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Semi-Quantitative Analysis of Post-Transarterial Radioembolization 90Y Microsphere Positron Emission Tomography Combined with Computed Tomography (PET/CT) Images in Advanced Liver Malignancy: Comparison With 99mTc Macroaggregated Albumin (MAA) Single Photon Emission Computed Tomography (SPECT)

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Abstract

Objectives

The purpose of this study is to evaluate the correlation between pretreatment planning technetium-99m (99mTc) macroaggregated albumin (MAA) SPECT images and posttreatment transarterial radioembolization (TARE) yttirum-90 (90Y) PET/CT images by comparing the ratios of tumor-to-normal liver counts.

Methods

Fifty-two patients with advanced hepatic malignancy who underwent 90Y microsphere radioembolization from January 2010 to December 2012 were retrospectively reviewed. Patients had undergone 99mTc MAA intraarterial injection SPECT for a pretreatment evaluation of microsphere distribution and therapy planning. After the administration of 90Y microspheres, the patients underwent posttreatment 90Y PET/CT within 24 h. For semiquantitative analysis, the tumor-to-normal uptake ratios in 90Y PET/CT (TNR-yp) and 99mTc MAA SPECT (TNR-ms) as well as the tumor volumes measured in angiographic CT were obtained and analyzed. The relationship of TNR-yp and TNR-ms was evaluated by Spearman's rank correlation and Wilcoxon's matched pairs test.

Results

In a total of 79 lesions of 52 patients, the distribution of microspheres was well demonstrated in both the SPECT and PET/CT images. A good correlation was observed of between TNR-ms and TNR-yp (rho value = 0.648, p < 0.001). The TNR-yp (median 2.78, interquartile range 2.43) tend to show significantly higher values than TNR-ms (median 2.49, interquartile range of 1.55) (p = 0.012). The TNR-yp showed weak correlation with tumor volume (rho = 0.230, p = 0.041).

Conclusions

The 99mTc MAA SPECT showed a good correlation with 90Y PET/CT in TNR values, suggesting that 99mTc MAA can be used as an adequate pretreatment evaluation method. However, the 99mTc MAA SPECT image consistently shows lower TNR values compared to 90Y PET/CT, which means the possibility of underestimation of tumorous uptake in the partition dosimetry model using 99mTc MAA SPECT. Considering that 99mTc MAA is the only clinically available surrogate marker for distribution of microsphere, we recommend measurement of tumorous uptake using 90Y PET/CT should be included routinely in the posttherapeutic evaluation.

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Acknowledgments

This study was partly supported by a research grant for R & D for Clinical and Translational Research, HI13C1611, Korea Health Industry Development Institute, Ministry of Health and Welfare, Republic of Korea.

Conflicts of Interest

Seunghong Rhee, Sungeun Kim, Jaehyuk Cho, Jukyung Park, Jae Seon Eo, Soyeon Park, Eunsub Lee, Yun Hwan Kim, and Jae-Gol Choe declare no conflict of interest.

Ethical Statement

The manuscript contains a statement that the study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

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Authors and Affiliations

  1. Departments of Nuclear Medicine, Korea University Anam Hospital, Inchon-ro 73, Seongbuk-gu, Seoul, Korea

    Seunghong Rhee, Sungeun Kim, Jaehyuk Cho, Jukyung Park & Jae-Gol Choe

  2. Departments of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea

    Jae Seon Eo, Soyeon Park & Eunsub Lee

  3. Departments of Radiology, Korea University Anam Hospital, Seoul, Korea

    Yun Hwan Kim

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  1. Seunghong Rhee
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Correspondence to Jae-Gol Choe.

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Rhee, S., Kim, S., Cho, J. et al. Semi-Quantitative Analysis of Post-Transarterial Radioembolization 90Y Microsphere Positron Emission Tomography Combined with Computed Tomography (PET/CT) Images in Advanced Liver Malignancy: Comparison With 99mTc Macroaggregated Albumin (MAA) Single Photon Emission Computed Tomography (SPECT). Nucl Med Mol Imaging 50, 63–69 (2016). https://doi.org/10.1007/s13139-015-0366-9

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