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Sag AA, Agritelley E, Ronald J, Young SJ, Kim CY. Vortex-assisted resin y90 delivery via 175 cm Truselect microcatheter: case factors for high residual despite double-flush protocol. Nucl Med Commun 2024; 45:61-67. [PMID: 37901924 DOI: 10.1097/mnm.0000000000001784] [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: 10/31/2023]
Abstract
PURPOSE To report efficiency of resin y90 delivery using SIROS via 175 cm TruSelect microcatheter with double-flush protocol (40 ml dextrose total). METHODS IRB-approved retrospective review of all patients undergoing SIROS injection of y90 Sir-Spheres via TruSelect from 2019 through 2022 at one quaternary-care academic institution, including medical records. RESULTS Included were 48 infusions in 25 patients across 11 cancer histologies. Mean planned, delivered, and residual activities were 28 ± 17, 27 ± 17, 1.1 ± 0.56 mCi respectively (mean residual 4.9% ± 2.8%) across flex-dosing precalibrations including 1-day, 2-day, and 3-day SIROS (4/51, 16/51, and 28/51). Mean liver treatment volume was 483 ± 306 ml with target dose mean of 128 ± 26 Gy in non-segmentectomy cases; Radiation segmentectomy was performed in 15/48 (31%). Arterial stasis was documented in 9/48 (19%) of cases. Use of a 3-day precalibrated SIROS dose, use of activity <10 mCi, treatment of smaller liver volumes (<200 ml) and documentation of stasis were associated with higher residual activity ( P = 0.025, P = 0.0007, P = 0.0177, and P = 0.049, respectively) were associated with higher residuals. CONCLUSION Combining the new technologies of SIROS and the Truselect microcatheter with a double-flush protocol yielded <10% residual in 94% of y90 infusions. Future studies may clarify if the predictors of high residual dose seen here may warrant microcatheter-specific considerations for dosimetry or dose preparation at the Radiopharmacy level.
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Affiliation(s)
- Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
| | | | - James Ronald
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
| | - Shamar J Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona Medical Center, Tucson, Arizona, USA
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center,
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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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Abstract
Liver cancer is one of the top leading causes of mortality worldwide. Conventional imaging using contrast enhanced CT and MRI are currently the mainstay of oncologic imaging of the liver for the diagnosis and management of cancer. In the past two decades, especially since the advent of hybrid imaging in the form of PET/CT and SPECT/CT, molecular imaging has been increasingly utilized for oncologic imaging and the variety of radionuclide probes for imaging liver cancers have been expanding. Beyond the usual workhorse of FDG as an oncologic tracer, there is a growing body of evidence showing that radiolabeled choline tracers, C-11 acetate and other new novel tracers may have increasing roles to play for the imaging of liver tumors. On the therapy front, there have also been advances in recent times in terms of targeted therapies for both primary and secondary liver malignancies, particularly with transarterial radioembolization. The concept of theranostics can be applied to transarterial radioembolization by utilizing a pretreatment planning scan, such as Tc-99m macroaggregated albumin scintigraphy, coupled with post treatment imaging. Radiation dose planning by personalized dosimetric calculations to the liver tumors is also being advocated. This article explores the general trends in the field of nuclear medicine for the imaging and treatment of liver cancer above and beyond routine diagnosis and management.
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Affiliation(s)
- Aaron Kian-Ti Tong
- Singapore General Hospital, Department of Nuclear Medicine and Molecular Imaging; DUKE-NUS Graduate Medical School, Singapore.
| | - Wei Ying Tham
- Singapore General Hospital, Department of Nuclear Medicine and Molecular Imaging; DUKE-NUS Graduate Medical School, Singapore
| | - Chow Wei Too
- Singapore General Hospital, Department of Vascular and Interventional Radiology; DUKE-NUS Graduate Medical School, Singapore
| | - David Wai-Meng Tai
- National Cancer Centre Singapore, Division of Medical Oncology; DUKE-NUS Graduate Medical School, Singapore
| | - Pierce Kah-Hoe Chow
- Singapore General Hospital, Department of Hepato-Pancreato-Biliary (HPB) and Transplant Surgery; National Cancer Centre Singapore, Division of Surgical Oncology; DUKE-NUS Graduate Medical School, Singapore
| | - David Chee-Eng Ng
- Singapore General Hospital, Department of Nuclear Medicine and Molecular Imaging; DUKE-NUS Graduate Medical School, Singapore
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Ezponda A, Rodríguez-Fraile M, Morales M, Vivas I, De La Torre M, Sangro B, Bilbao JI. Hepatic Flow Redistribution is Feasible in Patients with Hepatic Malignancies Undergoing Same-Day Work-Up Angiography and Yttrium-90 Microsphere Radioembolization. Cardiovasc Intervent Radiol 2019; 43:987-995. [PMID: 31848672 DOI: 10.1007/s00270-019-02371-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/31/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. MATERIALS AND METHODS From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. RESULTS Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. CONCLUSION Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.
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Affiliation(s)
- A Ezponda
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.
| | - M Rodríguez-Fraile
- Department of Nuclear Medicine, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - M Morales
- Department of Nuclear Medicine, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - I Vivas
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
| | - M De La Torre
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.,Clínica Universidad de Navarra, Calle Marquesado de Sta Marta n°1, 28027, Madrid, Spain
| | - B Sangro
- Department of Internal Medicine-Hepatology, Clínica Universidad de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain.,Clínica Universidad de Navarra, Calle Marquesado de Sta Marta n°1, 28027, Madrid, Spain
| | - J I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII n°36, 31008, Pamplona, Spain
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Huang HL, Tong AKT, Thang SP, Yan SX, Lam WWC, Loke KSH, Tang CYL, Cheng LTJ, Ooi GSK, Low HC, Magsombol BM, Tham WY, Goh CXY, Tan CJ, Khor YM, Zaheer S, Bharadwaj P, Xie W, Ng DCE. Current Status and Growth of Nuclear Theranostics in Singapore. Nucl Med Mol Imaging 2019; 53:96-101. [DOI: 10.1007/s13139-019-00580-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
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