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Kovan B, Denizmen D, Civan C, Kuyumcu S, Isik EG, Has Simsek D, Ozkan ZG, Poyanli A, Demir B, Sanli Y. Influence of Early Versus Delayed Hepatic Artery Perfusion Scan on 90Y Selective Internal Radiation Therapy Planning. Cancer Biother Radiopharm 2024; 39:330-336. [PMID: 38265813 DOI: 10.1089/cbr.2023.0149] [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] [Indexed: 01/25/2024] Open
Abstract
Purpose: This study evaluated the effect of an increase in the time interval between hepatic intra-arterial injection of 99mTc-macroaggregated albumin (MAA) and hepatic artery perfusion scintigraphy (HAPS) on the lung shunt fraction (LSF) and perfused volume (PV) calculations in the treatment planning of selective internal radiation therapy (SIRT). Methods: The authors enrolled 51 HAPS sessions from 40 patients diagnosed with primary or metastatic liver malignancy. All patients underwent scan at the first and fourth hour after hepatic arterial injection of 99mTc-MAA. Based on single-photon emission computed tomography images, LSF values were measured from each patient's first and fourth hour images. PV1 and PV4 were also calculated based on three-dimensional images using 5% and 10% cutoff threshold values and compared with each other. Results: The authors found that the median of LSF4 was statistically significantly higher than LSF1 (3.05 vs. 4.14, p ≤ 0.01). There was no statistically significant difference between PV1 and PV4 on the 10% (p = 0.72) thresholds. Conclusions: LSF values can be overestimated in case of delayed HAPS, potentially leading to treatment cancellation due to incorrectly high results in patients who could benefit from SIRT. Threshold-based PV values do not significantly change over time; nevertheless, keeping the short interval time would be safer.
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Affiliation(s)
- Bilal Kovan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Dilara Denizmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Caner Civan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Emine Goknur Isik
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Duygu Has Simsek
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Zeynep Gozde Ozkan
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Arzu Poyanli
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
| | - Bayram Demir
- Department of Physics, Faculty of Science, Istanbul University, Fatih/İstanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih/İstanbul, Turkey
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Budzyńska A, Kubik A, Kacperski K, Pastusiak P, Kuć M, Piasecki P, Konior M, Gryziński M, Dziuk M, Iller E. PET/CT and SPECT/CT imaging of 90Y hepatic radioembolization at therapeutic and diagnostic activity levels: Anthropomorphic phantom study. PLoS One 2024; 19:e0271711. [PMID: 38421965 PMCID: PMC10903856 DOI: 10.1371/journal.pone.0271711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Prior to 90Y radioembolization procedure, a pretherapy simulation using 99mTc-MAA is performed. Alternatively, a small dosage of 90Y microspheres could be used. We aimed to assess the accuracy of lung shunt fraction (LSF) estimation in both high activity 90Y posttreatment and pretreatment scans with isotope activity of ~100 MBq, using different imaging techniques. Additionally, we assessed the feasibility of visualising hot and cold hepatic tumours in PET/CT and Bremsstrahlung SPECT/CT images. MATERIALS AND METHODS Anthropomorphic phantom including liver (with two spherical tumours) and lung inserts was filled with 90Y chloride to simulate an LSF of 9.8%. The total initial activity in the liver was 1451 MBq, including 19.4 MBq in the hot sphere. Nine measurement sessions including PET/CT, SPECT/CT, and planar images were acquired at activities in the whole phantom ranging from 1618 MBq down to 43 MBq. The visibility of the tumours was appraised based on independent observers' scores. Quantitatively, contrast-to-noise ratio (CNR) was calculated for both spheres in all images. RESULTS LSF estimation. For high activity in the phantom, PET reconstructions slightly underestimated the LSF; absolute difference was <1.5pp (percent point). For activity <100 MBq, the LSF was overestimated. Both SPECT and planar scintigraphy overestimated the LSF for all activities. Lesion visibility. For SPECT/CT, the cold tumour proved too small to be discernible (CNR <0.5) regardless of the 90Y activity in the liver, while hot sphere was visible for activity >200 MBq (CNR>4). For PET/CT, the cold tumour was only visible with the highest 90Y activity (CNR>4), whereas the hot one was seen for activity >100 MBq (CNR>5). CONCLUSIONS PET/CT may accurately estimate the LSF in a 90Y posttreatment procedure. However, at low activities of about 100 MBq it seems to provide unreliable estimations. PET imaging provided better visualisation of both hot and cold tumours.
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Affiliation(s)
- Anna Budzyńska
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Agata Kubik
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Krzysztof Kacperski
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- National Centre for Nuclear Research, Particle Acceleration Physics and Technology Division (TJ1), Otwock—Świerk, Poland
| | - Patrycja Pastusiak
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Michał Kuć
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Marcin Konior
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
| | - Michał Gryziński
- National Centre for Nuclear Research, Radiological Metrology and Biomedical Physics Division (H2), Otwock—Świerk, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine - National Research Institute, Warsaw, Poland
- Affidea Mazovian PET-CT Medical Centre, Warsaw, Poland
| | - Edward Iller
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock - Świerk, Poland
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Lee JH, Lee CH, Kim M, Song YS, Yoon CJ, Lee WW. CT texture features and lung shunt fraction measured using 99mTc-macroaggregated albumin SPECT/CT before trans-arterial radioembolization for hepatocellular carcinoma patients. Sci Rep 2023; 13:22288. [PMID: 38097801 PMCID: PMC10721865 DOI: 10.1038/s41598-023-49787-7] [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: 05/30/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
The aim of this study is to determine whether contrast-enhanced computed tomography (CECT)-based texture parameters can predict high (> 30 Gy) expected lung dose (ELD) calculated using 99mTc macroaggregated albumin single-photon emission computed tomography/computed tomography (SPECT/CT) for pre-trans-arterial radioembolization (TARE) dosimetry. 35 patients were analyzed, with a treatable planned dose of ≥ 200 Gy for unresectable hepatocellular carcinoma (HCC). Lung shunt fraction (LSF) was obtained from planar and SPECT/CT scans. Texture features of the tumor lesion on CECT before TARE were analyzed. Univariate and multivariate linear regression analyses were performed to determine potential ELD > 30 Gy predictors. Among the 35 patients, nine (25.7%) had ELD > 30 Gy, and had a higher LSF than the ELD ≤ 30 Gy group using the planar (20.7 ± 8.0% vs. 6.3 ± 3.3%; P < 0.001) and SPECT/CT (12.4 ± 5.1% vs. 3.5 ± 2.0%; P < 0.001) scans. The tumor integral total (HU × L) value was a predictor for high LSF using SPECT/CT, with an area under the curve, sensitivity, and specificity of 0.983 (95% confidence interval: 0.869-1.000, P < 0.001), 100%, and 88.5%, respectively. The tumor integral total value is an imaging marker for predicting ELD > 30 Gy. Applying CECT texture analysis may assist in reducing time and cost in patient selection and modifying TARE treatment plans.
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Affiliation(s)
- Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| | - Chong-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Minuk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
| | - Won Woo Lee
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, The Graduate School of Convergence Science and Technology, Seoul National University, Suwon-si, Gyeonggi-do, Republic of Korea
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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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McArdle N, Cournane S, McCavana J, Lucey J, León Vintró L. Development of a scatter correction technique for planar 99mTc-MAA imaging to improve accuracy in lung shunt fraction estimation. Phys Med 2022; 99:94-101. [PMID: 35665625 DOI: 10.1016/j.ejmp.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Prior to 90Y selective internal radiation therapy (SIRT) treatment, 99mTc-MAA scintigraphy imaging is used in the estimation of the lung shunt fraction (LSF). Planar imaging is recommended for determining a LSF ratio. However, the estimate may be affected by scatter contributions, attenuation and respiratory motion. The objective of this study was to correct for the effects of scatter in the LSF, towards the determination of a more accurate estimation method of LSF derived from planar scintigraphy imaging, which is recommended by international guidelines. METHODS The open access SIMIND Monte Carlo modelling software was used to estimate an optimum scatter window (SW) for scatter correction. The uncertainties associated with scatter and scatter contributions from the liver on the LSF were evaluated using an anthropomorphic thorax phantom and a virtual Vox-Man phantom. A brief retrospective examination of patient scans and tumour location investigated the impact that the inclusion of the simulated scatter corrections had on the LSF estimation. RESULTS The percentage overestimation of the manufacturer recommended method of LSF estimation was 192%. SW corrections improved the uncertainty to within 19% for the range of known LSFs. Similar findings were observed for our patient and tumour location studies. CONCLUSION The incorporated scatter corrections can significantly improve the accuracy of the LSF estimation, thereby providing a robust gamma camera, patient and tumour depth specific correction which is easily implementable. This is supported by Monte Carlo, phantom and preliminary patient studies.
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Affiliation(s)
- Niamh McArdle
- St. Vincent's University Hospital, Ireland; University College Dublin, Ireland.
| | - Seán Cournane
- St. Vincent's University Hospital, Ireland; University College Dublin, Ireland
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Chiesa C, Sjogreen-Gleisner K, Walrand S, Strigari L, Flux G, Gear J, Stokke C, Gabina PM, Bernhardt P, Konijnenberg M. EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres. EJNMMI Phys 2021; 8:77. [PMID: 34767102 PMCID: PMC8589932 DOI: 10.1186/s40658-021-00394-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 06/21/2021] [Indexed: 11/27/2022] Open
Abstract
The aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient-relative calibration method for activity quantification.The identity of 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments.Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative 90Y bremsstrahlung SPECT can be used if dedicated correction methods are available.The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.
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Affiliation(s)
- Carlo Chiesa
- Nuclear Medicine Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Stephan Walrand
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
| | - Lidia Strigari
- Medical Physics Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, UK
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Pablo Minguez Gabina
- Department of Medical Physics and Radiation Protection, Gurutzeta/Cruces University Hospital, Barakaldo, Spain
| | - Peter Bernhardt
- Department of Radiation Physics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mark Konijnenberg
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Clinical and Dosimetric Implications of Calculating Lung Shunt Fraction for Hepatic Yttrium-90 Radioembolization Using SPECT/CT Versus Planar Scintigraphy. AJR Am J Roentgenol 2021; 218:728-737. [PMID: 34704460 DOI: 10.2214/ajr.21.26663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Accurate assessment of hepatopulmonary shunting, typically performed by planar scintigraphy, is critical in planning yttrium-90 radioembolization. High lung shunt fractions (LSFs) may alter treatment. Objective: To compare LSFs calculated from planar scintigraphy versus SPECT/CT in patients with high planar LSFs (>15%) and to describe potential clinical and dosimetric implications of SPECT/CT LSF calculations. Methods: This retrospective study included 36 patients (29 male, 7 female; mean age 62.4±9.8 years) who underwent technetium-99m labeled macroaggregated albumin planar scintigraphy for planning hepatic radioembolization, with planar LSF >15% and concurrent SPECT/CT. Clinically reported planar LSFs were recorded. SPECT/CT LSFs were retrospectively calculated using automatically generated volumetric ROIs around the lungs and liver with subsequent manual adjustments. Total lung and perfused liver doses were calculated using a medical internal radiation dose model. Values derived from planar and SPECT/CT data were compared with Mann-Whitney U tests. Multivariable regression analysis was performed of factors associated with LSF discrepancy between techniques. Results: Mean planar LSF was 25.1%±11.6%; mean SPECT/CT LSF was 16.0%±9.3% (p<.001). Mean lung dose was 18.8±8.0 Gy for planar LSF versus 12.3±7.2 Gy for SPECT/CT LSF (p<.001). Mean perfused liver dose was 92.9±36.1 Gy using planar LSF versus 102.7±39.1 Gy using SPECT/CT LSF (p<.001). In multivariable analysis, larger discrepancy in LSF between planar scintigraphy and SPECT/CT was associated with body mass index ≥26 (p=.02), maximum tumor size <9 cm (p = .05), and left hepatic intra-arterial injection (p=.02). Fourteen of 36 patients did not undergo upfront radioembolization due to planar LSF >20%, instead undergoing shunt-reducing embolization with subsequent radioembolization (n=7), transarterial chemoembolization (n=5), or no treatment (n=2). Five of these 14 patients had SPECT/CT LSF <20% and would have been eligible for upfront radioembolization based on SPECT/CT LSF. Seven of 29 patients treated with radioembolization underwent prescribed dose reductions based on planar LSF; six of these patients would have qualified for standard radioembolization without dose reduction using SPECT/CT LSF. Conclusion: Planar scintigraphy yields greater LSFs compared to SPECT/CT, possibly leading to unnecessary shunt-reducing procedures and prescribed dose reductions. Clinical Impact: SPECT/CT should be considered for clinical LSF calculations before radioembolization in patients with high LSFs.
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