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Pianka KT, Barahman M, Minocha J, Redmond JW, Schnickel GT, Rose SC, Fowler KJ, Berman ZT. Voxel-based tumor dose correlates to complete pathologic necrosis after transarterial radioembolization for hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 2024; 51:3744-3752. [PMID: 38913189 DOI: 10.1007/s00259-024-06813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/16/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE The transarterial radioembolization (TARE) dose is traditionally calculated using the single-compartment Medical Internal Radiation Dose (MIRD) formula. This study utilized voxel-based dosimetry to correlate tumor dose with explant pathology in order to identify dose thresholds that predicted response. METHODS All patients with HCC treated with TARE using yttrium-90 [90Y] glass microspheres at a single institution between January 2015 - June 2023 who underwent liver transplantation were eligible. The [90Y] distribution and dose-volume histograms were determined using Simplicity90 (Mirada Medical, Oxford UK) with a Bremsstrahlung SPECT/CT. A complete response was assigned if explant pathology showed complete necrosis and the patient had not undergone additional treatments to the same tumor after TARE. Logistic regression and receiver operator characteristic (ROC) curves were constructed to evaluate dose thresholds correlated with response. RESULTS Forty-one patients were included. Twenty-six (63%) met criteria for complete response. Dose to 95% (D95), 70% (D70), and 50% (D50) of the tumor volume were associated with likelihood of complete response by logistic regression (all p < 0.05). For lesions with complete response versus without, the median D95 was 813 versus 232 Gy, D70 was 1052 versus 315 Gy, and D50 was 1181 versus 369 Gy (all p < 0.01). A D95 > 719 Gy had the highest accuracy at 68% (58% sensitivity, 87% specificity) for predicting complete response. Median percent of tumor volume receiving at least 100 Gy (V100), 200 Gy (V200), 300 Gy (V300), and 400 Gy (V400) also differed by pathologic response: the median V100, V200, V300, and V400 was 100% versus 99%, 100% versus 97%, 100% versus 74%, and 100% versus 43% in the complete response versus non-complete response groups, respectively (all p < 0.05). CONCLUSION Voxel-based dosimetry was well-correlated with explant pathology. The D95 threshold had the highest accuracy, suggesting the D95 may be a relevant target for multi-compartment dosimetry.
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Affiliation(s)
- Kurt T Pianka
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mark Barahman
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA
| | - Jeet Minocha
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA
| | - Jonas W Redmond
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA
| | - Gabriel T Schnickel
- Department of Surgery, University of California San Diego, La Jolla, CA, 92103, USA
| | - Steven C Rose
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA
| | - Zachary T Berman
- Department of Radiology, University of California San Diego, 200 West Arbor Drive, Mail Code 8756, San Diego, CA, USA.
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Marquis H, Ocampo Ramos JC, Carter LM, Zanzonico P, Bolch WE, Laforest R, Kesner AL. MIRD Pamphlet No. 29: MIRDy90-A 90Y Research Microsphere Dosimetry Tool. J Nucl Med 2024; 65:jnumed.123.266743. [PMID: 38388514 PMCID: PMC11064830 DOI: 10.2967/jnumed.123.266743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
90Y-microsphere radioembolization has become a well-established treatment option for liver malignancies and is one of the first U.S. Food and Drug Administration-approved unsealed radionuclide brachytherapy devices to incorporate dosimetry-based treatment planning. Several different mathematical models are used to calculate the patient-specific prescribed activity of 90Y, namely, body surface area (SIR-Spheres only), MIRD single compartment, and MIRD dual compartment (partition). Under the auspices of the MIRDsoft initiative to develop community dosimetry software and tools, the body surface area, MIRD single-compartment, MIRD dual-compartment, and MIRD multicompartment models have been integrated into a MIRDy90 software worksheet. The worksheet was built in MS Excel to estimate and compare prescribed activities calculated via these respective models. The MIRDy90 software was validated against available tools for calculating 90Y prescribed activity. The results of MIRDy90 calculations were compared with those obtained from vendor and community-developed tools, and the calculations agreed well. The MIRDy90 worksheet was developed to provide a vetted tool to better evaluate patient-specific prescribed activities calculated via different models, as well as model influences with respect to varying input parameters. MIRDy90 allows users to interact and visualize the results of various parameter combinations. Variables, equations, and calculations are described in the MIRDy90 documentation and articulated in the MIRDy90 worksheet. The worksheet is distributed as a free tool to build expertise within the medical physics community and create a vetted standard for model and variable management.
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Affiliation(s)
- Harry Marquis
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan C Ocampo Ramos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lukas M Carter
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Wesley E Bolch
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida; and
| | - Richard Laforest
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Adam L Kesner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York;
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Quinton F, Presles B, Leclerc S, Nodari G, Lopez O, Chevallier O, Pellegrinelli J, Vrigneaud JM, Popoff R, Meriaudeau F, Alberini JL. Navigating the nuances: comparative analysis and hyperparameter optimisation of neural architectures on contrast-enhanced MRI for liver and liver tumour segmentation. Sci Rep 2024; 14:3522. [PMID: 38347017 PMCID: PMC10861452 DOI: 10.1038/s41598-024-53528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
In medical imaging, accurate segmentation is crucial to improving diagnosis, treatment, or both. However, navigating the multitude of available architectures for automatic segmentation can be overwhelming, making it challenging to determine the appropriate type of architecture and tune the most crucial parameters during dataset optimisation. To address this problem, we examined and refined seven distinct architectures for segmenting the liver, as well as liver tumours, with a restricted training collection of 60 3D contrast-enhanced magnetic resonance images (CE-MRI) from the ATLAS dataset. Included in these architectures are convolutional neural networks (CNNs), transformers, and hybrid CNN/transformer architectures. Bayesian search techniques were used for hyperparameter tuning to hasten convergence to the optimal parameter mixes while also minimising the number of trained models. It was unexpected that hybrid models, which typically exhibit superior performance on larger datasets, would exhibit comparable performance to CNNs. The optimisation of parameters contributed to better segmentations, resulting in an average increase of 1.7% and 5.0% in liver and tumour segmentation Dice coefficients, respectively. In conclusion, the findings of this study indicate that hybrid CNN/transformer architectures may serve as a practical substitute for CNNs even in small datasets. This underscores the significance of hyperparameter optimisation.
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Affiliation(s)
- Felix Quinton
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France.
| | - Benoit Presles
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
| | - Sarah Leclerc
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
| | - Guillaume Nodari
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, 21000, Dijon, France
| | - Olivier Lopez
- Service de Radiologie et Imagerie Medicale Diagnostique et Therapeutique, Centre Hospitalier Universitaire, 21000, Dijon, France
| | - Olivier Chevallier
- Service de Radiologie et Imagerie Medicale Diagnostique et Therapeutique, Centre Hospitalier Universitaire, 21000, Dijon, France
| | - Julie Pellegrinelli
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, 21000, Dijon, France
| | - Jean-Marc Vrigneaud
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, 21000, Dijon, France
| | - Romain Popoff
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, 21000, Dijon, France
| | - Fabrice Meriaudeau
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
| | - Jean-Louis Alberini
- Institut de Chimie Moléculaire de l'Université de Bourgogne, ICMUB UMR CNRS 6302, Université Bourgogne, 21000, Dijon, France
- Service de Médecine Nucléaire, Centre Georges-François Leclerc, 21000, Dijon, France
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Pham TP, Presles B, Popoff R, Alberini JL, Vrigneaud JM. Pre-treatment dosimetry in 90Y-SIRT: Is it possible to optimise SPECT reconstruction parameters and calculation methods for accurate dosimetry? Phys Med 2023; 115:103145. [PMID: 37852020 DOI: 10.1016/j.ejmp.2023.103145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 06/03/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
PURPOSE The aim of this study was (a) to optimise the99mTc-SPECT reconstruction parameters for the pre-treatment dosimetry of90Y-selective internal radiation therapy (SIRT) and (b) to compare the accuracy of clinical dosimetry methods with full Monte-Carlo dosimetry (fMCD) performed with Gate. METHODS To optimise the reconstruction parameters, two hundred reconstructions with different parameters were performed on a NEMA phantom, varying the number of iterations, subsets, and post-filtering. The accuracy of the dosimetric methods was then investigated using an anthropomorphic phantom. Absorbed dose maps were generated using (1) the Partition Model (PM), (2) the Dose Voxel Kernel (DVK) convolution, and (3) the Local Deposition Method (LDM) with known activity restricted to the whole phantom (WP) or to the liver and lungs (LL). The dose to the lungs was calculated using the "multiple DVK" and "multiple LDM" methods. RESULTS Optimal OSEM reconstruction parameters were found to depend on object size and dosimetric criterion chosen (Dmean or DVH-derived metric). The Dmean of all three dosimetric methods was close (≤ 10%) to the Dmean of fMCD simulations when considering large segmented volumes (whole liver, normal liver). In contrast, the Dmean to the small volume (∅=31) was systemically underestimated (12%-25%). For lungs, the "multiple DVK" and "multiple LDM" methods yielded a Dmean within 20% for the WP method and within 10% for the LL method. CONCLUSIONS All three methods showed a substantial degradation of the dose-volume histograms (DVHs) compared to fMCD simulations. The DVK and LDM methods performed almost equally well, with the "multiple DVK" method being more accurate in the lungs.
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Affiliation(s)
- Tien-Phong Pham
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France.
| | - Benoit Presles
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France
| | - Romain Popoff
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France
| | - Jean-Louis Alberini
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France
| | - Jean-Marc Vrigneaud
- Institut de Chimie Moléculaire de l'Université de Bourgogne (ICMUB) - UMR CNRS 6302, University of Burgundy, Dijon, France; Department of Nuclear Medicine, Georges-François Leclerc Cancer Centre, Dijon, France.
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Pinaquy JB, Lapuyade B, Blanc JF, Hindié E, Papadopoulos P, Debordeaux F. Personalized 90 Y-resin microspheres dose determination: a retrospective study on the impact of dosimetry software on the treatment of patients with selective internal radiotherapy. Nucl Med Commun 2023; 44:358-365. [PMID: 36862426 DOI: 10.1097/mnm.0000000000001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION The calculation of resin yttrium-90 ( 90 Y-) microspheres activity for selective internal radiotherapy (SIRT) needs to be investigated. METHODS AND MATERIALS Analyses using Simplicit 90 Y (Boston Scientific, Natick, Massachusetts, USA) dosimetry software were performed to determine the concordance between the absorbed doses to the tumor (D T1 and D T2 ) and healthy liver (D N1 and D N2 ) during the pre-treatment and the post-treatment phases. An optimized calculation of the activity of 90 Y-microspheres performed using dosimetry software was applied retrospectively to assess the impact of this calculation method on the treatment. RESULTS D T1 ranged from 38.8 to 372 Gy, with a mean value of 128.9 ± 73.6 Gy and median of 121.2 Gy [interquartile range (IQR): 81.7-158.8 Gy]. The median D N1 and D N2 was 10.5 Gy (IQR: 5.8-17.6). A significant correlation was between D T1 and D T2 ( r = 0.88, P < 0.001) and D N1 and D N2 ( r = 0.96, P < 0.001). The optimized activities were calculated; the target dose to the tumor compartment was 120 Gy. No activity reduction was applied in accordance with the tolerance of the healthy liver. Optimization of the microspheres dosages would have resulted in a significant increase in activity for nine treatments (0.21-2.54 GBq) and a reduction for seven others (0.25-0.76 GBq). CONCLUSIONS The development of customized dosimetry software adapted to clinical practice makes it possible to use dosimetry to optimize the dosage for each patient.
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Affiliation(s)
| | - Bruno Lapuyade
- CHU de Bordeaux, Service de radiologie et d'imagerie diagnostique et interventionnelle
| | - Jean-Frederic Blanc
- CHU de Bordeaux, Service d'hépato-gastro-entérologie et oncologie digestive, Bordeaux, France
| | - Elif Hindié
- CHU de Bordeaux, Service de Médecine nucléaire
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Milano A, Capotosti A, Zagaria L, Perotti G, Rizzo A, Longo V, De Leoni D, Moretti R, Breschi L, Meffe G, Placidi L, Cusumano D, Cerrito L, Annunziata S, Iezzi R, Indovina L. Dose-response Analysis in Hepatic Tumors Treated with 90Y-TARE According to a Personalized Dosimetric Workflow: Preliminary Results. Curr Radiopharm 2023; 16:326-336. [PMID: 37291781 DOI: 10.2174/1874471016666230608100921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transarterial Radioembolization (TARE) is a widespread radiation therapy for unresectable hepatic lesions, but a clear understanding of the dose-response link is still missing. The aim of this preliminary study is to investigate the role of both dosimetric and clinical parameters as classifiers or predictors of response and survival for TARE in hepatic tumors and to present possible response cut-off. METHODS 20 patients treated with glass or resin microspheres according to a personalized workflow were included. Dosimetric parameters were extracted from personalized absorbed dose maps obtained from the convolution of 90Y PET images with 90Y voxel S-values. RESULTS D95 ≥ 104 Gy and tumor mean absorbed dose MADt ≥ 229 Gy were found to be optimal cut-off values for complete response, while D30 ≥ 180 Gy and MADt ≥ 117 Gy were selected as cut-off values for at least partial response and predicted better survival. Clinical parameters Alanine Transaminase (ALT) and Model for End-Stage Liver Disease (MELD) didn't show sufficient classification capability for response or survival. CONCUSION These preliminary results highlight the importance of an accurate dosimetric evaluation and suggest a cautious approach when considering clinical indicators. Dosimetric cut-off values could be a support tool in both planning and post-treatment phases. Larger multi-centric randomized trials, with standardized methods regarding patient selection, response criteria, Regions of Interest definition, dosimetric approach and activity planning are needed to confirm these promising results.
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Affiliation(s)
- Alessia Milano
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Amedeo Capotosti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Luca Zagaria
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Germano Perotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO - IRCCS, Turin, Italy
| | - Valentina Longo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Davide De Leoni
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy
| | - Roberto Moretti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Laura Breschi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Guenda Meffe
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Davide Cusumano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
- UOS Fisica Medica, Mater Olbia Hospital, Strada Statale 125 Orientale Sarda - 07026 Olbia SS, Italy
| | - Lucia Cerrito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Salvatore Annunziata
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo F. Vito 1, 00168 Roma, Italy
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Taebi A, Janibek N, Goldman R, Pillai R, Vu CT, Roncali E. The Impact of Injection Distance to Bifurcations on Yttrium-90 Distribution in Liver Cancer Radioembolization. J Vasc Interv Radiol 2022; 33:668-677.e1. [PMID: 35301128 PMCID: PMC9156550 DOI: 10.1016/j.jvir.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To model the effect of the injection location on the distribution of yttrium-90 (90Y) microspheres in the liver during radioembolization using computational simulation and to determine the potential effects of radial movements of the catheter tip. MATERIALS AND METHODS Numerical studies were conducted using images from a representative patient with hepatocellular carcinoma. The right hepatic artery (RHA) was segmented from contrast-enhanced cone-beam computed tomography scans. The blood flow was investigated in the trunk of the RHA using numerical simulations for 6 injection position scenarios at 2 sites located at a distance of approximately 5 and 20 mm upstream of the first bifurcation (RHA diameters of approximately 4.6 mm). The 90Y delivery to downstream vessels was calculated from the simulated hepatic artery hemodynamics. RESULTS Varying the injection location along the RHA and across the vessel cross-section resulted in different simulated microsphere distributions in the downstream vascular bed. When the catheter tip was 5 mm upstream of the bifurcation, 90Y distribution in the downstream branches varied by as much as 53% with a 1.5-mm radial movement of the tip. However, the catheter radial movement had a weaker effect on the microsphere distribution when the injection plane was farther from the first bifurcation (20 mm), with a maximum delivery variation of 9% to a downstream branch. CONCLUSIONS An injection location far from bifurcations is recommended to minimize the effect of radial movements of the catheter tip on the microsphere distribution.
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Affiliation(s)
- Amirtaha Taebi
- Department of Agricultural and Biological Engineering, Mississippi State University
| | - Nursultan Janibek
- Department of Mechanical and Aerospace Engineering, University of California Davis
| | - Roger Goldman
- Department of Radiology, University of California Davis
| | - Rex Pillai
- Department of Radiology, University of California Davis
| | | | - Emilie Roncali
- Department of Radiology, University of California Davis,Department of Biomedical Engineering, University of California Davis
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Ebbers SC, Brabander T, Tesselaar MET, Hofland J, Braat MNGJA, Wessels FJ, Barentsz MW, Lam MGEH, Braat AJAT. Inflammatory markers and long term hematotoxicity of holmium-166-radioembolization in liver-dominant metastatic neuroendocrine tumors after initial peptide receptor radionuclide therapy. EJNMMI Res 2022; 12:7. [PMID: 35107642 PMCID: PMC8811020 DOI: 10.1186/s13550-022-00880-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In patients with neuroendocrine tumor liver metastases, additional tumor reduction can be achieved by sequential treatment with [166Ho]-radioembolization after peptide receptor radionuclide therapy (PRRT). The aim of this study was to analyze hematotoxicity profiles, (i.e. lymphocyte and neutrophile toxicity) and the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and thrombocyte-to-lymphocyte ratio (TLR). METHODS All patients included in the prospective HEPAR PLuS study were included in this study. Blood testing was performed at baseline (before radioembolization) and at regular intervals during 1-year follow-up. Radiological response was assessed at 3, 6, 9, and 12 months according to RECIST 1.1. Logistic regression was used to analyze the prognostic value of NLR and TLR on response. RESULTS Thirty-one patients were included in the toxicity analysis; thirty were included in the response analysis. Three weeks after radioembolization, a significant decrease in lymphocyte count (mean change - 0.26 × 109/L) was observed. Ten patients (32.2%) experienced grade 3-4 lymphocyte toxicity. This normalized at 6 weeks and 3 months after treatment, while after 6 months a significant increase in lymphocyte count was observed. An increase in NLR and TLR at 3 weeks, compared to baseline, significantly predicted response at 3 months (AUC = 0.841 and AUC = 0.839, respectively) and at 6 months (AUC = 0.779 and AUC = 0.765). No significant relation with survival was found. CONCLUSIONS Toxicity after sequential treatment with PRRT and [166Ho]-radioembolization is limited and temporary, while significant additional benefit can be expected. Change in NLR and TLR at 3-weeks follow-up may be valuable early predictors of response. Trial registration ClinicalTrials.gov, NCT02067988. Registered 20 February 2014, https://clinicaltrials.gov/ct2/show/record/NCT02067988 .
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Affiliation(s)
- Sander C Ebbers
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tessa Brabander
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Margot E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Johannes Hofland
- Department of Internal Medicine, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank J Wessels
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten W Barentsz
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Diagnostic and prognostic value of 99mTc-MAA SPECT/CT for treatment planning of 90Y-resin microsphere radioembolization for hepatocellular carcinoma: comparison with planar image. Sci Rep 2021; 11:3207. [PMID: 33547398 PMCID: PMC7864932 DOI: 10.1038/s41598-021-82887-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/25/2021] [Indexed: 12/25/2022] Open
Abstract
99mTc-macroaggregated albumin (MAA) imaging is performed before transarterial radioembolization (TARE), in which SPECT/CT is presumed more precise than planar image. However, additive role of SPECT/CT has not been well established. Thirty-four consecutive hepatocellular carcinoma patients of intermediate and advanced stages who underwent 90Y-microsphere TARE were recruited. On pre-treatment planning scan using 99mTc-MAA, image characteristics and absorbed dose for target tumors calculated by partition model methods were estimated on planar image and SPECT/CT, respectively. The measurements were repeated on post-treatment 90Y PET/CT, as the reference standard. Treatment response was assessed and predictive values of image parameters were analyzed. The image characteristics including heterogeneity, necrosis and thrombosis uptake were better delineated on SPECT/CT than planar scan. The agreement and correlation of TNr between SPECT/CT and PET/CT were stronger than those between planar scan and PET/CT. Tumor dose estimated on 99mTc-MAA SPECT/CT was more effective than planar image for prediction of treatment response, with cutoff value 125 Gy (sensitivity of 86% and specificity of 75%). In conclusion, 99mTc-MAA SPECT/CT is more closely correlated with post-treatment 90Y PET/CT, and is more effective for predicting treatment response than planar scan. SPECT/CT is superior to planar image in simulation before 90Y TARE.
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Morán V, Prieto E, Sancho L, Rodríguez-Fraile M, Soria L, Zubiria A, Martí-Climent JM. Impact of the dosimetry approach on the resulting 90Y radioembolization planned absorbed doses based on 99mTc-MAA SPECT-CT: is there agreement between dosimetry methods? EJNMMI Phys 2020; 7:72. [PMID: 33284389 PMCID: PMC7721939 DOI: 10.1186/s40658-020-00343-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prior radioembolization, a simulation using 99mTc-macroaggregated albumin as 90Y-microspheres surrogate is performed. Gamma scintigraphy images (planar, SPECT, or SPECT-CT) are acquired to evaluate intrahepatic 90Y-microspheres distribution and detect possible extrahepatic and lung shunting. These images may be used for pre-treatment dosimetry evaluation to calculate the 90Y activity that would get an optimal tumor response while sparing healthy tissues. Several dosimetry methods are available, but there is still no consensus on the best methodology to calculate absorbed doses. The goal of this study was to retrospectively evaluate the impact of using different dosimetry approaches on the resulting 90Y-radioembolization pre-treatment absorbed dose evaluation based on 99mTc-MAA images. METHODS Absorbed doses within volumes of interest resulting from partition model (PM) and 3D voxel dosimetry methods (3D-VDM) (dose-point kernel convolution and local deposition method) were evaluated. Additionally, a new "Multi-tumor Partition Model" (MTPM) was developed. The differences among dosimetry approaches were evaluated in terms of mean absorbed dose and dose volume histograms within the volumes of interest. RESULTS Differences in mean absorbed dose among dosimetry methods are higher in tumor volumes than in non-tumoral ones. The differences between MTPM and both 3D-VDM were substantially lower than those observed between PM and any 3D-VDM. A poor correlation and concordance were found between PM and the other studied dosimetry approaches. DVH obtained from either 3D-VDM are pretty similar in both healthy liver and individual tumors. Although no relevant global differences, in terms of absorbed dose in Gy, between both 3D-VDM were found, important voxel-by-voxel differences have been observed. CONCLUSIONS Significant differences among the studied dosimetry approaches for 90Y-radioembolization treatments exist. Differences do not yield a substantial impact in treatment planning for healthy tissue but they do for tumoral liver. An individual segmentation and evaluation of the tumors is essential. In patients with multiple tumors, the application of PM is not optimal and the 3D-VDM or the new MTPM are suggested instead. If a 3D-VDM method is not available, MTPM is the best option. Furthermore, both 3D-VDM approaches may be indistinctly used.
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Affiliation(s)
- Verónica Morán
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Elena Prieto
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Macarena Rodríguez-Fraile
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain.,Department of Nuclear Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Leticia Soria
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Madrid, Spain
| | - Arantxa Zubiria
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Josep M Martí-Climent
- Department of Medical Physics and Radiation Safety, Clínica Universidad de Navarra, Pamplona, Spain. .,IdisNA, Navarra Institute for Health Research, Pamplona, Spain.
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11
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Tiwari A, Saraf S, Jain A, Panda PK, Verma A, Jain SK. Basics to advances in nanotherapy of colorectal cancer. Drug Deliv Transl Res 2020; 10:319-338. [PMID: 31701486 DOI: 10.1007/s13346-019-00680-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer existing across the globe. It begins with the formation of polyps leading to the development of metastasis, especially in advanced stage patients, who necessitate intensive chemotherapy that usually results in a poor response and high morbidity owing to multidrug resistance and severe untoward effects to the non-cancerous cells. Advancements in the targeted drug delivery permit the targeting of tumor cells without affecting the non-tumor cells. Various nanocarriers such as liposomes, polymeric nanoparticles, carbon nanotubes, micelles, and nanogels, etc. are being developed and explored for effective delivery of cytotoxic drugs to the target site thereby enhancing the drug distribution and bioavailability, simultaneously subduing the side effects. Moreover, immunotherapy for CRC is being explored for last few decades. Few clinical trials have even potentially benefited patients suffering from CRC, still immunotherapy persists merely an experimental alternative. Assessment of the ongoing and completed trials is to be warranted for effective treatment of CRC. Scientists are paying efforts to develop novel carrier systems that may enhance the targeting potential of low therapeutic index chemo- and immune-therapeutics. Several preclinical studies have revealed the superior efficacy of nanotherapy in CRC as compared to conventional approaches. Clinical trials are being recruited to ascertain the safety and efficacy of CRC therapies. The present review discourses in a nutshell the molecular interventions including the genetics, signaling pathways involved in CRC, and advances in various strategies explored for the treatment of CRC with a special emphasis on nanocarriers based drug targeting.
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Affiliation(s)
- Ankita Tiwari
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India
| | - Shivani Saraf
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India
| | - Ankit Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India
- Institute of Pharmaceutical Research, GLA University, NH-2, Mathura-Delhi Road, Mathura, 281 406 (U.P.), India
| | - Pritish K Panda
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India
| | - Amit Verma
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India
| | - Sanjay K Jain
- Pharmaceutics Research Projects Laboratory, Department of Pharmaceutical Sciences, Dr. Harisingh Gour Central University, Sagar, 470 003 (M.P.), India.
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12
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van Roekel C, Braat AJAT, Smits MLJ, Bruijnen RCG, de Keizer B, Lam MGEH. Radioembolization. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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A guide to 90Y radioembolization and its dosimetry. Phys Med 2019; 68:132-145. [DOI: 10.1016/j.ejmp.2019.09.236] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 01/14/2023] Open
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14
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Kafrouni M, Allimant C, Fourcade M, Vauclin S, Guiu B, Mariano-Goulart D, Ben Bouallègue F. Analysis of differences between 99mTc-MAA SPECT- and 90Y-microsphere PET-based dosimetry for hepatocellular carcinoma selective internal radiation therapy. EJNMMI Res 2019; 9:62. [PMID: 31332585 PMCID: PMC6646451 DOI: 10.1186/s13550-019-0533-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/12/2019] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to compare predictive and post-treatment dosimetry and analyze the differences, investigating factors related to activity preparation and delivery, imaging modality used, and interventional radiology. Methods Twenty-three HCC patients treated by selective internal radiation therapy with 90Y glass microspheres were included in this study. Predictive and post-treatment dosimetry were calculated at the voxel level based on 99mTc-MAA SPECT/CT and 90Y-microsphere PET/CT respectively. Dose distribution was analyzed through mean dose, metrics extracted from dose-volume histograms, and Dice similarity coefficients applied on isodoses. Reproducibility of the radiological gesture and its influence on dose deviation was evaluated. Results 90Y delivered activity was lower than expected in 67% (16/24) of the cases mainly due to the residual activity. A mean deviation of − 6 ± 11% was observed between the delivered activity and the 90Y PET’s FOV activity. In addition, a substantial difference of − 20 ± 8% was measured on 90Y PET images between the activity in the liver and in the whole FOV. After normalization, 99mTc-MAA SPECT dosimetry was highly correlated and concordant with 90Y-microsphere PET dosimetry for all dose metrics evaluated (ρ = 0.87, ρc = 0.86, P = 3.10−8 and ρ = 0.91, ρc = 0.90, P = 7.10−10 for tumor and normal liver mean dose respectively for example). Besides, mean tumor dose deviation was lower when the catheter position was identical than when it differed (16 Gy vs. 37 Gy, P = 0.007). Concordance between predictive and post-treatment dosimetry, evaluated with Dice similarity coefficients applied on isodoses, significantly correlated with the distance of the catheter position from artery bifurcation (P = 0.04, 0.0004, and 0.05, for 50 Gy, 100 Gy, and 150 Gy isodoses respectively). Conclusions Discrepancies between planned activity and activity measured on 90Y PET images were observed and seemed to be mainly related to clinical hazards and equipment issues. Predictive vs. post-treatment comparison of relative dose distributions between tumor and normal liver showed a good correlation and no significant difference highlighting the predictive value of 99mTc MAA SPECT/CT-based dosimetry. Besides, the reproducibility of catheter tip position appears critical in the agreement between predictive and actual dose distribution.
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Affiliation(s)
- Marilyne Kafrouni
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France. .,PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France. .,DOSIsoft SA, Cachan, France.
| | - Carole Allimant
- Department of Radiology, Montpellier University Hospital, Montpellier, France
| | - Marjolaine Fourcade
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Boris Guiu
- PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France.,Department of Radiology, Montpellier University Hospital, Montpellier, France
| | - Denis Mariano-Goulart
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France.,PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France
| | - Fayçal Ben Bouallègue
- Department of Nuclear Medicine, Montpellier University Hospital, Montpellier, France.,PhyMedExp, Montpellier University, INSERM, CNRS, Montpellier, France
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15
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Jafargholi Rangraz E, Coudyzer W, Maleux G, Baete K, Deroose CM, Nuyts J. Multi-modal image analysis for semi-automatic segmentation of the total liver and liver arterial perfusion territories for radioembolization. EJNMMI Res 2019; 9:19. [PMID: 30788640 PMCID: PMC6382918 DOI: 10.1186/s13550-019-0485-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/29/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose We have developed a multi-modal imaging approach for SIRT, combining 99mTc-MAA SPECT/CT and/or 90Y PET, 18F-FDG PET/CT, and contrast-enhanced CBCT for voxel-based dosimetry, as a tool for treatment planning and verification. For radiation dose prediction calculations, a segmentation of the total liver volume and of the liver perfusion territories is required. Method In this paper, we proposed a procedure for multi-modal image analysis to assist SIRT treatment planning. The pre-treatment 18F-FDG PET/CT, 99mTc-MAA SPECT/CT, and contrast-enhanced CBCT images were registered to a common space using an initial rigid, followed by a deformable registration. The registration was scored by an expert using Likert scores. The total liver was segmented semi-automatically based on the PET/CT and SPECT/CT images, and the liver perfusion territories were determined based on the CBCT images. The segmentations of the liver and liver lobes were compared to the manual segmentations by an expert on a CT image. Result Our methodology showed that multi-modal image analysis can be used for determination of the liver and perfusion territories using CBCT in SIRT using all pre-treatment studies. The results for image registration showed acceptable alignment with limited impact on dosimetry. The image registration performs well according to the expert reviewer (scored as perfect or with little misalignment in 94% of the cases). The semi-automatic liver segmentation agreed well with manual liver segmentation (dice coefficient of 0.92 and an average Hausdorff distance of 3.04 mm). The results showed disagreement between lobe segmentation using CBCT images compared to lobe segmentation based on CT images (average Hausdorff distance of 14.18 mm), with a high impact on the dosimetry (differences up to 9 Gy for right and 21 Gy for the left liver lobe). Conclusion This methodology can be used for pre-treatment dosimetry and for SIRT planning including the determination of the activity that should be administered to achieve the therapeutical goal. The inclusion of perfusion CBCT enables perfusion-based definition of the liver lobes, which was shown to be markedly different from the anatomical definition in some of the patients.
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Affiliation(s)
| | - Walter Coudyzer
- Radiology Section, Department of imaging and pathology, UZ Leuven, Leuven, Belgium
| | - Geert Maleux
- Radiology Section, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Kristof Baete
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Christophe M Deroose
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
| | - Johan Nuyts
- Nuclear Medicine, Department of imaging and pathology, UZ & KU Leuven, Leuven, Belgium
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16
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Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases: International Multicenter Study on Efficacy and Toxicity. Cardiovasc Intervent Radiol 2019; 42:413-425. [DOI: 10.1007/s00270-018-2148-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/15/2018] [Indexed: 01/27/2023]
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17
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van der Velden S, Dietze MMA, Viergever MA, de Jong HWAM. Fast technetium-99m liver SPECT for evaluation of the pretreatment procedure for radioembolization dosimetry. Med Phys 2019; 46:345-355. [PMID: 30347130 PMCID: PMC7379506 DOI: 10.1002/mp.13253] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The efficiency of radioembolization procedures could be greatly enhanced if results of the 99m Tc-MAA pretreatment procedure were immediately available in the interventional suite, enabling 1-day procedures as a result of direct estimation of the hepatic radiation dose and lung shunt fraction. This would, however, require a relatively fast, but still quantitative, SPECT procedure, which might be achieved with acquisition protocols using nonuniform durations of the projection images. METHODS SPECT liver images of the 150-MBq 99m Tc-MAA pretreatment procedure were simulated for eight different lesion locations and two different lesion sizes using the digital XCAT phantom for both single- and dual-head scanning geometries with respective total acquisition times of 1, 2, 5, 10, and 30 min. Three nonuniform projection-time acquisition protocols ("half-circle SPECT (HCS)," "nonuniform SPECT (NUS) I," and "NUS II") for fast quantitative SPECT of the liver were designed and compared with the standard uniform projection-time protocol. Images were evaluated in terms of contrast-to-noise ratio (CNR), activity recovery coefficient (ARC), tumor/non-tumor (T/N) activity concentration ratio, and lung shunt fraction (LSF) estimation. In addition, image quality was verified with a physical phantom experiment, reconstructed with both clinical and Monte Carlo-based reconstruction software. RESULTS Simulations showed no substantial change in image quality and dosimetry by usage of a nonuniform projection-time acquisition protocol. Upon shortening acquisition times, CNR dropped, but ARC, T/N ratio, and LSF estimates were stable across all simulated acquisition times. Results of the physical phantom were in agreement with those of the simulations. CONCLUSION Both uniform and nonuniform projection-time acquisition liver SPECT protocols yield accurate dosimetric metrics for radioembolization treatment planning in the interventional suite within 10 min, without compromising image quality. Consequently, fast quantitative SPECT of the liver in the interventional suite is feasible.
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Affiliation(s)
- Sandra van der Velden
- Radiology and Nuclear MedicineUniversity Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
- Image Sciences InstituteUtrecht University and University Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
| | - Martijn M. A. Dietze
- Radiology and Nuclear MedicineUniversity Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
- Image Sciences InstituteUtrecht University and University Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
| | - Max A. Viergever
- Image Sciences InstituteUtrecht University and University Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
| | - Hugo W. A. M. de Jong
- Radiology and Nuclear MedicineUniversity Medical Center UtrechtP.O. Box 855003508 GAUtrechtNetherlands
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18
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Sapienza MT, Willegaignon J. Radionuclide therapy: current status and prospects for internal dosimetry in individualized therapeutic planning. Clinics (Sao Paulo) 2019; 74:e835. [PMID: 31365617 PMCID: PMC6644503 DOI: 10.6061/clinics/2019/e835] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/04/2019] [Indexed: 11/29/2022] Open
Abstract
The efficacy and toxicity of radionuclide therapy are believed to be directly related to the radiation doses received by target tissues; however, nuclear medicine therapy continues to be based primarily on the administration of empirical activities to patients and less frequently on the use of internal dosimetry for individual therapeutic planning. This review aimed to critically describe the techniques and clinical evidence of dosimetry as a tool for therapeutic planning and the main limitations to its implementation in clinical practice. The present article is a nonsystematic review of voxel-based dosimetry. Clinical evidence pointing to a correlation between the radiation dose and therapeutic response in various diseases, such as thyroid carcinoma, neuroendocrine tumors and prostate cancer, is reviewed. Its limitations include technical aspects related to image acquisition and processing and the lack of randomized clinical trials demonstrating the impact of dosimetry on patient therapy. A more widespread use of dosimetry in therapeutic planning involves the development of user-friendly dosimetric protocols and confirmation that dose estimation implies good efficacy and low treatment-related toxicity.
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Affiliation(s)
- Marcelo Tatit Sapienza
- Radiologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, BR
- *Corresponding Author. E-mail:
| | - José Willegaignon
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding Author. E-mail:
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19
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Hoang NS, Khalaf MH, Rosenberg JK, Kwofie J, Reposar AL, Wang DS, Louie JD, Sze DY. Quantification of Activity Lost to Delivery-System Residual and Decay in Yttrium-90 Radioembolization. J Vasc Interv Radiol 2018; 29:1672-1677. [DOI: 10.1016/j.jvir.2018.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 12/20/2022] Open
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20
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Mikell JK, Kaza RK, Roberson PL, Younge KC, Srinivasa RN, Majdalany BS, Cuneo KC, Owen D, Devasia T, Schipper MJ, Dewaraja YK. Impact of 90Y PET gradient-based tumor segmentation on voxel-level dosimetry in liver radioembolization. EJNMMI Phys 2018; 5:31. [PMID: 30498973 PMCID: PMC6265358 DOI: 10.1186/s40658-018-0230-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 10/09/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The purpose was to validate 90Y PET gradient-based tumor segmentation in phantoms and to evaluate the impact of the segmentation method on reported tumor absorbed dose (AD) and biological effective dose (BED) in 90Y microsphere radioembolization (RE) patients. A semi-automated gradient-based method was applied to phantoms and patient tumors on the 90Y PET with the initial bounding volume for gradient detection determined from a registered diagnostic CT or MR; this PET-based segmentation (PS) was compared with radiologist-defined morphologic segmentation (MS) on CT or MRI. AD and BED volume histogram metrics (D90, D70, mean) were calculated using both segmentations and concordance/correlations were investigated. Spatial concordance was assessed using Dice similarity coefficient (DSC) and mean distance to agreement (MDA). PS was repeated to assess intra-observer variability. RESULTS In phantoms, PS demonstrated high accuracy in lesion volumes (within 15%), AD metrics (within 11%), high spatial concordance relative to morphologic segmentation (DSC > 0.86 and MDA < 1.5 mm), and low intra-observer variability (DSC > 0.99, MDA < 0.2 mm, AD/BED metrics within 2%). For patients (58 lesions), spatial concordance between PS and MS was degraded compared to in-phantom (average DSC = 0.54, average MDA = 4.8 mm); the average mean tumor AD was 226 ± 153 and 197 ± 138 Gy, respectively for PS and MS. For patient AD metrics, the best Pearson correlation (r) and concordance correlation coefficient (ccc) between segmentation methods was found for mean AD (r = 0.94, ccc = 0.92), but worsened as the metric approached the minimum dose (for D90, r = 0.77, ccc = 0.69); BED metrics exhibited a similar trend. Patient PS showed low intra-observer variability (average DSC = 0.81, average MDA = 2.2 mm, average AD/BED metrics within 3.0%). CONCLUSIONS 90Y PET gradient-based segmentation led to accurate/robust results in phantoms, and showed high concordance with MS for reporting mean tumor AD/BED in patients. However, tumor coverage metrics such as D90 exhibited worse concordance between segmentation methods, highlighting the need to standardize segmentation methods when reporting AD/BED metrics from post-therapy 90Y PET. Estimated differences in reported AD/BED metrics due to segmentation method will be useful for interpreting RE dosimetry results in the literature including tumor response data.
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Affiliation(s)
- Justin K Mikell
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Peter L Roberson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kelly C Younge
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ravi N Srinivasa
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bill S Majdalany
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Theresa Devasia
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuni K Dewaraja
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Bastiaannet R, Kappadath SC, Kunnen B, Braat AJAT, Lam MGEH, de Jong HWAM. The physics of radioembolization. EJNMMI Phys 2018; 5:22. [PMID: 30386924 PMCID: PMC6212377 DOI: 10.1186/s40658-018-0221-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
Radioembolization is an established treatment for chemoresistant and unresectable liver cancers. Currently, treatment planning is often based on semi-empirical methods, which yield acceptable toxicity profiles and have enabled the large-scale application in a palliative setting. However, recently, five large randomized controlled trials using resin microspheres failed to demonstrate a significant improvement in either progression-free survival or overall survival in both hepatocellular carcinoma and metastatic colorectal cancer. One reason for this might be that the activity prescription methods used in these studies are suboptimal for many patients.In this review, the current dosimetric methods and their caveats are evaluated. Furthermore, the current state-of-the-art of image-guided dosimetry and advanced radiobiological modeling is reviewed from a physics' perspective. The current literature is explored for the observation of robust dose-response relationships followed by an overview of recent advancements in quantitative image reconstruction in relation to image-guided dosimetry.This review is concluded with a discussion on areas where further research is necessary in order to arrive at a personalized treatment method that provides optimal tumor control and is clinically feasible.
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Affiliation(s)
- Remco Bastiaannet
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - S. Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Unit 1352, Houston, TX 77030 USA
| | - Britt Kunnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Arthur J. A. T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Room E01.132, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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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] [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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Braat AJAT, Kwekkeboom DJ, Kam BLR, Teunissen JJM, de Herder WW, Dreijerink KMA, van Rooij R, Krijger GC, de Jong HWAM, van den Bosch MAAJ, Lam MGEH. Additional hepatic 166Ho-radioembolization in patients with neuroendocrine tumours treated with 177Lu-DOTATATE; a single center, interventional, non-randomized, non-comparative, open label, phase II study (HEPAR PLUS trial). BMC Gastroenterol 2018; 18:84. [PMID: 29902988 PMCID: PMC6003090 DOI: 10.1186/s12876-018-0817-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Neuroendocrine tumours (NET) consist of a heterogeneous group of neoplasms with various organs of origin. At diagnosis 21% of the patients with a Grade 1 NET and 30% with a Grade 2 NET have distant metastases. Treatment with peptide receptor radionuclide therapy (PRRT) shows a high objective response rate and long median survival after treatment. However, complete remission is almost never achieved. The liver is the most commonly affected organ in metastatic disease and is the most incriminating factor for patient survival. Additional treatment of liver disease after PRRT may improve outcome in NET patients. Radioembolization is an established therapy for liver metastasis. To investigate this hypothesis, a phase 2 study was initiated to assess effectiveness and toxicity of holmium-166 radioembolization (166Ho-RE) after PRRT with lutetium-177 (177Lu)-DOTATATE. Methods The HEPAR PLUS trial (“HolmiumEmbolizationParticles forArterialRadiotherapyPlus177Lu-DOTATATE inSalvage NET patients”) is a single centre, interventional, non-randomized, non-comparative, open label study. In this phase 2 study 30–48 patients with > 3 measurable liver metastases according to RECIST 1.1 will receive additional 166Ho-RE within 20 weeks after the 4th and last cycle of PRRT with 7.4 GBq 177Lu-DOTATATE. Primary objectives are to assess tumour response, complete and partial response according to RECIST 1.1, and toxicity, based on CTCAE v4.03, 3 months after 166Ho-RE. Secondary endpoints include biochemical response, quality of life, biodistribution and dosimetry. Discussion This is the first prospective study to combine PRRT with 177Lu-DOTATATE and additional 166Ho-RE in metastatic NET. A radiation boost on intrahepatic disease using 166Ho-RE may lead to an improved response rate without significant additional side-effects. Trial registration Clinicaltrials.gov NCT02067988, 13 February 2014. Protocol version: 6, 30 november 2016.
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Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - Dik J Kwekkeboom
- Department of Nuclear Medicine, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - Boen L R Kam
- Department of Nuclear Medicine, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - Jaap J M Teunissen
- Department of Nuclear Medicine, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - Wouter W de Herder
- Department of Endocrinology, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands
| | - Koen M A Dreijerink
- Department of Endocrinology, VU University Medical Centre Amsterdam, De Boelelaan 117, 1081, HV, Amsterdam, the Netherlands
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
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Chan KT, Alessio AM, Johnson GE, Vaidya S, Kwan SW, Monsky W, Wilson AE, Lewis DH, Padia SA. Prospective Trial Using Internal Pair-Production Positron Emission Tomography to Establish the Yttrium-90 Radioembolization Dose Required for Response of Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2018; 101:358-365. [DOI: 10.1016/j.ijrobp.2018.01.116] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 12/16/2022]
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Lim H, Fessler JA, Wilderman SJ, Brooks AF, Dewaraja YK. Y-90 SPECT ML image reconstruction with a new model for tissue-dependent bremsstrahlung production using CT information: a proof-of-concept study. Phys Med Biol 2018; 63:115001. [PMID: 29714716 PMCID: PMC6112241 DOI: 10.1088/1361-6560/aac1ad] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
While the yield of positrons used in Y-90 PET is independent of tissue media, Y-90 SPECT imaging is complicated by the tissue dependence of bremsstrahlung photon generation. The probability of bremsstrahlung production is proportional to the square of the atomic number of the medium. Hence, the same amount of activity in different tissue regions of the body will produce different numbers of bremsstrahlung photons. Existing reconstruction methods disregard this tissue-dependency, potentially impacting both qualitative and quantitative imaging of heterogeneous regions of the body such as bone with marrow cavities. In this proof-of-concept study, we propose a new maximum-likelihood method that incorporates bremsstrahlung generation probabilities into the system matrix, enabling images of the desired Y-90 distribution to be reconstructed instead of the 'bremsstrahlung distribution' that is obtained with existing methods. The tissue-dependent probabilities are generated by Monte Carlo simulation while bone volume fractions for each SPECT voxel are obtained from co-registered CT. First, we demonstrate the tissue dependency in a SPECT/CT imaging experiment with Y-90 in bone equivalent solution and water. Visually, the proposed reconstruction approach better matched the true image and the Y-90 PET image than the standard bremsstrahlung reconstruction approach. An XCAT phantom simulation including bone and marrow regions also demonstrated better agreement with the true image using the proposed reconstruction method. Quantitatively, compared with the standard reconstruction, the new method improved estimation of the liquid bone:water activity concentration ratio by 40% in the SPECT measurement and the cortical bone:marrow activity concentration ratio by 58% in the XCAT simulation.
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Affiliation(s)
- Hongki Lim
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, United States of America
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26
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Kafrouni M, Allimant C, Fourcade M, Vauclin S, Delicque J, Ilonca AD, Guiu B, Manna F, Molinari N, Mariano-Goulart D, Ben Bouallègue F. Retrospective Voxel-Based Dosimetry for Assessing the Ability of the Body-Surface-Area Model to Predict Delivered Dose and Radioembolization Outcome. J Nucl Med 2018; 59:1289-1295. [DOI: 10.2967/jnumed.117.202937] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/30/2017] [Indexed: 01/24/2023] Open
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27
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Dewaraja YK, Chun SY, Srinivasa RN, Kaza RK, Cuneo KC, Majdalany BS, Novelli PM, Ljungberg M, Fessler JA. Improved quantitative 90 Y bremsstrahlung SPECT/CT reconstruction with Monte Carlo scatter modeling. Med Phys 2017; 44:6364-6376. [PMID: 28940483 DOI: 10.1002/mp.12597] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In 90 Y microsphere radioembolization (RE), accurate post-therapy imaging-based dosimetry is important for establishing absorbed dose versus outcome relationships for developing future treatment planning strategies. Additionally, accurately assessing microsphere distributions is important because of concerns for unexpected activity deposition outside the liver. Quantitative 90 Y imaging by either SPECT or PET is challenging. In 90 Y SPECT model based methods are necessary for scatter correction because energy window-based methods are not feasible with the continuous bremsstrahlung energy spectrum. The objective of this work was to implement and evaluate a scatter estimation method for accurate 90 Y bremsstrahlung SPECT/CT imaging. METHODS Since a fully Monte Carlo (MC) approach to 90 Y SPECT reconstruction is computationally very demanding, in the present study the scatter estimate generated by a MC simulator was combined with an analytical projector in the 3D OS-EM reconstruction model. A single window (105 to 195-keV) was used for both the acquisition and the projector modeling. A liver/lung torso phantom with intrahepatic lesions and low-uptake extrahepatic objects was imaged to evaluate SPECT/CT reconstruction without and with scatter correction. Clinical application was demonstrated by applying the reconstruction approach to five patients treated with RE to determine lesion and normal liver activity concentrations using a (liver) relative calibration. RESULTS There was convergence of the scatter estimate after just two updates, greatly reducing computational requirements. In the phantom study, compared with reconstruction without scatter correction, with MC scatter modeling there was substantial improvement in activity recovery in intrahepatic lesions (from > 55% to > 86%), normal liver (from 113% to 104%), and lungs (from 227% to 104%) with only a small degradation in noise (13% vs. 17%). Similarly, with scatter modeling contrast improved substantially both visually and in terms of a detectability index, which was especially relevant for the low uptake extrahepatic objects. The trends observed for the phantom were also seen in the patient studies where lesion activity concentrations and lesion-to-liver concentration ratios were lower for SPECT without scatter correction compared with reconstruction with just two MC scatter updates: in eleven lesions the mean uptake was 4.9 vs. 7.1 MBq/mL (P = 0.0547), the mean normal liver uptake was 1.6 vs. 1.5 MBq/mL (P = 0.056) and the mean lesion-to-liver uptake ratio was 2.7 vs. 4.3 (P = 0.0402) for reconstruction without and with scatter correction respectively. CONCLUSIONS Quantitative accuracy of 90 Y bremsstrahlung imaging can be substantially improved with MC scatter modeling without significant degradation in image noise or intensive computational requirements.
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Affiliation(s)
- Yuni K Dewaraja
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Se Young Chun
- School of Electrical and Computer Engineering, Ulsan National Institute of Science and Technology, Ulsan, Korea
| | - Ravi N Srinivasa
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bill S Majdalany
- Department of Radiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paula M Novelli
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jeffrey A Fessler
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
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van der Velden S, Bastiaannet R, Braat AJAT, Lam MGEH, Viergever MA, de Jong HWAM. Estimation of lung shunt fraction from simultaneous fluoroscopic and nuclear images. Phys Med Biol 2017; 62:8210-8225. [PMID: 28837044 DOI: 10.1088/1361-6560/aa8840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radioembolisation with yttrium-90 (90Y) is increasingly used as a treatment of unresectable liver malignancies. For safety, a scout dose of technetium-99m macroaggregated albumin (99mTc-MAA) is used prior to the delivery of the therapeutic activity to mimic the deposition of 90Y. One-day procedures are currently limited by the lack of nuclear images in the intervention room. To cope with this limitation, an interventional simultaneous fluoroscopic and nuclear imaging device is currently being developed. The purpose of this simulation study was to evaluate the accuracy of estimating the lung shunt fraction (LSF) of the scout dose in the intervention room with this device and compare it against current clinical methods. METHODS A male and female XCAT phantom, both with two respiratory profiles, were used to simulate various LSFs resulting from a scout dose of 150 MBq 99mTc-MAA. Hybrid images were Monte Carlo simulated for breath-hold (5 s) and dynamic breathing (10 frames of 0.5 s) acquisitions. Nuclear images were corrected for attenuation with the fluoroscopic image and for organ overlap effects using a pre-treatment CT-scan. For comparison purposes, planar scintigraphy and mobile gamma camera images (both 300 s acquisition time) were simulated. Estimated LSFs were evaluated for all methods and compared to the phantom ground truth. RESULTS In the clinically relevant range of 10-20% LSF, hybrid imaging overestimated LSF with approximately 2 percentage points (pp) and 3 pp for the normal and irregular breathing phantoms, respectively. After organ overlap correction, LSF was estimated with a more constant error. Errors in planar scintigraphy and mobile gamma camera imaging were more dependent on LSF, body shape and breathing profile. CONCLUSION LSF can be estimated with a constant minor error with a hybrid imaging device. Estimated LSF is highly dependent on true LSF, body shape and breathing pattern when estimated with current clinical methods. The hybrid imaging device is capable of accurately estimating LSF within a few seconds in an interventional setting.
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Affiliation(s)
- Sandra van der Velden
- Radiology and Nuclear Medicine, UMC Utrecht, Mail E01.132, PO Box 85500, 3508 GA, Utrecht, Netherlands. Image Sciences Institute, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, Netherlands
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29
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Prince JF, van den Bosch MAAJ, Nijsen JFW, Smits MLJ, van den Hoven AF, Nikolakopoulos S, Wessels FJ, Bruijnen RCG, Braat MNGJA, Zonnenberg BA, Lam MGEH. Efficacy of Radioembolization with 166Ho-Microspheres in Salvage Patients with Liver Metastases: A Phase 2 Study. J Nucl Med 2017; 59:582-588. [PMID: 28916623 DOI: 10.2967/jnumed.117.197194] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022] Open
Abstract
Radioembolization of liver malignancies with 166Ho-microspheres has been shown to be safe in a phase 1 dose-escalation study. The purpose of this study was to investigate the efficacy of 166Ho radioembolization. Methods: In this prospective single-arm study, 56 patients were enrolled, all with liver metastases refractory to systemic therapy and ineligible for surgical resection. The primary outcome was a response by 2 target lesions on triphasic liver CT scans 3 mo after therapy, as assessed using RECIST, version 1.1. Secondary outcomes included overall tumor response, time to imaging progression, overall survival, toxicity, quality of life, and quantification of the microspheres on SPECT and MRI. Results: Between May 2012 and March 2015, 38 eligible patients were treated, one of whom was not evaluable. In 27 (73%) of 37 patients, the target lesions showed complete response, partial response, or stable disease (disease control) at 3 mo (95% confidence interval [CI], 57%-85%). The median overall survival was 14.5 mo (95% CI, 8.6-22.8 mo). For colorectal cancer patients (n = 23), the median overall survival was 13.4 mo (95% CI, 8.2-15.7 mo). Grade 3 or 4 toxic events after treatment (according to the Common Terminology Criteria for Adverse Events, version 4.03) included abdominal pain (in 18% of patients), nausea (8%), ascites (3%), fatigue (3%), gastric stenosis (3%), hepatic failure (3%), liver abscesses (3%), paroxysmal atrial tachycardia (3%), thoracic pain (3%), upper gastrointestinal hemorrhage (3%), and vomiting (3%). On SPECT, 166Ho could be quantified with high accuracy and precision, with a mean overestimation of 9.3% ± 7.1% in the liver. Conclusion: Radioembolization with 166Ho-microspheres induced a tumor response with an acceptable toxicity profile in salvage patients with liver metastases.
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Affiliation(s)
- Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Johannes F W Nijsen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Stavros Nikolakopoulos
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J Wessels
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Bernard A Zonnenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; and
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Mikell JK, Mahvash A, Siman W, Baladandayuthapani V, Mourtada F, Kappadath SC. Selective Internal Radiation Therapy With Yttrium-90 Glass Microspheres: Biases and Uncertainties in Absorbed Dose Calculations Between Clinical Dosimetry Models. Int J Radiat Oncol Biol Phys 2016; 96:888-896. [PMID: 27623307 DOI: 10.1016/j.ijrobp.2016.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/03/2016] [Accepted: 07/18/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE To quantify differences that exist between dosimetry models used for 90Y selective internal radiation therapy (SIRT). METHODS AND MATERIALS Retrospectively, 37 tumors were delineated on 19 post-therapy quantitative 90Y single photon emission computed tomography/computed tomography scans. Using matched volumes of interest (VOIs), absorbed doses were reported using 3 dosimetry models: glass microsphere package insert standard model (SM), partition model (PM), and Monte Carlo (MC). Univariate linear regressions were performed to predict mean MC from SM and PM. Analysis was performed for 2 subsets: cases with a single tumor delineated (best case for PM), and cases with multiple tumors delineated (typical clinical scenario). Variability in PM from the ad hoc placement of a single spherical VOI to estimate the entire normal liver activity concentration for tumor (T) to nontumoral liver (NL) ratios (TNR) was investigated. We interpreted the slope of the resulting regression as bias and the 95% prediction interval (95%PI) as uncertainty. MCNLsingle represents MC absorbed doses to the NL for the single tumor patient subset; other combinations of calculations follow a similar naming convention. RESULTS SM was unable to predict MCTsingle or MCTmultiple (p>.12, 95%PI >±177 Gy). However, SMsingle was able to predict (p<.012) MCNLsingle, albeit with large uncertainties; SMsingle and SMmultiple yielded biases of 0.62 and 0.71, and 95%PI of ±40 and ± 32 Gy, respectively. PMTsingle and PMTmultiple predicted (p<2E-6) MCTsingle and MCTmultiple with biases of 0.52 and 0.54, and 95%PI of ±38 and ± 111 Gy, respectively. The TNR variability in PMTsingle increased the 95%PI for predicting MCTsingle (bias = 0.46 and 95%PI = ±103 Gy). The TNR variability in PMTmultiple modified the bias when predicting MCTmultiple (bias = 0.32 and 95%PI = ±110 Gy). CONCLUSIONS The SM is unable to predict mean MC tumor absorbed dose. The PM is statistically correlated with mean MC, but the resulting uncertainties in predicted MC are large. Large differences observed between dosimetry models for 90Y SIRT warrant caution when interpreting published SIRT absorbed doses. To reduce uncertainty, we suggest the entire NL VOI be used for TNR estimates when using PM.
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Affiliation(s)
- Justin K Mikell
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wendy Siman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas
| | - Veera Baladandayuthapani
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Firas Mourtada
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Christiana Care, Newark, Delaware; Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - S Cheenu Kappadath
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas.
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Tong AKT, Kao YH, Too CW, Chin KFW, Ng DCE, Chow PKH. Yttrium-90 hepatic radioembolization: clinical review and current techniques in interventional radiology and personalized dosimetry. Br J Radiol 2016; 89:20150943. [PMID: 26943239 DOI: 10.1259/bjr.20150943] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In recent years, yttrium-90 ((90)Y) microsphere radioembolization has been establishing itself as a safe and efficacious treatment for both primary and metastatic liver cancers. This extends to both first-line therapies as well as in the salvage setting. In addition, radioembolization appears efficacious for patients with portal vein thrombosis, which is currently a contraindication for surgery, transplantation and transarterial chemoembolization. This article reviews the efficacy and expanding use of (90)Y microsphere radioembolization with an added emphasis on recent advances in personalized dosimetry and interventional radiology techniques. Directions for future research into combination therapies with radioembolization and expansion into sites other than the liver are also explored.
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Affiliation(s)
- Aaron K T Tong
- 1 Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Yung Hsiang Kao
- 2 Department of Nuclear Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Chow Wei Too
- 3 Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - David C E Ng
- 1 Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Pierce K H Chow
- 5 Department of Hepato-Pancreato-Biliary (HPB) and Transplant Surgery, Singapore General Hospital Surgical Oncology, National Cancer Centre, Singapore
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Rodríguez LS, Thang SP, Li H, Khor LK, Tay YS, Myint KO, Tong AKT. A descriptive analysis of remnant activity during (90)Y resin microspheres radioembolization of hepatic tumors: technical factors and dosimetric implications. Ann Nucl Med 2015; 30:255-61. [PMID: 26692012 DOI: 10.1007/s12149-015-1052-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/08/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Activity planning for (90)Y radioembolization aims to maximize the effect of the treatment while keeping toxicity acceptably low. Our aim was to describe the amount of residual activity in post-treatment v-vials and tubing and analyze the possible factors affecting it (total activity administered, number of split activity injection(s), previous treatments, administration artery and microcatheter size), as these may influence dosimetric planning and treatment. METHODS This was a retrospective review using case records of patients who received (90)Y-radioembolization for hepatic tumors at a single tertiary center. From August 2013 to September 2015, seventy-seven out of one hundred and fifty patients who received radioembolization with (90)Y resin microspheres due to inoperable Hepatocellular Carcinoma (HCC) or liver metastases were included. The rest were mainly excluded due to incomplete data sets. The number of split activities (injections) for the radioembolization could be: one single injection, two or three. The remnant activity in post-treatment v-vials and tubing were measured for every patient. The administration arteries evaluated were: proper hepatic artery (PHA), right hepatic artery (RHA), middle hepatic artery (MHA), left hepatic artery (LHA) and small caliber branch arteries. The sizes of the microcatheters (2.2 or 2.7 Fr) used to administer the dose were also evaluated. RESULTS In total, 77 out of 150 patients were included in the final analysis. There were 59 men of median age 64.0 years old. The total median dose loss was 0.10 GBq. The total dose loss increased 0.244 GBq [95 % CI = (0.169, 0.318)] when three split activities were given compared to single activity injection. Activity loss for each injection increased 0.0297 GBq [95 % CI = (0.0151, 0.0443)] for every 1.0 GBq increase of split activity injection. There were no significant statistical differences in the rest of patient characteristics. CONCLUSIONS There is significant loss of activity observed during radioembolization, which can have a major dosimetric impact. The total administered activity and the number of split injections during radioembolization are the main influencing factors. Further prospective studies as well as measures of clinical outcome are warranted.
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Affiliation(s)
- Lidia Sancho Rodríguez
- Department of Nuclear Medicine, Clínica Universidad de Navarra, Avenida Pio XII, 36, Pamplona, 31008, Navarra, Spain.
| | - Sue Ping Thang
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - HuiHua Li
- Division of Research, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Lih Kin Khor
- Department of Diagnostic Imaging, National University Hospital, Singapore, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Young Soon Tay
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Khin Ohnmar Myint
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Aaron Kian Ti Tong
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Braat AJAT, Smits MLJ, Braat MNGJA, van den Hoven AF, Prince JF, de Jong HWAM, van den Bosch MAAJ, Lam MGEH. ⁹⁰Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments. J Nucl Med 2015; 56:1079-87. [PMID: 25952741 DOI: 10.2967/jnumed.115.157446] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/25/2015] [Indexed: 12/14/2022] Open
Abstract
Radioembolization is an established treatment modality that has been subjected to many improvements over the last decade. Developments are occurring at a high pace, affecting patient selection and treatment. The aim of this review is therefore to provide an overview of current practice, with a focus on recent developments in the field of radioembolization. Several practical issues and recommendations in the application of radioembolization will be discussed, ranging from patient selection to treatment response and future applications.
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Affiliation(s)
- Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Manon N G J A Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands
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