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Systematic review of lung shunt fraction quantification comparing SPECT/CT and planar scintigraphy for yttrium 90 radioembolization planning

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Abstract

Purpose

Yttrium 90-labeled intra-arterial liver therapy is an effective treatment for patients with unresectable primary or metastatic liver malignancy. Optimal radioisotope dose calculation is dependent upon lung shunt fraction (LSF) which is typically estimated by planar scintigraphy. The goal of this systematic review was to compare LSF using 2D planar scintigraphy and 3D SPECT/CT. A secondary outcome was to assess the impact on lung dosimetry.

Methods

PubMed, SCOPUS and Web of Science database were searched for studies in English language related to lung shunt fraction quantification utilizing technetium 99m-labeled macroaggregated albumin (99mTc-MAA) planar scintigraphy and SPECT/CT, published between January 2010 and November 2020. The review was conducted using the PRISMA statement and QUADAS-2 criteria.

Results

A total of 8 studies (one prospective, 4 retrospective studies and 3 abstracts from national conferences) with a sample size of 552 were included in this review. There were 456 patients (82.6%) with hepatocellular carcinoma and 95 patients (17.4%) with hepatic metastasis. A wider range of LSF percentages was noted in planar scintigraphy methodology (range 1.2–33.3%) when compared to SPECT/CT (range 0.4–21.7%). The median LSF percentages were 6.7 and 2.9% using planar scintigraphy and SPECT/CT, respectively.

Conclusion

The current clinical assessment of LSF is substantially overestimated by 2D planar scintigraphy when compared to 3D SPECT/CT. However, unclearness of blinding between the index test and reference standard was an area of quality concern. Hence, further randomized or prospective studies are needed to strengthen the role of SPECT/CT in lung shunt fraction estimation.

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References

  1. Salem R, Lewandowski RJ, Kulik L et al (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507

    Article  Google Scholar 

  2. Hendlisz A, Van den Eynde M, Peeters M et al (2010) Phase III trial comparing protracted intravenous fluorouracil infusion alone or with yttrium-90 resin microspheres radioembolization for liver-limited metastatic colorectal cancer refractory to standard chemotherapy. J Clin Oncol 28:3687–3694

    Article  CAS  Google Scholar 

  3. Riaz A, Gates VL, Atassi B et al (2011) Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys 79(1):163–171

    Article  Google Scholar 

  4. Jia Z, Wang W (2018) Yttrium-90 radioembolization for unresectable metastatic neuroendocrine liver tumor: a systematic review. Eur J Radiol 100:23–29

    Article  Google Scholar 

  5. Kritzinger J, Klass D, Ho S et al (2013) Hepatic embolotherapy in interventional oncology: technology, techniques, and applications. Clin Radiol 68:1–15

    Article  CAS  Google Scholar 

  6. https://www.sirtex.com/media/169247/ssl-us-14-sir-spheres-microspheres-ifu-us.pdf. Accessed Sept 2020

  7. https://www.bostonscientific.com/en-US/products/cancer-therapies/therasphere-y90-glass-microspheres/therasphere-y90-microspheres-brief-summary.html. Accessed Sept 2020

  8. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536

    Article  Google Scholar 

  9. Dittmann H, Kopp D, Kupferschlaeger J, Feil D, Groezinger G, Syha R, Weissinger M, la Fougère C (2018) A prospective study of quantitative SPECT/CT for evaluation of lung shunt fraction before SIRT of liver tumors. J Nucl Med 59(9):1366–1372

    Article  CAS  Google Scholar 

  10. Elsayed M, Cheng B, Xing M, Sethi I, Brandon D, Schuster DM, Bercu Z, Galt J, Barron B, Kokabi N (2020) Comparison of Tc-99m MAA planar versus SPECT/CT imaging for lung shunt fraction evaluation prior to Y-90 radioembolization: are we overestimating lung shunt fraction? Cardiovasc Intervent Radiol. 44(2):254–260

    Article  Google Scholar 

  11. Lopez B, Mahvash A, Lam MGEH, Kappadath SC (2019) Calculation of lung mean dose and quantification of error for 90Y-microsphere radioembolization using 99mTc-MAA SPECT/CT and diagnostic chest CT. Med Phys 46(9):3929–3940

    Article  Google Scholar 

  12. Allred JD, Niedbala J, Mikell JK, Owen D, Frey KA, Dewaraja YK (2018) The value of 99mTc-MAA SPECT/CT for lung shunt estimation in 90Y radioembolization: a phantom and patient study. EJNMMI Res 8(1):50

    Article  Google Scholar 

  13. Kao YH, Magsombol BM, Toh Y, Tay KH, Chow PKh, Goh AS, Ng DC (2014) Personalized predictive lung dosimetry by technetium-99m macroaggregated albumin SPECT/CT for yttrium-90 radioembolization. EJNMMI Res 29(4):33

    Article  Google Scholar 

  14. Georgiou M, Kuker R, Portelance L, Studenski M, Lorenzo A (2018) Comparison of 2D planar versus 3D SPECT/CT lung shunt fraction calculation from 99mTc MAA pre-90Y imaging for hepatic microsphere radioembolization. J Nucl Med 59(supplement 1):601

    Google Scholar 

  15. Poon-iad N, Teyateeti A, Chaudakshetrin P (2019) Selective internal radiotherapy dose calculation: a pilot study to compare lung shunt fraction on planar and SPECT/CT imaging. International Symposium on Standards, Applications and Quality Assurance in Medical Radiation Dosimetry (18–21 June 2019), IAEA, Vienna

  16. Gill H, Bian J, Gabriel M, Molvar C, Wagner R, Halama J (2019) 99mTc-MAA SPECT/CT imaging for quantitative assessment of lung shunt fraction prior to 90Y transarterial radioembolization. J Nucl Med 60(supplement 1):265

    Google Scholar 

  17. Ho S, Lau WY, Leung TW, Chan M, Johnson PJ, Li AK (1997) Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med 24:293–298

    CAS  PubMed  Google Scholar 

  18. Dezarn WA, Cessna JT, DeWerd LA et al (2011) American Association of Physicists in Medicine. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys 38(8):4824–4845

    Article  Google Scholar 

  19. Lewandowski RJ, Gabr A, Abouchaleh N, Ali R, Al Asadi A, Mora RA et al (2018) Radiation segmentectomy: potential curative therapy for early hepatocellular carcinoma. Radiology 287(3):1050–1058

    Article  Google Scholar 

  20. Gabr A, Kulik L, Mouli S, Riaz A, Ali R, Desai K et al (2020) Liver transplantation following yttrium-90 radioembolization: 15-year experience in 207-patient cohort. Hepatology. https://doi.org/10.1002/hep.31318

    Article  PubMed  Google Scholar 

  21. Vouche M, Habib A, Ward TJ, Kim E, Kulik L, Ganger D et al (2014) Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation: multicenter radiology-pathology correlation and survival of radiation segmentectomy. Hepatology. 60(1):192–201. https://doi.org/10.1002/hep.27057

    Article  PubMed  Google Scholar 

  22. Zaharakis A, Leveque F, Backiel J, Tursi G, Palestro C, Nichols K (2014) SPECT/CT for estimating hepatopulmonary shunting in selective internal radiotherapy: a phantom study. J Nucl Med 55(supplement 1):1496

    Google Scholar 

  23. Gaba RC, Zivin SP, Dikopf MS, Parvinian A, Casadaban LC, Lu Y, Bui JT (2014) Characteristics of primary and secondary hepatic malignancies associated with hepatopulmonary shunting. Radiology 271(2):602–612

    Article  Google Scholar 

  24. Ludwig JM, Ambinder EM, Ghodadra A, Xing M, Prajapati HJ, Kim HS (2016) Lung shunt fraction prior to yttrium-90 radioembolization predicts survival in patients with neuroendocrine liver metastases: single-center prospective analysis. Cardiovasc Interv Radiol 39(7):1007–1014

    Article  Google Scholar 

  25. Yu N, Srinivas SM, Difilippo FP et al (2013) Lung dose calculation with SPECT/CT for 90yttrium radioembolization of liver cancer. Int J Radiat Oncol Biol Phys 85:834–839

    Article  Google Scholar 

  26. Peters SMB, van der Werf NR, Segbers M, van Velden FHP, Wierts R, Blokland KJAK, Konijnenberg MW, Lazarenko SV, Visser EP, Gotthardt M (2019) Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study. EJNMMI Phys 6(1):29

    Article  Google Scholar 

  27. Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, Scheidhauer K, Wester HJ, Rummeny EJ, Schwaiger M, Drzezga A (2008) SPECT/CT. J Nucl Med 49:1305–1319

    Article  Google Scholar 

  28. Roach PJ, Schembri GP, Ho Shon IA et al (2006) SPECT/CT imaging using a spiral CT scanner for anatomical localization: impact on diagnostic accuracy and reporter confidence in clinical practice. Nucl Med Commun 27:977–987

    Article  Google Scholar 

  29. Salem R, Parikh P, Atassi B et al (2008) Incidence of radiation pneumonitis after hepatic intra-arterial radiotherapy with yttrium-90 microspheres assuming uniform lung distribution. Am J Clin Oncol 31:431–438

    Article  Google Scholar 

  30. Van de Wiele C, Maes A, Brugman E, D’Asseler Y, De Spiegeleer B, Mees G, Stellamans K (2012) SIRT of liver metastases: physiological and pathophysiological considerations. Eur J Nucl Med Mol Imaging 39:1646–1655

    Article  CAS  Google Scholar 

  31. Elschot M, Nijsen JF, Lam MG et al (2014) 99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with 166Ho-microspheres. Eur J Nucl Med Mol Imaging 41:1965–1975

    Article  CAS  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Diagnostic Radiology and Imaging Sciences, University of Oklahoma HSC, Oklahoma, OK, 73104, USA

    Harkanwar Gill & Jay Hiller

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  1. Harkanwar Gill
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Contributions

Conceptualization and idea: HG; methodology: HG and JH; literature search and data analysis: HG and JH; writing—original draft preparation: HG; writing—review and editing: JH.

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Correspondence to Harkanwar Gill.

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Gill, H., Hiller, J. Systematic review of lung shunt fraction quantification comparing SPECT/CT and planar scintigraphy for yttrium 90 radioembolization planning. Clin Transl Imaging 9, 181–188 (2021). https://doi.org/10.1007/s40336-021-00417-0

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  • DOI: https://doi.org/10.1007/s40336-021-00417-0

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