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Li CMY, Briggs MT, Lee YR, Tin T, Young C, Pierides J, Kaur G, Drew P, Maddern GJ, Hoffmann P, Klingler-Hoffmann M, Fenix K. Use of tryptic peptide MALDI mass spectrometry imaging to identify the spatial proteomic landscape of colorectal cancer liver metastases. Clin Exp Med 2024; 24:53. [PMID: 38492056 PMCID: PMC10944452 DOI: 10.1007/s10238-024-01311-5] [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: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide. CRC liver metastases (CRLM) are often resistant to conventional treatments, with high rates of recurrence. Therefore, it is crucial to identify biomarkers for CRLM patients that predict cancer progression. This study utilised matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI-MSI) in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS) to spatially map the CRLM tumour proteome. CRLM tissue microarrays (TMAs) of 84 patients were analysed using tryptic peptide MALDI-MSI to spatially monitor peptide abundances across CRLM tissues. Abundance of peptides was compared between tumour vs stroma, male vs female and across three groups of patients based on overall survival (0-3 years, 4-6 years, and 7+ years). Peptides were then characterised and matched using LC-MS/MS. A total of 471 potential peptides were identified by MALDI-MSI. Our results show that two unidentified m/z values (1589.876 and 1092.727) had significantly higher intensities in tumours compared to stroma. Ten m/z values were identified to have correlation with biological sex. Survival analysis identified three peptides (Histone H4, Haemoglobin subunit alpha, and Inosine-5'-monophosphate dehydrogenase 2) and two unidentified m/z values (1305.840 and 1661.060) that were significantly higher in patients with shorter survival (0-3 years relative to 4-6 years and 7+ years). This is the first study using MALDI-MSI, combined with LC-MS/MS, on a large cohort of CRLM patients to identify the spatial proteome in this malignancy. Further, we identify several protein candidates that may be suitable for drug targeting or for future prognostic biomarker development.
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Affiliation(s)
- Celine Man Ying Li
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, 5011, Australia
| | - Matthew T Briggs
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Yea-Rin Lee
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Teresa Tin
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, 5011, Australia
| | - Clifford Young
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - John Pierides
- SA Pathology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Gurjeet Kaur
- Institute for Research in Molecular Medicine, University Sains Malaysia, 11800, Pulau Pinang, Malaysia
| | - Paul Drew
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, 5011, Australia
| | - Guy J Maddern
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, 5011, Australia
| | - Peter Hoffmann
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | | | - Kevin Fenix
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia.
- The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, 5011, Australia.
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d'Abadie P, Walrand S, Hesse M, Borbath I, Lhommel R, Jamar F. TCP post-radioembolization and TCP post-EBRT in HCC are similar and can be predicted using the in vitro radiosensitivity. EJNMMI Res 2022; 12:40. [PMID: 35802307 PMCID: PMC9270555 DOI: 10.1186/s13550-022-00911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tumor equivalent uniform dose (EUD) is proposed as a predictor of patient outcome after liver radioembolization (RE) of hepatocellular carcinoma (HCC) and can be evaluated with 90Y-TOF-PET. The aim is to evaluate the correlation between PET-based tumors EUD and the clinical response evaluated with dual molecular tracer (11C-acetate and 18F-FDG) PET/CT post-RE. Methods 34 HCC tumors in 22 patients were prospectively evaluated. The metabolic response was characterized by the total lesion metabolism variation (ΔTLM) between baseline and follow-up. This response allowed to compute a tumor control probability (TCP) as a function of the tumor EUD. Results The absorbed dose response correlation was highly significant (R = 0.72, P < 0.001). With an absorbed dose threshold of 40 Gy, the metabolic response was strongly different in both groups (median response 35% versus 100%, P < 0.001). Post-RE TCP as a function of the EUD was very similar to that observed in external beam radiation therapy (EBRT), with TCP values equal to 0.5 and 0.95 for a EUD of 51 Gy and 100 Gy, respectively. The TCP was perfectly predicted by the Poisson model assuming an inter tumor radiosensitivity variation of 30% around the HCC cell in vitro value. Conclusions EUD-based 90Y TOF-PET/CT predicts the metabolic response post-RE in HCC assessed using dual molecular PET tracers and provides a similar TCP curve to that observed in EBRT. In vivo and in vitro HCC radiosensitivities are similar. Both TCPs show that a EUD of 100 Gy is needed to control HCC for the three devices (resin spheres, glass spheres, EBRT). Observed absorbed doses achieving this 100 Gy-EUD ranged from 190 to 1800 Gy! Supplementary Information The online version contains supplementary material available at 10.1186/s13550-022-00911-0.
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Affiliation(s)
- Philippe d'Abadie
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium.
| | - Stephan Walrand
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium
| | - Michel Hesse
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium
| | - Ivan Borbath
- Department of Medical Oncology, CIiniques Universitaires Saint Luc, Institut Roi Albert II, Brussels, Belgium
| | - Renaud Lhommel
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint Luc, Institut Roi Albert II, 10, avenue Hippocrate, 1200, Brussels, Belgium
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Hesse M, d'Abadie P, Lhommel R, Jamar F, Walrand S. Yttrium-90 TOF-PET-Based EUD Predicts Response Post Liver Radioembolizations Using Recommended Manufacturer FDG Reconstruction Parameters. Front Oncol 2021; 11:592529. [PMID: 34676157 PMCID: PMC8523947 DOI: 10.3389/fonc.2021.592529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Explaining why 90Y TOF-PET based equivalent uniform dose (EUD) using recommended manufacturer FDG reconstruction parameters has been shown to predict response. Methods The hot rods insert of a Jaszczak deluxe phantom was partially filled with a 2.65 GBq 90Y - 300ml DTPA water solution resulting in a 100 Gy mean absorbed dose in the 6 sectors. A two bed 20min/position acquisition was performed on a 550ps- and on a 320ps- TOF-PET/CT and reconstructed with recommended manufacturer FDG reconstruction parameters, without and with additional filtering. The whole procedure was repeated on both PET after adding 300ml of water (50Gy setup). The phantom was acquired again after decay by a factor of 10 (5Gy setup), but with 200min per bed position. For comparison, the phantom was also acquired with 18F activity corresponding to a clinical FDG whole body acquisition. Results The 100Gy-setup provided a hot rod sectors image almost as good as the 18F phantom. However, despite acquisition time compensation, the 5Gy-setup provides much lower quality imaging. TOF-PET based sectors EUDs for the three large rod sectors agreed with the actual EUDs computed with a radiosensitivity of 0.021Gy-1 well in the range observed in external beam radiotherapy (EBRT), i.e. 0.01-0.04Gy-1. This agreement explains the reunification of the dose-response relationships of the glass and resin spheres in HCC using the TOF-PET based EUD. Additional filtering reduced the EUDs agreement quality. Conclusions Recommended manufacturer FDG reconstruction parameters are suitable in TOF-PET post 90Y liver radioembolization for accurate tumour EUD computation. The present results rule out the use of low specific activity phantom studies to optimize reconstruction parameters.
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Affiliation(s)
- Michel Hesse
- Nuclear Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Philipe d'Abadie
- Nuclear Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Renaud Lhommel
- Nuclear Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Francois Jamar
- Nuclear Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Stephan Walrand
- Nuclear Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
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d'Abadie P, Walrand S, Hesse M, Annet L, Borbath I, Van den Eynde M, Lhommel R, Jamar F. Prediction of tumor response and patient outcome after radioembolization of hepatocellular carcinoma using 90Y-PET-computed tomography dosimetry. Nucl Med Commun 2021; 42:747-754. [PMID: 33741864 DOI: 10.1097/mnm.0000000000001395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM 90Y-radioembolization using glass or resin microspheres is increasingly used for the treatment of hepatocellular carcinoma (HCC). The aim of this retrospective study is to determine the prognostic relevance of dosimetric parameters defined with 90Y-PET-CT obtained immediately after radioembolization. METHODS Forty-five HCC patients, mostly with multiple lesions, were treated by radioembolization between 2011 and 2017. After treatment, all underwent a 90Y PET-CT with time of flight reconstruction (90Y-TOF-PET-CT). Tumor absorbed dose and cumulative tumor dose-volume histogram were calculated using a dose point Kernel convolution algorithm. The radiological tumor response was assessed using modified (m)-RECIST criteria. Progression-free-survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS Twenty-six patients were treated with glass microspheres (73 lesions) and nineteen with resin microspheres (60 lesions). Thresholds of 118 and 61 Gy for glass and resin microspheres respectively correlate well with radiological response with a positive predictive value (PPV) of 98 and 80% and discriminate patient outcome with regard to PFS (P = 0.03 and 0.005) and OS (P = 0.003 and 0.007). Using dose volume histogram, a minimal absorbed dose of 40 Gy in 66% of the tumor volume (defined as D66) was highly predictive of radiological response (PPV = 94%), PFS (P < 0.001) and OS (P = 0. 008), for either device. CONCLUSION Dosimetric parameters obtained using 90Y-PET-CT are predictive of tumor response, PFS and OS. In clinical practice, a systematic dosimetric evaluation using 90Y PET should be implemented to help predicting patient outcomes.
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Affiliation(s)
| | | | | | | | - Ivan Borbath
- Gastroenterology and Oncology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marc Van den Eynde
- Gastroenterology and Oncology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
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Bong JW, Lim SB, Ryu H, Lee JL, Kim CW, Yoon YS, Park IJ, Yu CS, Kim JC. Effect of anaemia on the response to preoperative chemoradiotherapy for rectal cancer. ANZ J Surg 2021; 91:E286-E291. [PMID: 33404094 DOI: 10.1111/ans.16547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUNDS Radiation therapy with concurrent chemotherapy is an important treatment for rectal cancer, especially for advanced stage disease. Low serum haemoglobin levels are accepted as a negative indicator in the response to radiation therapy. This study aimed to evaluate the relationship between anaemia and the response to preoperative chemoradiotherapy for rectal cancer and its effect on oncologic outcomes. METHODS We retrospectively reviewed medical records of primary rectal cancer patients who were treated with preoperative chemoradiotherapy followed by total mesorectal excision between January 2011 and December 2015. Anaemia was defined as serum haemoglobin levels ≤9 g/dL before or during radiotherapy. Patients were divided into good and poor responders according to pathologic tumour regression grades. The effect of anaemia on the response to radiation therapy, recurrence-free survival and overall survival were analysed after subgroup analysis. RESULTS Overall, 301 and 394 patients were categorized into good and poor responder groups, respectively. Proportions of anaemia patients were higher in the poor responder group than in the good responder group (7.6% versus 4.0%, P = 0.042). Anaemia was associated with less pathologic complete regression but was not a risk factor for worse recurrence-free or overall survival. There was no significant difference in survival between patients with and without anaemia. CONCLUSION Haemoglobin levels ≤9 g/dL before or during radiotherapy were risk factors for achieving pathologic complete regression after preoperative chemoradiotherapy for rectal cancer. However, anaemia was not independently associated with worse survival outcomes.
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Affiliation(s)
- Jun Woo Bong
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyoseon Ryu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Wood J, Yasmin-Karim S, Moreau M, Kumar R, Akwanwi J, Derek A, Atoneche F, Kress J, Ngwa W. Characterization of Isolated Extracts from Justicia Plant Leaves used as Remedy for Anemia. Molecules 2020; 25:E534. [PMID: 31991819 PMCID: PMC7037932 DOI: 10.3390/molecules25030534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 01/10/2023] Open
Abstract
Indigenous populations use plants as an important healthcare resource or remedy for different diseases. Here, isolated extracts from Justicia (family Acanthanceae) plant leaves used in Africa as remedy for anemia are characterized by different methods to assess composition and potential nutritional or therapeutic value. Extracts from Justicia leaves were obtained by aqueous extraction, with further isolation by centrifuging and high-performance liquid chromatography. Extracts and isolated compounds were characterized by ultraviolet-visible (UV-Vis) spectroscopy and inductively coupled plasma mass spectrometry (ICP-MS). Hemoglobin activity was assessed using different hemoglobin assays (Cayman Chemical, and Sigma-Aldrich), as well as ELISA. In addition, the safety of the isolated samples was assessed in vitro and in vivo in mice. ICP-MS study results revealed many essential metabolites found in blood plasma. The UV-Vis spectroscopy results highlighted the presence of hemoglobin, with assays showing levels over 4 times higher than that of similar mass of lyophilized human hemoglobin. Meanwhile, in vivo studies showed faster recovery from anemia in mice administered with the isolated extracts compared to untreated mice. Moreover, in vitro and in vivo studies highlighted safety of the extracts. This study reveals the presence of high levels of elements essential for blood health in the isolated extracts from Justicia plant leaves. The findings inspire further research with the potential applications in food fortification, and as remedy for blood disorders like anemia, which disproportionally affects cancer patients, pregnant women, and populations in low- and middle-income countries.
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Affiliation(s)
- Jana Wood
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (J.W.); (S.Y.-K.); (M.M.)
| | - Sayeda Yasmin-Karim
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (J.W.); (S.Y.-K.); (M.M.)
| | - Michele Moreau
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (J.W.); (S.Y.-K.); (M.M.)
- Kennedy College of Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Rajiv Kumar
- College of Science, Northeastern University, Boston, MA 02115, USA;
| | - Janet Akwanwi
- Sts Stephen and Paul’s Foundation, Bafut 2060, Cameroon;
| | | | - Fred Atoneche
- Department of Physics, University of Buea, Buea, Cameroon;
| | - John Kress
- Department of Botany, MRC-166, National Museum of Natural History, Smithsonian, Institution, Washington, DC 20560, USA;
| | - Wilfred Ngwa
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; (J.W.); (S.Y.-K.); (M.M.)
- Kennedy College of Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
- College of Science, Northeastern University, Boston, MA 02115, USA;
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Ljungberg M, Sjogreen Gleisner K. 3-D Image-Based Dosimetry in Radionuclide Therapy. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018. [DOI: 10.1109/trpms.2018.2860563] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Levillain H, Duran Derijckere I, Marin G, Guiot T, Vouche M, Reynaert N, Hendlisz A, Vanderlinden B, Flamen P. 90Y-PET/CT-based dosimetry after selective internal radiation therapy predicts outcome in patients with liver metastases from colorectal cancer. EJNMMI Res 2018; 8:60. [PMID: 30006851 PMCID: PMC6045565 DOI: 10.1186/s13550-018-0419-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/27/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The aim of this work was to confirm that post-selective internal radiation therapy (SIRT) 90Y-PET/CT-based dosimetry correlates with lesion metabolic response and to determine its correlation with overall survival (OS) in liver-only metastases from colorectal cancer (mCRC) patients treated with SIRT. Twenty-four mCRC patients underwent pre/post-SIRT FDG-PET/CT and post-SIRT 90Y-PET/CT. Lesions delineated on pre/post-SIRT FDG-PET/CT were classified as non-metabolic responders (total lesion glycolysis (TLG)-decrease < 15%) and high-metabolic responders (TLG-decrease ≥ 50%). Lesion delineations were projected on the anatomically registered 90Y-PET/CT. Voxel-based 3D dosimetrywas performed on the 90Y-PET/CT and lesions' mean absorbed dose (Dmean) was measured. The coefficient of correlation between Dmean and TLG-decrease was calculated. The ability of lesion Dmean to predict non-metabolic response and high-metabolic response was tested and two cutoff values (Dmean-under-treated and Dmean-well-treated) were determined using ROC analysis. Patients were dichotomised in the "treated" group (all the lesions received a Dmean > Dmean-under-treated) and in the "under-treated" group (at least one lesion received a Dmean < Dmean-under-treated). Kaplan-Meier product limit method was used to describe OS curves. RESULTS Fifty-seven evaluable mCRC lesions were included. The coefficient of correlation between Dmean and TLG-decrease was 0.82. Two lesion Dmean cutoffs of 39 Gy (sensitivity 80%, specificity 95%, predictive-positive-value 86% and negative-predictive-value 92%) and 60 Gy (sensitivity 70%, specificity 95%, predictive positive-value 96% and negative-predictive-value 63%) were defined to predict non-metabolic response and high-metabolic response respectively. Patients with all lesions Dmean> 39 Gy had a significantly longer OS (13 months) than patients with at least one lesion Dmean < 39 Gy (OS = 5 months) (p = 0.012;hazard-ratio, 2.6 (95% CI 0.98-7.00)). CONCLUSIONS In chemorefractory mCRC patients treated with SIRT, lesion Dmean determined on post-SIRT 90Y-PET/CT correlates with metabolic response and higher lesion Dmean is associated with prolonged OS.
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Affiliation(s)
- Hugo Levillain
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium.
| | - Ivan Duran Derijckere
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Gwennaëlle Marin
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Thomas Guiot
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Michaël Vouche
- Department of Radiology, Hôpital St-Pierre, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Alain Hendlisz
- Department of Digestive Oncology, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Bruno Vanderlinden
- Department of Medical Physics, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
| | - Patrick Flamen
- Department of Nuclear Medicine, Jules Bordet Institute, Université Libre de Bruxelles, Rue Héger-Bordet 1, B-1000, Brussels, Belgium
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Willowson KP, Hayes AR, Chan DLH, Tapner M, Bernard EJ, Maher R, Pavlakis N, Clarke SJ, Bailey DL. Clinical and imaging-based prognostic factors in radioembolisation of liver metastases from colorectal cancer: a retrospective exploratory analysis. EJNMMI Res 2017; 7:46. [PMID: 28536968 PMCID: PMC5442040 DOI: 10.1186/s13550-017-0292-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/12/2017] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to investigate the relationship between absorbed dose and response of colorectal cancer liver metastases treated with [90Y]-resin microspheres and to explore possible clinical and imaging derived prognostic factors. Methods FDG PET/CT was used to measure response of individual lesions to a measured absorbed dose, derived from post-treatment 90Y PET imaging. Predicted dose was also derived from planning [99mTc]-MAA SPECT data. Peak standardised uptake value and total lesion glycolysis (TLG) were explored as response measures, and compared to dose metrics including average dose (Davg), biologically effective dose, minimum dose to 70% of lesion volume and volume receiving at least 50 Gy. Prognostic factors examined included baseline TLG, RAS mutation status, FDG heterogeneity and dose heterogeneity. In an exploratory analysis, response and clinico-pathological variables were evaluated and compared to overall survival. Results Sixty-three lesions were analysed from 22 patients. Poor agreement was seen between predicted and measured dose values. TLG was a superior measure of response, and all dose metrics were significant prognostic factors, with a Davg of ~50 Gy derived as the critical threshold for a significant response (>50% reduction in TLG). No significant correlation was found between baseline TLG or RAS mutation status and response. Measured dose heterogeneity was a significant prognostic factor and when combined with Davg had a positive predictive value for response >80%. In the exploratory analysis for prognostic factors of survival, low hepatic tumour burden and mean reduction in TLG >65% were independently associated with improved overall survival. Conclusions Lesions receiving an average dose greater than 50 Gy are likely to have a significant response. For lesions receiving less than 50 Gy, dose heterogeneity is a significant prognostic factor. Lesions receiving an average dose less than 20 Gy are unlikely to respond. A reduction in TLG may be associated with improved overall survival. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0292-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathy P Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW, Australia.
| | - Aimee R Hayes
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - David L H Chan
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael Tapner
- Research and Development, Sirtex Medical Limited, North Sydney, Australia
| | - Elizabeth J Bernard
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Richard Maher
- Department of Radiology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Stephen J Clarke
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Dale L Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.,Faculty of Health Sciences, University of Sydney, Camperdown, NSW, Australia
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Kennedy AS, Ball D, Cohen SJ, Cohn M, Coldwell DM, Drooz A, Ehrenwald E, Kanani S, Moeslein FM, Nutting CW, Putnam SG, Rose SC, Savin M, Schirm S, Sharma NK, Wang E. Baseline hemoglobin and liver function predict tolerability and overall survival of patients receiving radioembolization for chemotherapy-refractory metastatic colorectal cancer. J Gastrointest Oncol 2017; 8:70-80. [PMID: 28280611 DOI: 10.21037/jgo.2017.01.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients with liver metastatic colorectal cancer (mCRC) often benefit from receiving 90Y-microsphere radioembolization (RE) administered via the hepatic arteries. Prior to delivery of liver-directed radiation, standard laboratory tests may assist in improving outcome by identifying correctable pre-radiation abnormalities. METHODS A database containing retrospective review of consecutively treated patients of mCRC from July 2002 to December 2011 at 11 US institutions was used. Data collected included background characteristics, prior chemotherapy, surgery/ablation, radiotherapy, vascular procedures, 90Y treatment, subsequent adverse events and survival. Kaplan-Meier estimates compared the survival of patients across lines of chemotherapy. The following values were obtained within 10 days prior to each RE treatment: haemoglobin (HGB), albumin, alkaline phosphatase (Alk phosph), aspartate aminotransferase (AST), alanine transaminase (ALT), total bilirubin and creatinine. Common Terminology Criteria Adverse Events (CTCAEs) 3.0 grade was assigned to each parameter and analysed for impact on survival by line of chemotherapy. Consensus Guidelines were used to categorize the parameter grades as either within or outside guidelines for treatment. RESULTS A total of 606 patients (370 male; 236 female) were studied with a median follow-up was 8.5 mo. (IQR 4.3-15.6) after RE. Fewer than 11% of patients were treated outside recommended RE guidelines, with albumin being the most common, 10.5% grade 2 (<3-2.0 g/dL) at time of RE. All seven parameters showed statistically significant decreased median survivals with any grade >0 (P<0.001) across all lines of prior chemotherapy. Compared to grade 0, grade 2 albumin decreased overall survival 67%; for grade 2 total bilirubin a 63% drop occurred, and grade 1 HGB resulted in 66% lower median survival. CONCLUSIONS Review of pre-RE laboratory parameters may aid in improving median survivals if correctable grade >0 values are addressed prior to radiation delivery. HGB <10 g/dL is a well-known negative factor in radiation response and is easily corrected. Improving other parameters is more challenging. These efforts are important in optimizing treatment response to liver radiotherapy.
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Affiliation(s)
| | - David Ball
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | | | - Michael Cohn
- Radiology Associates of Hollywood, Pembroke Pines, FL 33024, USA
| | - Douglas M Coldwell
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA
| | - Alain Drooz
- Fairfax Radiological Consultants, Fairfax, VA 22031, USA
| | | | - Samir Kanani
- Inova Fairfax Hospital, Annandale, VA 22003, USA
| | - Fred M Moeslein
- University of Maryland Medical Center, Baltimore, MD 21201, USA
| | | | | | - Steven C Rose
- UC San Diego Moores Cancer Center, La Jolla, CA 92103-875, USA
| | | | - Sabine Schirm
- Cancer Centers of North Carolina, Cary, NC 27518, USA
| | - Navesh K Sharma
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Eric Wang
- Charlotte Radiology, Charlotte, NC 28211, USA
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Smits MLJ, Bastiaannet R, Prince JF, de Jong HWAM, van den Bosch MAAJ, Lam MGEH. Lung Shunting: An Indicator of Survival, But Not Necessarily a Tool for Selecting Patients for Radioembolization. Radiology 2017; 282:612-613. [DOI: 10.1148/radiol.2017162087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Pasciak AS, Lin A, Georgiades C, Findeiss LK, Kauffman S, Bradley YC. Computational simulation of the predicted dosimetric impact of adjuvant yttrium-90 PET/CT-guided percutaneous ablation following radioembolization. EJNMMI Res 2016; 6:89. [PMID: 27957721 PMCID: PMC5153383 DOI: 10.1186/s13550-016-0244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND 90Y PET/CT post-radioembolization imaging has demonstrated that the distribution of 90Y in a tumor can be non-uniform. Using computational modeling, we predicted the dosimetric impact of post-treatment 90Y PET/CT-guided percutaneous ablation of the portions of a tumor receiving the lowest absorbed dose. A cohort of fourteen patients with non-resectable liver cancer previously treated using 90Y radioembolization were included in this retrospective study. Each patient exhibited potentially under-treated areas of tumor following treatment based on quantitative 90Y PET/CT. 90Y PET/CT was used to guide electrode placement for simulated adjuvant radiofrequency ablation in areas of tumor receiving the lowest dose. The finite element method was used to solve Penne's bioheat transport equation, coupled with the Arrhenius thermal cell-death model to determine 3D thermal ablation zones. Tumor and unablated tumor absorbed-dose metrics (average dose, D50, D70, D90, V100) following ablation were compared, where D70 is the minimum dose to 70% of tumor and V100 is the fractional tumor volume receiving more than 100 Gy. RESULTS Compared to radioembolization alone, 90Y radioembolization with adjuvant ablation was associated with predicted increases in all tumor dose metrics evaluated. The mean average absorbed dose increased by 11.2 ± 6.9 Gy. Increases in D50, D70, and D90 were 11.0 ± 6.9 Gy, 13.3 ± 10.9 Gy, and 11.8 ± 10.8 Gy, respectively. The mean increase in V100 was 7.2 ± 4.2%. All changes were statistically significant (P < 0.01). A negative correlation between pre-ablation tumor volume and D50, average dose, and V100 was identified (ρ < - 0.5, P < 0.05) suggesting that adjuvant radiofrequency ablation may be less beneficial to patients with large tumor burdens. CONCLUSIONS This study has demonstrated that adjuvant 90Y PET/CT-guided radiofrequency ablation may improve tumor absorbed-dose metrics. These data may justify a prospective clinical trial to further evaluate this hybrid approach.
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Affiliation(s)
- Alexander S Pasciak
- Department of Radiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
- School of Medicine, The Johns Hopkins Hospital, 733 N Broadway, Baltimore, MD, 21205, USA.
| | - Abigail Lin
- School of Medicine, The Johns Hopkins Hospital, 733 N Broadway, Baltimore, MD, 21205, USA
| | | | - Laura K Findeiss
- Department of Radiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | | | - Yong C Bradley
- Department of Radiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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14
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Walrand S, Hesse M, Jamar F. Update on novel trends in PET/CT technology and its clinical applications. Br J Radiol 2016; 91:20160534. [PMID: 27730823 DOI: 10.1259/bjr.20160534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
After a brief history of the major evolutions of positron emission tomography since its introduction in 1972, this article reviews the recent improvements and novel trends in positron emission tomography with a special focus on the time of flight that is currently the major research topic. Novel emerging acquisition modalities, such as dual tracer acquisition, inline hadron therapy dose imaging and yttrium-90 imaging are reviewed.
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Affiliation(s)
- Stephan Walrand
- Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Michel Hesse
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
| | - François Jamar
- Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain, Brussels, Belgium
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van den Hoven AF, Prince JF, Bruijnen RCG, Verkooijen HM, Krijger GC, Lam MGEH, van den Bosch MAAJ. Surefire infusion system versus standard microcatheter use during holmium-166 radioembolization: study protocol for a randomized controlled trial. Trials 2016; 17:520. [PMID: 27782851 PMCID: PMC5080784 DOI: 10.1186/s13063-016-1643-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/05/2016] [Indexed: 12/31/2022] Open
Abstract
Background An anti-reflux catheter (ARC) may increase the tumor absorbed dose during radioembolization (RE) by elimination of particle reflux and its effects on hemodynamics. Since the catheter is fixed in a centro-luminal position, it may also increase the predictive accuracy of a scout dose administration before treatment. The purpose of the SIM trial is to compare the effects of ARC use during RE with holmium-166 (166Ho) microspheres in patients with colorectal liver metastases (CRLM), with the use of a standard end-hole microcatheter. Methods/Design A within-patient randomized controlled trial (RCT) will be conducted in 25 patients with unresectable chemorefractory liver-dominant CRLM. Study participants will undergo a 166Ho scout dose procedure in the morning and a therapeutic procedure in the afternoon. The ARC will be randomly allocated to the left/right hepatic artery, and a standard microcatheter will be used in the contralateral artery. SPECT/CT imaging will be performed for quantitative analyses of the microsphere distribution directly after the scout and treatment procedure. Baseline and follow-up investigations include 18F-FDG-PET + liver CT, clinical and laboratory examinations. The primary endpoint is the comparison of tumor to non-tumor (T/N) activity ratio in both groups. Secondary endpoints include comparisons of mean absorbed dose in tumors and healthy liver tissue, infusion efficiency, the predictive value of 166Ho scout dose for tumor response. In the entire cohort, a dose-response relationship, clinical toxicity, and overall survival will be assessed. The sample was determined for the expectation that the ARC will increase the T/N ratio by 25 % (mean T/N ratio 2.0 vs. 1.6). Discussion The SIM trial is a within-patient RCT that will assess whether 166Ho RE treatment can be optimized by using an ARC. Trial registration The SIM trial is registered at clinicaltrials.gov (NCT02208804). Registered on 31 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1643-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andor F van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jip F Prince
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gerard C Krijger
- 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
| | - Maurice A A J van den Bosch
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Chiesa C, Mira M, Maccauro M, Spreafico C, Romito R, Morosi C, Camerini T, Carrara M, Pellizzari S, Negri A, Aliberti G, Sposito C, Bhoori S, Facciorusso A, Civelli E, Lanocita R, Padovano B, Migliorisi M, De Nile MC, Seregni E, Marchianò A, Crippa F, Mazzaferro V. Radioembolization of hepatocarcinoma with (90)Y glass microspheres: development of an individualized treatment planning strategy based on dosimetry and radiobiology. Eur J Nucl Med Mol Imaging 2015; 42:1718-1738. [PMID: 26112387 DOI: 10.1007/s00259-015-3068-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/09/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to optimize the dosimetric approach and to review the absorbed doses delivered, taking into account radiobiology, in order to identify the optimal methodology for an individualized treatment planning strategy based on (99m)Tc-macroaggregated albumin (MAA) single photon emission computed tomography (SPECT) images. METHODS We performed retrospective dosimetry of the standard TheraSphere® treatment on 52 intermediate (n = 17) and advanced (i.e. portal vein thrombosis, n = 35) hepatocarcinoma patients with tumour burden < 50% and without obstruction of the main portal vein trunk. Response was monitored with the densitometric radiological criterion (European Association for the Study of the Liver) and treatment-related liver decompensation was defined ad hoc with a time cut-off of 6 months. Adverse events clearly attributable to disease progression or other causes were not attributed to treatment. Voxel dosimetry was performed with the local deposition method on (99m)Tc-MAA SPECT images. The reconstruction protocol was optimized. Concordance of (99m)Tc-MAA and (90)Y bremsstrahlung microsphere biodistributions was studied in 35 sequential patients. Two segmentation methods were used, based on SPECT alone (home-made code) or on coregistered SPECT/CT images (IMALYTICS™ by Philips). STRATOS™ absorbed dose calculation was validated for (90)Y with a single time point. Radiobiology was used introducing other dosimetric variables besides the mean absorbed dose D: equivalent uniform dose (EUD), biologically effective dose averaged over voxel values (BEDave) and equivalent uniform biologically effective dose (EUBED). Two sets of radiobiological parameters, the first derived from microsphere irradiation and the second from external beam radiotherapy (EBRT), were used. A total of 16 possible methodologies were compared. Tumour control probability (TCP) and normal tissue complication probability (NTCP) were derived. The area under the curve (AUC) of the receiver-operating characteristic (ROC) curve was used as a figure of merit to identify the methodology which gave the best separation in terms of dosimetry between responding and non-responding lesions and liver decompensated vs non-decompensated liver treatment. RESULTS MAA and (90)Y biodistributions were not different (71% of cases), different in 23% and uncertain in 6%. Response correlated with absorbed dose (Spearman's r from 0.48 to 0.69). Responding vs non-responding lesion absorbed doses were well separated, regardless of the methodology adopted (p = 0.0001, AUC from 0.75 to 0.87). EUBED gave significantly better separation with respect to mean dose (AUC = 0.87 vs 0.80, z = 2.07). Segmentation on SPECT gave better separation than on SPECT/CT. TCP(50%) was at 250 Gy for small lesion volumes (<10 cc) and higher than 1,000 Gy for large lesions (>10 cc). Apparent radiosensitivity values from TCP were around 0.003/Gy, a factor of 3-5 lower than in EBRT, as found by other authors. The dose-rate effect was negligible: a purely linear model can be applied. Toxicity incidence was significantly larger for Child B7 patients (89 vs 14%, p < 0.0001), who were therefore excluded from dose-toxicity analysis. Child A toxic vs non-toxic treatments were significantly separated in terms of dose averaged on whole non-tumoural parenchyma (including non-irradiated regions) with AUC from 0.73 to 0.94. TD50 was ≈ 100 Gy. No methodology was superior to parenchyma mean dose, which therefore can be used for planning, with a limit of TD15 ≈ 75 Gy. CONCLUSION A dosimetric treatment planning criterion for Child A patients without complete obstruction of the portal vein was developed.
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Affiliation(s)
- C Chiesa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy.
| | - M Mira
- Postgraduate Health Physics School, University of Milan, Milan, Italy
| | - M Maccauro
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - C Spreafico
- Radiology 2, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R Romito
- Surgery 1, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Morosi
- Radiology 2, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - T Camerini
- Scientific Direction, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Carrara
- Health Physics, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Pellizzari
- Engineering Faculty, University La Sapienza, Rome, Italy
| | - A Negri
- Postgraduate Health Physics School, University of Milan, Milan, Italy
| | - G Aliberti
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - C Sposito
- Surgery 1, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Bhoori
- Surgery 1, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Facciorusso
- Surgery 1, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - E Civelli
- Radiology 2, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R Lanocita
- Radiology 2, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - B Padovano
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - M Migliorisi
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
- Clinical Engineering, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M C De Nile
- Physics Faculty, University of Pavia, Pavia, Lombardy, Italy
| | - E Seregni
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - A Marchianò
- Radiology 2, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - F Crippa
- Nuclear Medicine Division, Foundation IRCCS Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milan, Italy
| | - V Mazzaferro
- Surgery 1, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy
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Willowson KP, Tapner M, Bailey DL. A multicentre comparison of quantitative (90)Y PET/CT for dosimetric purposes after radioembolization with resin microspheres : The QUEST Phantom Study. Eur J Nucl Med Mol Imaging 2015; 42:1202-22. [PMID: 25967868 PMCID: PMC4480824 DOI: 10.1007/s00259-015-3059-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/01/2015] [Indexed: 01/02/2023]
Abstract
Purpose To investigate and compare the quantitative accuracy of 90Y imaging across different generation PET/CT scanners, for the purpose of dosimetry after radioembolization with resin microspheres. Methods A strict experimental and imaging protocol was followed by 47 international sites using the NEMA 2007/IEC 2008 PET body phantom with an 8-to-1 sphere-to-background ratio of 90Y solution. The phantom was imaged over a 7-day period (activity ranging from 0.5 to 3.0 GBq) and all reconstructed data were analysed at a core laboratory for consistent processing. Quantitative accuracy was assessed through measures of total phantom activity, activity concentration in background and hot spheres, misplaced counts in a nonradioactive insert, and background variability. Results Of the 69 scanners assessed, 37 had both time-of-flight (ToF) and resolution recovery (RR) capability. These current generation scanners from GE, Philips and Siemens could reconstruct background concentration measures to within 10 % of true values over the evaluated range, with greater deviations on the Philips systems at low count rates, and demonstrated typical partial volume effects on hot sphere recovery, which dominated spheres of diameter <20 mm. For spheres >20 mm in diameter, activity concentrations were consistently underestimated by about 20 %. Non-ToF scanners from GE Healthcare and Siemens were capable of producing accurate measures, but with inferior quantitative recovery compared with ToF systems. Conclusion Current generation ToF scanners can consistently reconstruct 90Y activity concentrations, but they underestimate activity concentrations in small structures (≤37 mm diameter) within a warm background due to partial volume effects and constraints of the reconstruction algorithm. At the highest count rates investigated, measures of background concentration (about 300 kBq/ml) could be estimated on average to within 1 %, 5 % and 2 % for GE Healthcare (all-pass filter, RR + ToF), Philips (4i8s ToF) and Siemens (2i21s all-pass filter, RR + ToF) ToF systems, respectively. Over the range of activities investigated, comparable performance between GE Healthcare and Siemens ToF systems suggests suitability for quantitative analysis in a scenario analogous to that of postradioembolization imaging for treatment of liver cancer.
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Affiliation(s)
- Kathy P Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, 2006, NSW, Australia,
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Cremonesi M, Chiesa C, Strigari L, Ferrari M, Botta F, Guerriero F, De Cicco C, Bonomo G, Orsi F, Bodei L, Di Dia A, Grana CM, Orecchia R. Radioembolization of hepatic lesions from a radiobiology and dosimetric perspective. Front Oncol 2014; 4:210. [PMID: 25191640 PMCID: PMC4137387 DOI: 10.3389/fonc.2014.00210] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/23/2014] [Indexed: 12/18/2022] Open
Abstract
Radioembolization (RE) of liver cancer with 90Y-microspheres has been applied in the last two decades with notable responses and acceptable toxicity. Two types of microspheres are available, glass and resin, the main difference being the activity/sphere. Generally, administered activities are established by empirical methods and differ for the two types. Treatment planning based on dosimetry is a prerogative of few centers, but has notably gained interest, with evidence of predictive power of dosimetry on toxicity, lesion response, and overall survival (OS). Radiobiological correlations between absorbed doses and toxicity to organs at risk, and tumor response, have been obtained in many clinical studies. Dosimetry methods have evolved from the macroscopic approach at the organ level to voxel analysis, providing absorbed dose spatial distributions and dose–volume histograms (DVH). The well-known effects of the external beam radiation therapy (EBRT), such as the volume effect, underlying disease influence, cumulative damage in parallel organs, and different tolerability of re-treatment, have been observed also in RE, identifying in EBRT a foremost reference to compare with. The radiobiological models – normal tissue complication probability and tumor control probability – and/or the style (DVH concepts) used in EBRT are introduced in RE. Moreover, attention has been paid to the intrinsic different activity distribution of resin and glass spheres at the microscopic scale, with dosimetric and radiobiological consequences. Dedicated studies and mathematical models have developed this issue and explain some clinical evidences, e.g., the shift of dose to higher toxicity thresholds using glass as compared to resin spheres. This paper offers a comprehensive review of the literature incident to dosimetry and radiobiological issues in RE, with the aim to summarize the results and to identify the most useful methods and information that should accompany future studies.
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Affiliation(s)
| | | | - Lidia Strigari
- Istituto Nazionale dei Tumori Regina Elena , Rome , Italy
| | | | | | | | | | | | - Franco Orsi
- Istituto Europeo di Oncologia , Milan , Italy
| | - Lisa Bodei
- Istituto Europeo di Oncologia , Milan , Italy
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Elschot M, Smits MLJ, Nijsen JFW, Lam MGEH, Zonnenberg BA, van den Bosch MAAJ, Viergever MA, de Jong HWAM. Quantitative Monte Carlo-based holmium-166 SPECT reconstruction. Med Phys 2014; 40:112502. [PMID: 24320461 DOI: 10.1118/1.4823788] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Quantitative imaging of the radionuclide distribution is of increasing interest for microsphere radioembolization (RE) of liver malignancies, to aid treatment planning and dosimetry. For this purpose, holmium-166 ((166)Ho) microspheres have been developed, which can be visualized with a gamma camera. The objective of this work is to develop and evaluate a new reconstruction method for quantitative (166)Ho SPECT, including Monte Carlo-based modeling of photon contributions from the full energy spectrum. METHODS A fast Monte Carlo (MC) simulator was developed for simulation of (166)Ho projection images and incorporated in a statistical reconstruction algorithm (SPECT-fMC). Photon scatter and attenuation for all photons sampled from the full (166)Ho energy spectrum were modeled during reconstruction by Monte Carlo simulations. The energy- and distance-dependent collimator-detector response was modeled using precalculated convolution kernels. Phantom experiments were performed to quantitatively evaluate image contrast, image noise, count errors, and activity recovery coefficients (ARCs) of SPECT-fMC in comparison with those of an energy window-based method for correction of down-scattered high-energy photons (SPECT-DSW) and a previously presented hybrid method that combines MC simulation of photopeak scatter with energy window-based estimation of down-scattered high-energy contributions (SPECT-ppMC+DSW). Additionally, the impact of SPECT-fMC on whole-body recovered activities (A(est)) and estimated radiation absorbed doses was evaluated using clinical SPECT data of six (166)Ho RE patients. RESULTS At the same noise level, SPECT-fMC images showed substantially higher contrast than SPECT-DSW and SPECT-ppMC+DSW in spheres ≥ 17 mm in diameter. The count error was reduced from 29% (SPECT-DSW) and 25% (SPECT-ppMC+DSW) to 12% (SPECT-fMC). ARCs in five spherical volumes of 1.96-106.21 ml were improved from 32%-63% (SPECT-DSW) and 50%-80% (SPECT-ppMC+DSW) to 76%-103% (SPECT-fMC). Furthermore, SPECT-fMC recovered whole-body activities were most accurate (A(est) = 1.06 × A - 5.90 MBq, R(2) = 0.97) and SPECT-fMC tumor absorbed doses were significantly higher than with SPECT-DSW (p = 0.031) and SPECT-ppMC+DSW (p = 0.031). CONCLUSIONS The quantitative accuracy of (166)Ho SPECT is improved by Monte Carlo-based modeling of the image degrading factors. Consequently, the proposed reconstruction method enables accurate estimation of the radiation absorbed dose in clinical practice.
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Affiliation(s)
- Mattijs Elschot
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Walrand S, Hesse M, Wojcik R, Lhommel R, Jamar F. Optimal design of anger camera for bremsstrahlung imaging: monte carlo evaluation. Front Oncol 2014; 4:149. [PMID: 24982849 PMCID: PMC4056384 DOI: 10.3389/fonc.2014.00149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/29/2014] [Indexed: 11/29/2022] Open
Abstract
A conventional Anger camera is not adapted to bremsstrahlung imaging and, as a result, even using a reduced energy acquisition window, geometric x-rays represent <15% of the recorded events. This increases noise, limits the contrast, and reduces the quantification accuracy. Monte Carlo (MC) simulations of energy spectra showed that a camera based on a 30-mm-thick BGO crystal and equipped with a high energy pinhole collimator is well-adapted to bremsstrahlung imaging. The total scatter contamination is reduced by a factor 10 versus a conventional NaI camera equipped with a high energy parallel hole collimator enabling acquisition using an extended energy window ranging from 50 to 350 keV. By using the recorded event energy in the reconstruction method, shorter acquisition time and reduced orbit range will be usable allowing the design of a simplified mobile gantry. This is more convenient for use in a busy catheterization room. After injecting a safe activity, a fast single photon emission computed tomography could be performed without moving the catheter tip in order to assess the liver dosimetry and estimate the additional safe activity that could still be injected. Further long running time MC simulations of realistic acquisitions will allow assessing the quantification capability of such system. Simultaneously, a dedicated bremsstrahlung prototype camera reusing PMT–BGO blocks coming from a retired PET system is currently under design for further evaluation.
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Affiliation(s)
- Stephan Walrand
- Department of Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain , Brussels , Belgium
| | - Michel Hesse
- Department of Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain , Brussels , Belgium
| | | | - Renaud Lhommel
- Department of Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain , Brussels , Belgium
| | - François Jamar
- Department of Nuclear Medicine, Molecular Imaging, Radiotherapy and Oncology Unit (MIRO), IECR, Université Catholique de Louvain , Brussels , Belgium
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Ahmadzadehfar H, Duan H, Haug AR, Walrand S, Hoffmann M. The role of SPECT/CT in radioembolization of liver tumours. Eur J Nucl Med Mol Imaging 2014; 41 Suppl 1:S115-24. [PMID: 24442600 DOI: 10.1007/s00259-013-2675-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 01/14/2023]
Abstract
Radioembolization (RE) with (90)Y microspheres is a promising catheter-based therapeutic option for patients with unresectable primary and metastatic liver tumours. Its rationale arises from the dual blood supply of liver tissue through the hepatic artery and the portal vein. Metastatic hepatic tumours measuring >3 mm derive 80 - 100 % of their blood supply from the arterial rather than the portal hepatic circulation. Typically, an angiographic evaluation combined with (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) scan precedes therapy to map the tumour feeding vessels as well as to avoid the inadvertent deposition of microspheres in organs other than the liver. Prior to administration of (99m)Tc-MAA, prophylactic coil embolization of the gastroduodenal artery is recommended to avoid extrahepatic deposition of the microspheres. SPECT/CT allows direct correlation of anatomic and functional information in patients with unresectable liver disease. SPECT/CT is recommended to assess intrahepatic distribution as well as extrahepatic gastrointestinal uptake in these patients. Pretherapeutic SPECT/CT is an important component of treatment planning including catheter positioning and dose finding. A post-therapy bremsstrahlung (BS) scan should follow RE to verify the distribution of the administered tracer. BS SPECT/CT imaging enables better localization and definition of intrahepatic and possible extrahepatic sphere distribution and to a certain degree allows posttreatment dosimetry. In this paper we address the usefulness and significance of SPECT/CT in therapy planning and therapy monitoring of RE.
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van den Hoven AF, Smits MLJ, Rosenbaum CENM, Verkooijen HM, van den Bosch MAAJ, Lam MGEH. The effect of intra-arterial angiotensin II on the hepatic tumor to non-tumor blood flow ratio for radioembolization: a systematic review. PLoS One 2014; 9:e86394. [PMID: 24466071 PMCID: PMC3895031 DOI: 10.1371/journal.pone.0086394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/06/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Treatment efficacy of intra-arterial radioembolization for liver tumors depends on the selective targeting of tumorous tissue. Recent investigations have demonstrated that tumors may receive inadequate doses of radioactivity after radioembolization, due to unfavorable tumor to non-tumor (T/N) uptake ratios of radioactive microspheres. Hepatic arterial infusion of the vasoconstrictor angiotensin II (AT-II) is reported to increase the T/N blood flow ratio. The purpose of this systematic review was to provide a comprehensive overview of the effect of hepatic arterial AT-II on T/N blood flow ratio in patients with hepatic malignancies, and determine its clinical value for radioembolization. METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A structured search was performed in the PubMed, EMBASE and Cochrane databases. Only studies that presented data on T/N ratios before and after infusion of AT-II into the hepatic artery, in human patients with hepatic malignancies, were selected. Median T/N ratios before, during and after AT-II infusion, and the median T/N ratio improvement factor were extracted from the selected articles. All data on systemic blood pressure measurements and clinical symptoms were also extracted. RESULTS The search identified 524 titles of which 5 studies, including a total of 71 patients were considered relevant. Median T/N ratios before infusion of AT-II ranged from 0.4 to 3.4. All studies observed a substantial improvement of the T/N ratio after AT-II infusion, with median improvement factors ranging from 1.8 to 3.1. A transitory increase of systemic blood pressure was observed during AT-II infusion. CONCLUSIONS Infusion of AT-II into the hepatic artery leads to an increase of the tumor to non-tumor blood flow ratio, as measured by T/N uptake ratios. Clinical trials are warranted to assess safety aspects, optimal administration strategy and impact on treatment efficacy during radioembolization.
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Affiliation(s)
- Andor F. van den Hoven
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten L. J. Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Helena M. Verkooijen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Elschot M, Lam MGEH, van den Bosch MAAJ, Viergever MA, de Jong HWAM. Quantitative Monte Carlo-based 90Y SPECT reconstruction. J Nucl Med 2013; 54:1557-63. [PMID: 23907758 DOI: 10.2967/jnumed.112.119131] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED The evaluation of radiation absorbed doses in tumorous and healthy tissues is of increasing interest for (90)Y microsphere radioembolization of liver malignancies. The objectives of this work were to introduce and validate a new reconstruction method for quantitative (90)Y bremsstrahlung SPECT to improve posttreatment dosimetry. METHODS A fast Monte Carlo simulator was adapted for (90)Y and incorporated into a statistical reconstruction algorithm (SPECT-MC). Photon scatter and attenuation for all photons sampled from the full (90)Y energy spectrum were modeled during reconstruction by Monte Carlo simulations. The energy- and distance-dependent collimator-detector response was modeled with precalculated convolution kernels. The National Electrical Manufacturers Association 2007/International Electrotechnical Commission 2008 image quality phantom was used to quantitatively evaluate the performance of SPECT-MC in comparison with those of state-of-the-art clinical SPECT reconstruction and PET. The liver radiation absorbed doses estimated by SPECT, PET, and SPECT-MC were evaluated in 5 patients consecutively treated with radioembolization. RESULTS In comparison with state-of-the-art clinical (90)Y SPECT reconstruction, SPECT-MC substantially improved image contrast (e.g., from 25% to 88% for the 37-mm sphere) and decreased the mean residual count error in the lung insert (from 73% to 15%) at the cost of higher image noise. Image noise and the mean count error were lower for SPECT-MC than for PET. Image contrast was higher in the larger spheres (diameter of ≥28 mm) but lower in the smaller spheres (≤22 mm) for SPECT-MC than for PET. In the clinical study, mean absorbed dose estimates in liver regions with high absorbed doses were consistently higher for SPECT-MC than for SPECT (P = 0.0625) and consistently higher for SPECT-MC than for PET (P = 0.0625). CONCLUSION The quantitative accuracy of (90)Y bremsstrahlung SPECT is substantially improved by Monte Carlo-based modeling of the image-degrading factors. Consequently, (90)Y bremsstrahlung SPECT may be used as an alternative to (90)Y PET.
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Affiliation(s)
- Mattijs Elschot
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
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Kao YH, Steinberg JD, Tay YS, Lim GK, Yan J, Townsend DW, Budgeon CA, Boucek JA, Francis RJ, Cheo TS, Burgmans MC, Irani FG, Lo RH, Tay KH, Tan BS, Chow PK, Satchithanantham S, Tan AE, Ng DC, Goh AS. Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res 2013; 3:57. [PMID: 23885971 PMCID: PMC3733999 DOI: 10.1186/2191-219x-3-57] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/16/2013] [Indexed: 12/25/2022] Open
Abstract
Background Coincidence imaging of low-abundance yttrium-90 (90Y) internal pair production by positron emission tomography with integrated computed tomography (PET/CT) achieves high-resolution imaging of post-radioembolization microsphere biodistribution. Part 2 analyzes tumor and non-target tissue dose-response by 90Y PET quantification and evaluates the accuracy of tumor 99mTc macroaggregated albumin (MAA) single-photon emission computed tomography with integrated CT (SPECT/CT) predictive dosimetry. Methods Retrospective dose quantification of 90Y resin microspheres was performed on the same 23-patient data set in part 1. Phantom studies were performed to assure quantitative accuracy of our time-of-flight lutetium-yttrium-oxyorthosilicate system. Dose-responses were analyzed using 90Y dose-volume histograms (DVHs) by PET voxel dosimetry or mean absorbed doses by Medical Internal Radiation Dose macrodosimetry, correlated to follow-up imaging or clinical findings. Intended tumor mean doses by predictive dosimetry were compared to doses by 90Y PET. Results Phantom studies demonstrated near-perfect detector linearity and high tumor quantitative accuracy. For hepatocellular carcinomas, complete responses were generally achieved at D70 > 100 Gy (D70, minimum dose to 70% tumor volume), whereas incomplete responses were generally at D70 < 100 Gy; smaller tumors (<80 cm3) achieved D70 > 100 Gy more easily than larger tumors. There was complete response in a cholangiocarcinoma at D70 90 Gy and partial response in an adrenal gastrointestinal stromal tumor metastasis at D70 53 Gy. In two patients, a mean dose of 18 Gy to the stomach was asymptomatic, 49 Gy caused gastritis, 65 Gy caused ulceration, and 53 Gy caused duodenitis. In one patient, a bilateral kidney mean dose of 9 Gy (V20 8%) did not cause clinically relevant nephrotoxicity. Under near-ideal dosimetric conditions, there was excellent correlation between intended tumor mean doses by predictive dosimetry and those by 90Y PET, with a low median relative error of +3.8% (95% confidence interval, -1.2% to +13.2%). Conclusions Tumor and non-target tissue absorbed dose quantification by 90Y PET is accurate and yields radiobiologically meaningful dose-response information to guide adjuvant or mitigative action. Tumor 99mTc MAA SPECT/CT predictive dosimetry is feasible. 90Y DVHs may guide future techniques in predictive dosimetry.
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Affiliation(s)
- Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Kao YH, Steinberg JD, Tay YS, Lim GK, Yan J, Townsend DW, Takano A, Burgmans MC, Irani FG, Teo TK, Yeow TN, Gogna A, Lo RH, Tay KH, Tan BS, Chow PK, Satchithanantham S, Tan AE, Ng DC, Goh AS. Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting. EJNMMI Res 2013; 3:56. [PMID: 23883566 PMCID: PMC3726297 DOI: 10.1186/2191-219x-3-56] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022] Open
Abstract
Background Yttrium-90 (90Y) positron emission tomography with integrated computed tomography (PET/CT) represents a technological leap from 90Y bremsstrahlung single-photon emission computed tomography with integrated computed tomography (SPECT/CT) by coincidence imaging of low abundance internal pair production. Encouraged by favorable early experiences, we implemented post-radioembolization 90Y PET/CT as an adjunct to 90Y bremsstrahlung SPECT/CT in diagnostic reporting. Methods This is a retrospective review of all paired 90Y PET/CT and 90Y bremsstrahlung SPECT/CT scans over a 1-year period. We compared image resolution, ability to confirm technical success, detection of non-target activity, and providing conclusive information about 90Y activity within targeted tumor vascular thrombosis. 90Y resin microspheres were used. 90Y PET/CT was performed on a conventional time-of-flight lutetium-yttrium-oxyorthosilicate scanner with minor modifications to acquisition and reconstruction parameters. Specific findings on 90Y PET/CT were corroborated by 90Y bremsstrahlung SPECT/CT, 99mTc macroaggregated albumin SPECT/CT, follow-up diagnostic imaging or review of clinical records. Results Diagnostic reporting recommendations were developed from our collective experience across 44 paired scans. Emphasis on the continuity of care improved overall diagnostic accuracy and reporting confidence of the operator. With proper technique, the presence of background noise did not pose a problem for diagnostic reporting. A counter-intuitive but effective technique of detecting non-target activity is proposed, based on the pattern of activity and its relation to underlying anatomy, instead of its visual intensity. In a sub-analysis of 23 patients with a median follow-up of 5.4 months, 90Y PET/CT consistently outperformed 90Y bremsstrahlung SPECT/CT in all aspects of qualitative analysis, including assessment for non-target activity and tumor vascular thrombosis. Parts of viscera closely adjacent to the liver remain challenging for non-target activity detection, compounded by a tendency for mis-registration. Conclusions Adherence to proper diagnostic reporting technique and emphasis on continuity of care are vital to the clinical utility of post-radioembolization 90Y PET/CT. 90Y PET/CT is superior to 90Y bremsstrahlung SPECT/CT for the assessment of target and non-target activity.
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Affiliation(s)
- Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One 2013; 8:e55742. [PMID: 23405207 PMCID: PMC3566032 DOI: 10.1371/journal.pone.0055742] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/30/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After yttrium-90 ((90)Y) microsphere radioembolization (RE), evaluation of extrahepatic activity and liver dosimetry is typically performed on (90)Y Bremsstrahlung SPECT images. Since these images demonstrate a low quantitative accuracy, (90)Y PET has been suggested as an alternative. The aim of this study is to quantitatively compare SPECT and state-of-the-art PET on the ability to detect small accumulations of (90)Y and on the accuracy of liver dosimetry. METHODOLOGY/PRINCIPAL FINDINGS SPECT/CT and PET/CT phantom data were acquired using several acquisition and reconstruction protocols, including resolution recovery and Time-Of-Flight (TOF) PET. Image contrast and noise were compared using a torso-shaped phantom containing six hot spheres of various sizes. The ability to detect extra- and intrahepatic accumulations of activity was tested by quantitative evaluation of the visibility and unique detectability of the phantom hot spheres. Image-based dose estimates of the phantom were compared to the true dose. For clinical illustration, the SPECT and PET-based estimated liver dose distributions of five RE patients were compared. At equal noise level, PET showed higher contrast recovery coefficients than SPECT. The highest contrast recovery coefficients were obtained with TOF PET reconstruction including resolution recovery. All six spheres were consistently visible on SPECT and PET images, but PET was able to uniquely detect smaller spheres than SPECT. TOF PET-based estimates of the dose in the phantom spheres were more accurate than SPECT-based dose estimates, with underestimations ranging from 45% (10-mm sphere) to 11% (37-mm sphere) for PET, and 75% to 58% for SPECT, respectively. The differences between TOF PET and SPECT dose-estimates were supported by the patient data. CONCLUSIONS/SIGNIFICANCE In this study we quantitatively demonstrated that the image quality of state-of-the-art PET is superior over Bremsstrahlung SPECT for the assessment of the (90)Y microsphere distribution after radioembolization.
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