Influence of Time Delay on the Estimated Lung Shunt Fraction on 99mTc-Labeled MAA Scintigraphy for 90Y Microsphere Treatment Planning

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.

[1]  Y. Rolland,et al.  Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization , 2012, European Journal of Nuclear Medicine and Molecular Imaging.

[2]  Y. Rolland,et al.  Effectiveness of quantitative MAA SPECT/CT for the definition of vascularized hepatic volume and dosimetric approach: phantom validation and clinical preliminary results in patients with complex hepatic vascularization treated with yttrium-90-labeled microspheres , 2011, Nuclear medicine communications.

[3]  E. Van Cutsem,et al.  Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  Jeroen Mertens,et al.  99mTc-labelled macroaggregated albumin (MAA) scintigraphy for planning treatment with 90Y microspheres , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  Samer Ezziddin,et al.  Radioembolization of liver tumors with yttrium-90 microspheres. , 2010, Seminars in nuclear medicine.

[6]  Torsten Kuwert,et al.  A review on the clinical uses of SPECT/CT , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[7]  P. Flamen,et al.  Multimodality imaging can predict the metabolic response of unresectable colorectal liver metastases to radioembolization therapy with Yttrium-90 labeled resin microspheres , 2008, Physics in medicine and biology.

[8]  A. Benson,et al.  Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. , 2007, International journal of radiation oncology, biology, physics.

[9]  M. Burton,et al.  Analysis of the distribution of intra-arterial microspheres in human liver following hepatic yttrium-90 microsphere therapy. , 2000, Physics in medicine and biology.

[10]  N. Ackerman,et al.  The blood supply of experimental liver metastases. I. The distribution of hepatic artery and portal vein blood to "small" and "large" tumors. , 1969, Surgery.