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Affiliation(s)
- Bilal Kovan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Dilara Denizmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Caner Civan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Emine Goknur Isik
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Duygu Has Simsek
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Zeynep Gozde Ozkan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Arzu Poyanli
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Bayram Demir
- Department of Physics, Faculty of Science, Istanbul University, Fatih/İstanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
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Feng L, Fang J, Zeng X, Liu H, Zhang J, Huang L, Guo Z, Zhuang R, Zhang X. 68Ga-Labeled Maleimide for Blood Pool and Lymph PET Imaging through Covalent Bonding to Serum Albumin In Vivo. ACS Omega 2022; 7:28597-28604. [PMID: 35990434 PMCID: PMC9386703 DOI: 10.1021/acsomega.2c03505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
This study aims to develop a novel 68Ga-labeled tracer, which can covalently bind to albumin in vivo based on the maleimide-thiol strategy, and to evaluate its potential applications using positron emission tomography (PET). 68Ga-labeled maleimide-monoamide-DOTA (denoted as [68Ga]Ga-DM) was prepared conveniently with a high radiochemical yield (>90%) and radiochemical purity (>99%). Its molar activity was calculated as 249.60 ± 68.50 GBq/μmol, and the octanol-water partition coefficient (LogP) was -3.15 ± 0.08 with good stabilities. In vitro experiments showed that [68Ga]Ga-DM can bind to albumin efficiently and rapidly, with a binding fraction of over 70%. High uptake and excellent retention in blood were observed with a long half-life (t 1/2Z) of 190.15 ± 24.14 min, which makes it possible for blood pool PET imaging with high contrast. The transient micro-bleeding in the rat model was detected successfully with PET imaging. In addition, the uptakes of [68Ga]Ga-DM in the inflammatory popliteal lymph nodes depend on the severity (5.90% ID/g and 2.32% ID/g vs 1.01% ID/g for healthy lymph nodes at 0.5 h post-injection) indicating its feasibility for lymphatic imaging. In conclusion, a novel 68Ga-labeled tracer was prepared with high efficiency and yield in mild conditions. Based on the promising properties of bonding covalently to albumin, great stability, high blood contrast with a long half-life, and well environmental tolerance, [68Ga]Ga-DM could be developed as a potential tracer for PET imaging of blood pool, bleeding, and vascular permeability alteration diseases in the clinic.
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Weber M, Lam M, Chiesa C, Konijnenberg M, Cremonesi M, Flamen P, Gnesin S, Bodei L, Kracmerova T, Luster M, Garin E, Herrmann K. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging 2022; 49:1682-1699. [PMID: 35146577 PMCID: PMC8940802 DOI: 10.1007/s00259-021-05600-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022]
Abstract
Primary liver tumours (i.e. hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC)) are among the most frequent cancers worldwide. However, only 10-20% of patients are amenable to curative treatment, such as resection or transplant. Liver metastases are most frequently caused by colorectal cancer, which accounts for the second most cancer-related deaths in Europe. In both primary and secondary tumours, radioembolization has been shown to be a safe and effective treatment option. The vast potential of personalized dosimetry has also been shown, resulting in markedly increased response rates and overall survival. In a rapidly evolving therapeutic landscape, the role of radioembolization will be subject to changes. Therefore, the decision for radioembolization should be taken by a multidisciplinary tumour board in accordance with the current clinical guidelines. The purpose of this procedure guideline is to assist the nuclear medicine physician in treating and managing patients undergoing radioembolization treatment. PREAMBLE: The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. These guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set out in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine involves not only the science but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognised that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
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Affiliation(s)
- M Weber
- Department of Nuclear medicine, University clinic Essen, Essen, Germany.
| | - M Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - C Chiesa
- Nuclear Medicine, Foundation IRCCS National Tumour Institute, Milan, Italy
| | - M Konijnenberg
- Nuclear Medicine Department, Erasmus MC, Rotterdam, The Netherlands
| | - M Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milan, MI, Italy
| | - P Flamen
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
| | - S Gnesin
- Institute of Radiation physics, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - L Bodei
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - T Kracmerova
- Department of Medical Physics, Motol University Hospital, Prague, Czech Republic
| | - M Luster
- Department of Nuclear medicine, University hospital Marburg, Marburg, Germany
| | - E Garin
- Department of Nuclear Medicine, Cancer, Institute Eugène Marquis, Rennes, France
| | - K Herrmann
- Department of Nuclear medicine, University clinic Essen, Essen, Germany
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De la Garza-Ramos C, Muneer MS, Lewis JT, Harnois DM, Taner CB, Frey GT, Rosser B, Toskich BB. Transportal Technetium-99m Labeled Macroaggregated Albumin Scintigraphy to Quantify Occult Intrahepatic Microvascular Portosystemic Shunting. Radiol Case Rep 2021; 16:975-978. [PMID: 33664925 PMCID: PMC7900641 DOI: 10.1016/j.radcr.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) of the liver may lead to noncirrhotic portal hypertension with subsequent development of portosystemic shunts. While extrahepatic and macrovascular shunts are readily visualized with imaging or endoscopy, there is no standard technique to detect intrahepatic microvascular portosystemic shunting and quantitatively assess shunt burden. We present a case of a 53-year-old female with suspected NRH and hepatopulmonary syndrome with inconclusive liver biopsies and absent portosystemic shunts per abdominal imaging. A percutaneous transportal infusion of Technetium-99m labeled macroaggregated albumin (99mTc-MAA) successfully identified intrahepatic microvascular portosystemic shunting and quantified a lung shunt fraction of more than 30%. NRH was subsequently confirmed with a surgical wedge biopsy and the patient was successfuly treated with a liver transplant. Transportal 99mTc-MAA could be used to both identify and quantify otherwise occult microvascular portosystemic shunts in patients with clinical sequelae of portal hypertension.
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Affiliation(s)
- Cynthia De la Garza-Ramos
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Mohamed S. Muneer
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Jason T. Lewis
- Department of Pathology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Denise M. Harnois
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - C. Burcin Taner
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Gregory T. Frey
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Barry Rosser
- Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
| | - Beau B. Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224
- Corresponding author.
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Duan H, Khalaf MH, Ferri V, Baratto L, Srinivas SM, Sze DY, Iagaru A. High quality imaging and dosimetry for yttrium-90 ( 90Y) liver radioembolization using a SiPM-based PET/CT scanner. Eur J Nucl Med Mol Imaging 2021; 48:2426-36. [PMID: 33443618 DOI: 10.1007/s00259-021-05188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Transarterial radioembolization (TARE) with yttrium-90 (90Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from 99mTc macroaggregated albumin (MAA) SPECT/CT with post-treatment 90Y PET/CT for absorbed dose values, and to evaluate image quality of 90Y SiPM-based PET/CT. METHODS Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning 99mTc-MAA SPECT/CT and post-therapy 90Y PET/CT were assessed. 90Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from 99mTc-MAA SPECT/CT and 90Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from 99mTc-MAA SPECT/CT and 90Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of 90Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS 99mTc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of 90Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
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Spina JC, Hume I, Pelaez A, Peralta O, Quadrelli M, Garcia Monaco R. Expected and Unexpected Imaging Findings after 90Y Transarterial Radioembolization for Liver Tumors. Radiographics 2020; 39:578-595. [PMID: 30844345 DOI: 10.1148/rg.2019180095] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transarterial radioembolization (TARE), also called radioembolization or selective internal radiation therapy, is an interventional radiology technique used to treat primary liver tumors and liver metastases. The aim of this therapy is to deliver tumoricidal doses of radiation to liver tumors while selecting a safe radiation dose limit for nontumoral liver and lung tissue. Hence, correct treatment planning is essential to obtaining good results. However, this treatment invariably results in some degree of irradiation of normal liver parenchyma, inducing different radiologic findings that may affect follow-up image interpretation. When evaluating treatment response, the treated area size, tumor necrosis, devascularization, and changes seen at functional MRI must be taken into account. Unlike with other interventional procedures, with TARE, it can take several months for the tumor response to become evident. Ideally, responding lesions will show reduced size and decreased enhancement 3-6 months after treatment. In addition, during follow-up, there are many imaging findings related to the procedure itself (eg, peritumoral edema, inflammation, ring enhancement, hepatic fibrosis, and capsular retraction) that can make image interpretation and response evaluation difficult. Possible complications, either hepatic or extrahepatic, also can occur and include biliary injuries, hepatic abscess, radioembolization-induced liver disease, and radiation pneumonitis or dermatitis. A complete understanding of these possible posttreatment changes is essential for correct radiologic interpretations during the follow-up of patients who have undergone TARE. ©RSNA, 2019.
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Affiliation(s)
- Juan C Spina
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Isabel Hume
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ana Pelaez
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Oscar Peralta
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Marcos Quadrelli
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
| | - Ricardo Garcia Monaco
- From the Departments of Radiology (J.C.S., A.P., O.P., M.Q., R.G.M.) and Nuclear Medicine (I.H.), Hospital Italiano, Tte Gral Juan Domingo Perón 4230, C1199ABH CABA, Buenos Aires, Argentina
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Kunnen B, Beijst C, Lam MGEH, Viergever MA, de Jong HWAM. Comparison of the Biograph Vision and Biograph mCT for quantitative 90Y PET/CT imaging for radioembolisation. EJNMMI Phys 2020; 7:14. [PMID: 32130554 PMCID: PMC7056802 DOI: 10.1186/s40658-020-0283-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND New digital PET scanners with improved time of flight timing and extended axial field of view such as the Siemens Biograph Vision have come on the market and are expected to replace current generation photomultiplier tube (PMT)-based systems such as the Siemens Biograph mCT. These replacements warrant a direct comparison between the systems, so that a smooth transition in clinical practice and research is guaranteed, especially when quantitative values are used for dosimetry-based treatment guidance. The new generation digital PET scanners offer increased sensitivity. This could particularly benefit 90Y imaging, which tends to be very noisy owing to the small positron branching ratio and high random fraction of 90Y. This study aims to determine the ideal reconstruction settings for the digital Vision for quantitative 90Y imaging and to evaluate the image quality and quantification of the digital Vision in comparison with its predecessor, the PMT-based mCT, for 90Y imaging in radioembolisation procedures. METHODS The NEMA image quality phantom was scanned to determine the ideal reconstruction settings for the Vision. In addition, an anthropomorphic phantom was scanned with both the Vision and the mCT, mimicking a radioembolisation patient with lung, liver, tumour, and extrahepatic deposition inserts. Image quantification of the anthropomorphic phantom was assessed by the lung shunt fraction, the tumour to non-tumour ratio, the parenchymal dose, and the contrast to noise ratio of extrahepatic depositions. RESULTS For the Vision, a reconstruction with 3 iterations, 5 subsets, and no post-reconstruction filter is recommended for quantitative 90Y imaging, based on the convergence of the recovery coefficient. Comparing both systems showed that the noise level of the Vision is significantly lower than that of the mCT (background variability of 14% for the Vision and 25% for the mCT at 2.5·103 MBq for the 37 mm sphere size). For quantitative 90Y measures, such as needed in radioembolisation, both systems perform similarly. CONCLUSIONS We recommend to reconstruct 90Y images acquired on the Vision with 3 iterations, 5 subsets, and no post-reconstruction filter for quantitative imaging. The Vision provides a reduced noise level, but similar quantitative accuracy as compared with its predecessor the mCT.
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Affiliation(s)
- Britt Kunnen
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, GA 3508, Utrecht, the Netherlands.
- Image Sciences Institute, UMC Utrecht & University Utrecht, Heidelberglaan 100, CX 3584, Utrecht, the Netherlands.
| | - Casper Beijst
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, GA 3508, Utrecht, the Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, GA 3508, Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, UMC Utrecht & University Utrecht, Heidelberglaan 100, CX 3584, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, GA 3508, Utrecht, the Netherlands
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Kunnen B, Dietze MMA, Braat AJAT, Lam MGEH, Viergever MA, de Jong HWAM. Feasibility of imaging 90 Y microspheres at diagnostic activity levels for hepatic radioembolization treatment planning. Med Phys 2020; 47:1105-1114. [PMID: 31855282 PMCID: PMC7078991 DOI: 10.1002/mp.13974] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Prior to 90Y hepatic radioembolization, a dosage of 99mTc‐macroaggregated albumin (99mTc‐MAA) is administered to simulate the distribution of the 90Y‐loaded microspheres. This pretreatment procedure enables lung shunt estimation, detection of potential extrahepatic depositions, and estimation of the intrahepatic dose distribution. However, the predictive accuracy of the MAA particle distribution is often limited. Ideally, 90Y microspheres would also be used for the pretreatment procedure. Based on previous research, the pretreatment activity should be limited to the estimated safety threshold of 100 MBq, making imaging challenging. The purpose of this study was to evaluate the quality of intra‐ and extrahepatic imaging of 90Y‐based pretreatment positron emission tomography/computed tomography (PET/CT) and quantitative single photon emission computed tomography (SPECT)/CT scans, by means of phantom experiments and a patient study. Methods An anthropomorphic phantom with three extrahepatic depositions was filled with 90Y chloride to simulate a lung shunt fraction (LSF) of 5.3% and a tumor to nontumor ratio (T/N) of 7.9. PET /CT (Siemens Biograph mCT) and Bremsstrahlung SPECT/CT (Siemens Symbia T16) images were acquired at activities ranging from 1999 MBq down to 24 MBq, representing post‐ and pretreatment activities. PET/CT images were reconstructed with the clinical protocol and SPECT/CT images were reconstructed with a quantitative Monte Carlo‐based reconstruction protocol. Estimated LSF, T/N, contrast to noise ratio of all extrahepatic depositions, and liver parenchymal and tumor dose were compared with the phantom ground truth. A clinically reconstructed SPECT/CT of 150 MBq 99mTc represented the current clinical standard. In addition, a 90Y pretreatment scan was simulated for a patient by acquiring posttreatment PET/CT and SPECT/CT data with shortened acquisition times. Results At an activity of 100 MBq 90Y, PET/CT overestimated LSF [+10 percentage point (pp)], underestimated liver parenchymal dose (−3 Gy/GBq), and could not detect the extrahepatic depositions. SPECT/CT more accurately estimated LSF (−0.7 pp), parenchymal dose (−0.3 Gy/GBq) and could detect all three extrahepatic depositions. 99mTc SPECT/CT showed similar accuracy as 90Y SPECT/CT (LSF: +0.2 pp, parenchymal dose: +0.4 Gy/GBq, all extrahepatic depositions visible), although the noise level in the liver compartment was considerably lower for 99mTc SPECT/CT compared to 90Y SPECT/CT. The patient’s SPECT/CT simulating a pretreatment 90Y procedure accurately represented the posttreatment 90Y microsphere distribution. Conclusions Quantitative SPECT/CT of 100 MBq 90Y could accurately estimate LSF, T/N, parenchymal and tumor dose, and visualize extrahepatic depositions.
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Affiliation(s)
- Britt Kunnen
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Image Sciences Institute, UMC Utrecht & University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Martijn M A Dietze
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Image Sciences Institute, UMC Utrecht & University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, UMC Utrecht & University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Lee EJ, Chung HW, Jo JH, So Y. Radioembolization for the Treatment of Primary and Metastatic Liver Cancers. Nucl Med Mol Imaging 2019; 53:367-373. [PMID: 31867071 DOI: 10.1007/s13139-019-00615-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023] Open
Abstract
Radioembolization using 90Y microspheres (glass or resin) has been introduced as an effective intraarterial therapy for unresectable primary and metastatic liver cancers. Although the basic therapeutic effect of chemoembolization results from ischemia, the therapeutic efficacy of radioembolization comes from radiation. Furthermore, compared with surgical resection and local ablation therapy, radioembolization is available with less limitation on the sites or number of liver cancers. The radioisotope 90Y is a β-radiation emitter without γ-radiation, with the emission of secondary bremsstrahlung photons and small numbers of positrons. Administration of 90Y microspheres into the hepatic artery can deliver a high dose of radiation selectively to the target tumor with limited radiation exposure to the surrounding normal parenchyma, and has low systemic toxicity. In general, radioembolization has been considered for patients with unresectable primary or metastatic liver-only or liver-dominant cancers with no ascites or other clinical signs of liver failure, life expectancy of > 12 weeks, and good performance status. Here, we review the current radioactive compounds, pretreatment assessment, and indications for radioembolization in patients with hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and liver metastases from colorectal cancer.
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Affiliation(s)
- Eun Jeong Lee
- 1Department of Nuclear Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea
| | - Hyun Woo Chung
- 2Departments of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Joon-Hyung Jo
- 2Departments of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
| | - Young So
- 2Departments of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea
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11
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Yonekura Y, Mattsson S, Flux G, Bolch WE, Dauer LT, Fisher DR, Lassmann M, Palm S, Hosono M, Doruff M, Divgi C, Zanzonico P. ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals. Ann ICRP 2019; 48:5-95. [PMID: 31565950 DOI: 10.1177/0146645319838665] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.
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Abstract
Dosimetry for yttrium-90 radioembolization continues to generate interest and controversy, as multiple approaches have been used effectively. Traditionally, simple formulas primarily based on patients' body weight or perfused liver volume were used. Over the past several years, dosimetry refinements have led to marked improvements in this therapy from both a safety and efficacy standpoint. Technetium-99m macroaggregated albumin single photon emission computed tomography (SPECT) optimizes pretreatment dosimetry to ensure delivery of a therapeutic radiation dose to the tumor while minimizing nontarget radiation to healthy hepatic tissue. Post-treatment yttrium-90 PET utilizing the inherent internal pair production of yttrium-90 accurately calculates the absorbed dose to tumors and to the normal hepatic parenchyma, which correlates with patient outcomes. As dosimetric calculations become more complex, quantitative imaging with Tc-99m SPECT and Y-90 PET may set the new standard for radioembolization dosimetry.
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Affiliation(s)
- Bashir A Tafti
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Siddharth A Padia
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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13
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Wen X, Shi C, Xu D, Zhang P, Li Z, Li J, Su X, Zhuang R, Liu T, Guo Z, Zhang X. Radioiodinated Portable Albumin Binder as a Versatile Agent for in Vivo Imaging with Single-Photon Emission Computed Tomography. Mol Pharm 2019; 16:816-824. [PMID: 30604976 DOI: 10.1021/acs.molpharmaceut.8b01116] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, radioiodinated 4-( p-iodophenyl)butyric acid ([131I]IBA) was synthesized and evaluated as a portable albumin-binder for potential applications in single photon emission computed tomography imaging of blood pool, tumor, and lymph node with significantly improved pharmacokinetic properties. The [131I]IBA was prepared under the catalyst of Cu2O/1,10-phenanthroline. After that, the albumin-binding capability of [131I]IBA was tested in vitro, ex vivo, and in vivo, respectively. [131I]IBA was obtained with very high radiolabeling yield (>99%) and good radiochemical purity (>98%) within 10 min. It binds to albumin effectively with high affinity (IC50= 46.5 μM) and has good stability. The results of biodistribution indicated that the [131I]IBA was mainly accumulated in blood with good retention (10.51 ± 2.58%ID/g at 30 min p.i. and 4.63 ± 0.17%ID/g at 4 h p.i.). In the SPECT imaging of mice models with [131I]IBA, blood pool, lymph node, and tumors could be imaged clearly with high target-to-background ratio. Overall, the radioiodinated albumin binder of [131I]IBA with long blood half-life and excellent stability could be used to decorate diversified albumin-binding radioligands and developed as a versatile theranostic agent.
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Affiliation(s)
- Xuejun Wen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Changrong Shi
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Duo Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Pu Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Zizhen Li
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Key Laboratory of the Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences , Xiamen University , Xiamen 361102 , China
| | - Jindian Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Xinhui Su
- Zhongshan Hospital Affiliated to Xiamen University , Hubin South Road , Xiamen 361004 , China
| | - Rongqiang Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Ting Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Zhide Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
| | - Xianzhong Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health , Xiamen University , 4221-116 Xiang'An South Road , Xiamen 361102 , China
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Kunnen B, van der Velden S, Bastiaannet R, Lam MGEH, Viergever MA, de Jong HWAM. Radioembolization lung shunt estimation based on a 90
Y pretreatment procedure: A phantom study. Med Phys 2018; 45:4744-4753. [DOI: 10.1002/mp.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Britt Kunnen
- Radiology and Nuclear Medicine; UMC Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
- Image Sciences Institute; UMC Utrecht; University Utrecht; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Sandra van der Velden
- Radiology and Nuclear Medicine; UMC Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
- Image Sciences Institute; UMC Utrecht; University Utrecht; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Remco Bastiaannet
- Radiology and Nuclear Medicine; UMC Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
- Image Sciences Institute; UMC Utrecht; University Utrecht; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Marnix G. E. H. Lam
- Radiology and Nuclear Medicine; UMC Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
| | - Max A. Viergever
- Image Sciences Institute; UMC Utrecht; University Utrecht; Heidelberglaan 100 3584 CX Utrecht The Netherlands
| | - Hugo W. A. M. de Jong
- Radiology and Nuclear Medicine; UMC Utrecht; P.O. Box 85500 3508 GA Utrecht The Netherlands
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15
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Dickinson NJ, Kalirai C, O'Connor RA, Mullin K. Hepatic selective internal radiation therapy: how well does pretreatment 99mTc-macroaggregated albumin activity distribution and quantification agree with post-therapy bremsstrahlung imaging? Nucl Med Commun 2018; 39:809-17. [PMID: 29879091 DOI: 10.1097/MNM.0000000000000872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to examine the agreement of pretreatment Tc-macroaggregated albumin imaging performed for selective internal radiation therapy (SIRT) workup with Y percentage lung shunt (PLS) and regional hepatic distribution in subsequent post-therapy bremsstrahlung imaging. PATIENTS AND METHODS Planar images were used to calculate PLS. The significant Y bremsstrahlung scatter required background correction. Results using both Y lung background regions of interest (ROI) reported in previous studies and extended ROIs (reflecting lung background variation) were compared with Tc-MAA PLS. Lesion and healthy liver volumes were outlined on diagnostic computed tomography scans and registered to Tc-MAA and Y single-photon emission computed tomography/computed tomographydata. Single-photon emission computed tomography voxel values were normalized to injected Y activity. Volume mean activities were calculated, and converted into the mean absorbed dose. Agreement was quantified using Bland-Altman analysis. RESULTS PLS: The bias using previous studies' lung background ROIs was -10.71%, with a 95% confidence interval (CI) of -18.79 to -2.64%. The extended ROI yielded a bias of 0.77% (95% CI: -2.23 to 3.70%). Liver: The healthy liver bias was 0.01 MBq/ml (0.17 Gy), with a -0.05 to 0.06 MBq/ml (95% CI:0.80 -1.93 Gy). The lesion mean activity/ml bias was -0.02 MBq/ml (3.71 Gy), with a -0.81 to 0.76 MBq/ml (95% CI: -35.49 to 28.07 Gy). CONCLUSIONS The PLS agreement was sensitive to the Y lung background correction ROI, potentially explaining a previously published controversy. The mean activity and absorbed dose agreement for the metastatic lesions was poorer than the healthy liver volumes studied here.
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Ones T, Eryuksel E, Baltacioglu F, Ceyhan B, Erdil TY. The effect of selective internal radiation therapy with yttrium-90 resin microspheres on lung carbon monoxide diffusion capacity. EJNMMI Res 2017; 7:103. [PMID: 29285636 PMCID: PMC5746495 DOI: 10.1186/s13550-017-0353-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/15/2017] [Indexed: 01/27/2023] Open
Abstract
Background Selective internal radiation therapy (SIRT) with embolization of branches of the hepatic artery is a valuable therapeutic tool for patients with hepatic malignancies; however, it is also associated with lung injury risk due to shunting. Diffusion capacity of the lungs for carbon monoxide (DLCO) is a clinically significant lung function test, and worsening in DLCO is suggested to reflect a limited gas exchange reserve caused by the potential toxicity of chemoradiotherapy or it may be a marker of related lung injury. This study aimed to examine the changes in DLCO during SIRT with resin microspheres in newly treated and retreated patients. Forty consecutive patients who received SIRT for a variety of malignant conditions were included. All subjects were treated with Yttrium-90 labelled resin microspheres. DLCO tests were performed after the procedures. In addition, patients were specifically followed for radiation pneumonitis. Results The mean DLCO did not significantly change after the first (82.8 ± 19.4 vs. 83.1 ± 20.9, p = 0.921) and the second treatments (87.4 ± 19.7 vs. 88.6 ± 23.2, p = 0.256). Proportion of patients with impaired DLCO at baseline was not altered significantly after the first (37.5 vs. 45.0%, p = 0.581) and the second treatments (27.3 vs. 27.3%, p = 1.000). Also, percent change in DLCO values did not correlate with radiation dose, lung shunt fraction, or lung exposure dose (p > 0.05 for all comparisons). None of the patients developed radiation pneumonitis. Conclusions Our results suggest that no significant change in DLCO in association with SIRT occurs, both after the first or the second treatment sessions. Further larger studies possibly with different protocols are warranted to better delineate DLCO changes after SIRT in a larger spectrum of patients.
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Affiliation(s)
- Tunc Ones
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey.
| | - Emel Eryuksel
- Department of Pulmonary and Critical Care, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Berrin Ceyhan
- Department of Pulmonary and Critical Care, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Tanju Yusuf Erdil
- Department of Nuclear Medicine, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
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Camacho JC, Moncayo V, Kokabi N, Reavey HE, Galt JR, Yamada K, Kies DD, Williams RS, Kim HS, Schuster DM. 90Y Radioembolization: Multimodality Imaging Pattern Approach with Angiographic Correlation for Optimized Target Therapy Delivery. Radiographics 2015; 35:1602-18. [DOI: 10.1148/rg.2015140314] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Rodríguez-Fraile M, Iñarrairaegui M. Radioembolization with 90Y-microspheres for liver tumors. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Yttrium-90 radioembolization (90Y-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 90Y-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 high-resolution imaging, novel surgical procedures and the use of other radiopharmaceuticals for therapy and pre-therapeutic planning.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
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20
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Rodríguez-Fraile M, Iñarrairaegui M. [Radioembolization with (90)Y-microspheres for liver tumors]. Rev Esp Med Nucl Imagen Mol 2015; 34:244-57. [PMID: 25911062 DOI: 10.1016/j.remn.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- M Rodríguez-Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España.
| | - M Iñarrairaegui
- Unidad de Hepatología, Clínica Universidad de Navarra, Pamplona, Navarra, España; Área de Oncología Hepatobiliopancreática, Clínica Universidad de Navarra, Pamplona, Navarra, España; Instituto de Investigaciones Sanitarias de Navarra (IDISNA), España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Pamplona, España
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22
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Smits MLJ, Elschot M, Sze DY, Kao YH, Nijsen JFW, Iagaru AH, de Jong HWAM, van den Bosch MAAJ, Lam MGEH. Radioembolization Dosimetry: The Road Ahead. Cardiovasc Intervent Radiol 2015; 38:261-9. [DOI: 10.1007/s00270-014-1042-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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23
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Dobrocky T, Fuerstner M, Klaeser B, Lopez-Benitez R, Wälti YB, Kara L. Regional Radiation Pneumonitis After SIRT of a Subcapsular Liver Metastasis: What is the Effect of Direct Beta Irradiation? Cardiovasc Intervent Radiol 2014; 38:1025-30. [PMID: 25373797 DOI: 10.1007/s00270-014-1015-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/08/2014] [Indexed: 01/15/2023]
Abstract
We herein present a patient undergoing selective internal radiation therapy with an almost normal lung shunt fraction of 11.5%, developing histologically proven radiation pneumonitis. Due to a predominance of pulmonary consolidations in the right lower lung and its proximity to a large liver metastases located in the dome of the right liver lobe a Monte Carlo simulation was performed to estimate the effect of direct irradiation of the lung parenchyma. According to our calculations direct irradiation seems negligible and RP is almost exclusively due to ectopic draining of radioactive spheres.
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Affiliation(s)
- Tomas Dobrocky
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland,
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Martí-Climent JM, Prieto E, Elosúa C, Rodríguez-Fraile M, Domínguez-Prado I, Vigil C, García-Velloso MJ, Arbizu J, Peñuelas I, Richter JA. PET optimization for improved assessment and accurate quantification of 90
Y-microsphere biodistribution after radioembolization. Med Phys 2014; 41:092503. [DOI: 10.1118/1.4892383] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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25
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Abstract
Transcatheter intra-arterial therapies play a vital role in treatment of HCC due to the unique tumor vasculature. Evolution of techniques and newer efficacious modalities of tumor destruction have made these techniques popular. Various types of intra-arterial therapeutic options are currently available. These constitute: bland embolization, trans-arterial chemotherapy, trans-arterial chemo embolization with or without drug-eluting beads and trans-arterial radio embolization, which are elaborated in this review.
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Key Words
- AFP, alpha feto protein
- CR, complete response
- HAIC, hepatic artery infusion chemotherapy
- HCC, hepatocellular carcinoma
- LA, laser ablation
- OLT, orthotopic liver transplant
- PD, progressive disease
- PEI, percutaneous ethanol injection
- PR, partial response
- PVT, portal vein thrombosis
- RFA, ablation
- SD, stable disease
- TACE, trans-arterial chemoembolization
- TAE, Trans-arterial embolization
- TART, trans-arterial radiotherapy
- drug eluting bead (DEB)
- hepatocellular carcinoma (HCC)
- trans-arterial chemoembolization (TACE)
- trans-arterial embolization (TAE)
- trans-arterial radiotherapy (TART)
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Affiliation(s)
- Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Hanish Sharma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
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van den Hoven AF, Prince JF, van den Bosch MA, Lam MG. Hepatic Radioembolization as a True Single-Session Treatment. J Vasc Interv Radiol 2014; 25:1143-4. [DOI: 10.1016/j.jvir.2014.01.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022] Open
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De Gersem R, Maleux G, Vanbilloen H, Baete K, Verslype C, Haustermans K, Verbruggen A, Van Cutsem E, Deroose CM. Influence of time delay on the estimated lung shunt fraction on 99mTc-labeled MAA scintigraphy for 90Y microsphere treatment planning. Clin Nucl Med 2013; 38:940-2. [PMID: 24212439 DOI: 10.1097/RLU.0000000000000241] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
90Y-microspheres therapy is used to treat selected patients with primary or metastatic liver tumors in a safe and effective way. As a preparation for 90Y-microspheres treatment, a 99mTc-macroaggregated albumin (99mTc-MAA) simulation procedure is essential to evaluate particle shunting to the lung or gastrointestinal tract. We investigated the effect of interval between injection of 99mTc-MAA and time of scanning on the lung shunt fraction (LSF). In 4 patients with secondary hepatic malignancies who underwent repeated whole-body scintigraphy up to 5 hours after injection of 99mTc-MAA, a marked change in LSF was observed. It appears that tracer degradation leads to an important overestimation of LSF at later time points. An overestimation of LSF can lead to dose reduction or canceling of the planned 90Y-microspheres treatment. It is concluded that the interval between injection and scanning should be kept as short as possible.
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Gaba RC, Zivin SP, Dikopf MS, Parvinian A, Casadaban LC, Lu Y, Bui JT. Characteristics of primary and secondary hepatic malignancies associated with hepatopulmonary shunting. Radiology 2014; 271:602-12. [PMID: 24533871 DOI: 10.1148/radiol.14131969] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To identify liver tumor characteristics associated with low (<10%), intermediate (10%-20%), and high (>20%) lung shunt fraction (LSF) at technetium 99m ((99m)Tc) macroaggregated albumin (MAA) imaging performed before yttrium 90 ((90)Y) radioembolization (RE). MATERIALS AND METHODS In this single-center retrospective study, 141 patients (70 with hepatocellular carcinoma [HCC], 71 with other tumors; 95 men, 45 women; median age, 61 years) underwent mapping arteriography with (99m)Tc-MAA LSF calculation before (90)Y RE from 2006 to 2012. Tumor characteristics, including tumor type, index lesion size and morphologic structure (circumscribed, infiltrative), focality (solitary oligonodular, multinodular), disease distribution (unilobar, bilobar), tumor burden (≤50%, 50%), portal vein invasion (present, absent), and arterioportal shunting (present, absent) were correlated with (99m)Tc-MAA imaging-calculated LSFs at univariate and multivariate analysis. RESULTS Median LSF was 8.4% (HCC, 9.0%; other tumors, 8.3%). LSF greater than 20% occurred in 14% of HCCs, but only in 3% of other tumors (P = .004). For HCC, tumor morphologic structure (P = .022), tumor burden (P < .001), main portal vein invasion (P = .033), and arterioportal shunting (P < .001) were significantly associated with different LSF categories at univariate analysis; infiltrative morphologic structure, tumor burden greater than 50%, portal vein invasion, and shunting had confirmed association with high LSF at multivariate analysis. For other liver tumors, tumor size (P = .001) and tumor burden (P = .003) were significantly associated with different LSF categories at univariate analysis. Multivariate confirmation was precluded by small sample size. Patients underwent a median of one (90)Y RE session (range, one to six), with median per-treatment and cumulative lung doses of 6.0 Gy and 8.5 Gy, respectively. CONCLUSION LSF greater than 20% periodically occurs in HCC but is uncommon in other liver tumors. Specific tumor characteristics are associated with LSF greater than 20% and may indicate need for interventions to reduce LSF.
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Affiliation(s)
- Ron C Gaba
- From the Department of Radiology (R.C.G., S.P.Z., Y.L., J.T.B.) and College of Medicine (M.S.D., A.P., L.C.C.), University of Illinois Hospital and Health Sciences System, 1740 W Taylor St, MC 931, Chicago, IL 60612
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Volkan-Salancı B, Bozkurt MF, Peynircioğlu B, Cil B, Uğur O. The relation between perfusion pattern of hepatic artery perfusion scintigraphy and response to y-90 microsphere therapy. Mol Imaging Radionucl Ther 2013; 22:98-102. [PMID: 24416626 PMCID: PMC3888020 DOI: 10.4274/mirt.77487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/24/2013] [Indexed: 01/17/2023] Open
Abstract
Objective: Hepatic artery perfusion scintigraphy is a routine procedure for patient evaluation before Y-90 radiomicrosphere therapy and mostly used for prediction of extrahepatic leakage. Moreover, it also displays perfusion pattern of tumours, which is an important parameter on success of the therapy. The aim of this study is to assess the relation between the perfusion pattern on hepatic artery perfusion scintigraphy and radiomicrosphere therapy response. Methods: A total of 99 radiomicrosphere therapy applications were carried out in 80 patients (M/F: 55/25). Results: Heterogeneous and diffuse perfusion patterns were observed in 47 patients and 52 patients, respectively. The patients with diffuse perfusion pattern had better therapy response both on FDG PET/CT (p= 0.04) and CT (p=0.008) when compared to those with heterogenous perfusion pattern. Conclusion: Perfusion pattern observed on hepatic artery perfusion scintigraphy may be a successful predictor of early response to radiomicrosphere therapy. Conflict of interest:None declared.
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Affiliation(s)
- Bilge Volkan-Salancı
- Department of Nuclear Medicine, Hacettepe University, Medical Faculty, Ankara, Turkey
| | - Murat Fani Bozkurt
- Department of Nuclear Medicine, Hacettepe University, Medical Faculty, Ankara, Turkey
| | - Bora Peynircioğlu
- Department of Radiology, Hacettepe University, Medical Faculty, Ankara, Turkey
| | - Barbaros Cil
- Department of Radiology, Hacettepe University, Medical Faculty, Ankara, Turkey
| | - Omer Uğur
- Department of Nuclear Medicine, Hacettepe University, Medical Faculty, Ankara, Turkey
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Ulrich G, Dudeck O, Furth C, Ruf J, Grosser OS, Adolf D, Stiebler M, Ricke J, Amthauer H. Predictive Value of Intratumoral 99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with 90Y-Microspheres. J Nucl Med 2013; 54:516-22. [DOI: 10.2967/jnumed.112.112508] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Seinstra BA, Defreyne L, Lambert B, Lam MGEH, Verkooijen HM, van Erpecum KJ, van Hoek B, van Erkel AR, Coenraad MJ, Al Younis I, van Vlierberghe H, van den Bosch MAAJ. Transarterial radioembolization versus chemoembolization for the treatment of hepatocellular carcinoma (TRACE): study protocol for a randomized controlled trial. Trials 2012; 13:144. [PMID: 22913492 PMCID: PMC3493260 DOI: 10.1186/1745-6215-13-144] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 08/09/2012] [Indexed: 02/08/2023] Open
Abstract
Background Hepatocellular carcinoma is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10 to 15% of hepatocellular carcinoma patients are suitable candidates for treatment with curative intent, such as hepatic resection and liver transplantation. A majority of patients have locally advanced, liver restricted disease (Barcelona Clinic Liver Cancer (BCLC) staging system intermediate stage). Transarterial loco regional treatment modalities offer palliative treatment options for these patients; transarterial chemoembolization (TACE) is the current standard treatment. During TACE, a catheter is advanced into the branches of the hepatic artery supplying the tumor, and a combination of embolic material and chemotherapeutics is delivered through the catheter directly into the tumor. Yttrium-90 radioembolization (90Y-RE) involves the transarterial administration of minimally embolic microspheres loaded with Yttrium-90, a β-emitting isotope, delivering selective internal radiation to the tumor. 90Y-RE is increasingly used in clinical practice for treatment of intermediate stage hepatocellular carcinoma, but its efficacy has never been prospectively compared to that of the standard treatment (TACE). In this study, we describe the protocol of a multicenter randomized controlled trial aimed at comparing the effectiveness of TACE and 90Y-RE for treatment of patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma. Methods/design In this pragmatic randomized controlled trial, 140 patients with unresectable (BCLC intermediate stage) hepatocellular carcinoma, with Eastern Cooperative Oncology Group performance status 0 to 1 and Child-Pugh A to B will be randomly assigned to either 90Y-RE or TACE with drug eluting beads. Patients assigned to 90Y-RE will first receive a diagnostic angiography, followed by the actual transarterial treatment, which can be divided into two sessions in case of bilobar disease. Patients assigned to TACE will receive a maximum of three consecutive transarterial treatment sessions. Patients will undergo structural follow-up for a timeframe of two years post treatment. Post procedural magnetic resonance imaging (MRI) will be performed at one and three months post trial entry and at three-monthly intervals thereafter for two years to assess tumor response. Primary outcome will be time to progression. Secondary outcomes will be overall survival, tumor response according to the modified RECIST criteria, toxicities/adverse events, treatment related effect on total liver function, quality of life, treatment-related costs and cost-effectiveness. Trial registration NCT01381211
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Affiliation(s)
- Beatrijs A Seinstra
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Walrand S, Hesse M, Demonceau G, Pauwels S, Jamar F. Yttrium-90-labeled microsphere tracking during liver selective internal radiotherapy by bremsstrahlung pinhole SPECT: feasibility study and evaluation in an abdominal phantom. EJNMMI Res 2011; 1:32. [PMID: 22214246 PMCID: PMC3377914 DOI: 10.1186/2191-219x-1-32] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/02/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of the study is to evaluate whether a pinhole collimator is better adapted to bremsstrahlung single photon emission computed tomography [SPECT] than parallel-hole collimators and in the affirmative, to evaluate whether pinhole bremsstrahlung SPECT, including a simple model of the scatter inside the patient, could provide a fast dosimetry assessment in liver selective internal radiotherapy [SIRT]. MATERIALS AND METHODS Bremsstrahlung SPECT of an abdominal-shaped phantom including one cold and five hot spheres was performed using two long-bore parallel-hole collimators: a medium-energy general-purpose [MEGP] and a high-energy general-purpose [HEGP], and also using a medium-energy pinhole [MEPH] collimator. In addition, ten helical MEPH SPECTs (acquisition time 3.6 min) of a realistic liver-SIRT phantom were also acquired. RESULTS Without scatter correction for SPECT, MEPH SPECT provided a significantly better contrast recovery coefficient [CRC] than MEGP and HEGP SPECTs. The CRCs obtained with MEPH SPECT were still improved with the scatter correction and became comparable to those obtained with positron-emission tomography [PET] for the 36-, 30- (cold), 28-, and 24-mm-diameter spheres: CRC = 1.09, 0.59, 0.91, and 0.69, respectively, for SPECT and CRC = 1.07, 0.56, 0.84, and 0.63, respectively, for PET. However, MEPH SPECT gave the best CRC for the 19-mm-diameter sphere: CRC = 0.56 for SPECT and CRC = 0.01 for PET. The 3.6-min helical MEPH SPECT provided accurate and reproducible activity estimation for the liver-SIRT phantom: relative deviation = 10 ± 1%. CONCLUSION Bremsstrahlung SPECT using a pinhole collimator provided a better CRC than those obtained with parallel-hole collimators. The different designs and the better attenuating material used for the collimation (tungsten instead of lead) explain this result. Further, the addition of an analytical modeling of the scattering inside the phantom resulted in an almost fully recovered contrast. This fills the gap between the performance of90Y-PET and bremsstrahlung pinhole SPECT which is a more affordable technique and could even be used during the catheterization procedure in order to optimize the90Y activity to inject.
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Affiliation(s)
- Stephan Walrand
- Center of Nuclear Medicine, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium.
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Großer OS, Nultsch M, Laatz K, Ulrich G, Seidensticker R, Pethe A, Dudeck O, Pech M, Knoop BO, Ricke J, Amthauer H, Geworski L. Radioembolisation mit 90Y-markierten Mikrosphären: Posttherapeutische Therapievalidierung mit Bremsstrahlungs-SPECT. Z Med Phys 2011; 21:274-80. [DOI: 10.1016/j.zemedi.2011.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 11/19/2022]
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Abstract
A method is proposed for accurate quantification of lung uptake during shunt studies for liver cancer patients undergoing radio-embolization. The current standard for analysis of [(99m)Tc]-MAA shunt studies is subjective and highly variable. The technique proposed in this work involves a small additional peripheral intravenous injection of macroaggregated albumin (MAA) and two additional static acquisitions (before and after injection) to quantify the absolute activity in the lungs as a result of arterio-venous shunting. Such quantification also allows for estimates of absorbed dose to lung tissue at the time of treatment based on MIRD formalism. The method was used on six radio-embolization patients attending the department for lung shunt analysis. Quantitative values for each were compared to a previously validated technique using fully quantitative SPECT/CT imaging, treated as the gold standard. The average difference between absolute activity shunted to the lungs calculated by the proposed technique compared to the previously validated technique was found to be 2%, with a range of (1-8)%. The proposed method is simple and fast, allowing for accurate quantification of lung shunting and estimates of absorbed dose to lung tissue at treatment, and may one day be used in a one-stop procedure for planning and therapy in a single interventional procedure.
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Affiliation(s)
- Kathy Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2006, Australia.
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Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer. 1985;56:918-928. [PMID: 2990661 DOI: 10.1007/s00259-011-1812-2] [Citation(s) in RCA: 148] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A total of 850 patients with hepatocellular carcinoma seen during the last 8 years were analyzed retrospectively for survival in relation to treatment and disease stage. A new staging scheme based on tumor size, ascites, jaundice and serum albumin was used. Clearly, the prognosis depended on disease stage. The median survival of 229 patients who received no specific treatment was 1.6 months, 0.7 month for Stage III patients, 2.0 months for Stage II, and 8.3 months for Stage I. The median survival of Stage I patients who had hepatic resection (n = 115) was 25.6 months and Stage II patients with resection (n = 42) was 12.2 months. In patients who had a small cancer (less than or equal to 25% of liver area in size) the median survival was 29.0 months. Survival of the surgically treated patients, which represented a highly selected group, was better than that of medically treated patients of a comparable stage. Median survival of Stage I medically treated patients (n = 124) was 9.4 months, for Stage II (n = 290) 3.5 months, and for Stage III (n = 50) 1.6 months. Medical treatment prolonged survival in Stage II and III patients, but not in Stage I. Transcatheter arterial embolization gave a better survival compared with chemotherapy, whether intra-arterial bolus administration of mitomycin C, systemic mitomycin C, or oral/rectal tegafur, in Stage II. Among various chemotherapeutic modalities, intra-arterial bolus injection was superior to systemic chemotherapy in survival in Stage II. In Stage III, chemotherapy improved survival as compared with no specific treatment. The major causes of death were hepatic failure and gastrointestinal bleeding, probably due to the coexistent advanced cirrhosis. These results in survival are much improved over the past reports, and the differences are probably a result of earlier diagnosis and frequent hepatic resections.
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