Skip to main content

99mTc-labelled macroaggregated albumin (MAA) scintigraphy for planning treatment with 90Y microspheres



90Y microspheres are used for intra-arterial treatment of liver tumours. In the patient preparation, a hepatic angiogram is performed and all arteries that could transport microspheres from the targeted liver vasculature to extrahepatic organs are blocked. 99mTc-labelled macroaggregated albumin (MAA) is injected intra-arterially to simulate the treatment and whole-body scintigraphy and single photon emission computed tomography (SPECT) of the abdomen are performed.


Various aspects of lung shunt fraction (LSF) estimation were studied: interobserver and intrapatient variability, influence of scan quality and underlying disease. Secondly, the interobserver variability in reading the MAA SPECT of the abdomen was investigated. We reviewed 90 whole-body scans and 20 SPECT scans performed at our institution. Readers were blinded to each other’s findings. Scoring the scan quality was based on the visualization of tracer degradation.


The mean difference in LSF between the readers was 1%. In 1 of 23 patients who underwent repeated MAA injections a marked change in LSF was observed. No significant differences in LSF were recorded for primary versus secondary liver tumours. There was a correlation between scan quality and LSF, suggesting that low scan quality leads to overestimation of the LSF. Concordant results in ruling out the presence of extrahepatic tracer deposition were reached in 17 of 20 scans (85%).


Interobserver and intrapatient variability in LSF calculation was limited. LSF was clearly dependent on scan quality. The underlying disease had no significant impact on the LSF. Interobserver variability for reading the MAA SPECT scans was acceptable.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Parkin MD, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108.

    Article  PubMed  Google Scholar 

  2. Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioembolization of liver tumors with yttrium-90 microspheres. Semin Nucl Med 2010;40:105–21.

    Article  PubMed  Google Scholar 

  3. Annals of the ICRP. Publication 38: radionuclide transformations: energy and intensity of emissions. Oxford: Pergamon; 1983.

    Google Scholar 

  4. ICRU. Stopping powers for electrons and positrons report 37. Bethesda: International Commission on Radiation Units and Measurements; 1984

  5. Ho S, Lau WY, Leung TW, Chan M, Johnson PJ, Li AK. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer. Eur J Nucl Med 1997;24:293–8.

    CAS  PubMed  Google Scholar 

  6. Kennedy A, Nag S, Salem R, Murthy R, McEwan AJ, Nutting C, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007;68:13–23.

    PubMed  Google Scholar 

  7. Flamen P, Vanderlinden B, Delatte P, Ghanem G, Ameye L, Van Den Eynde M, et al. Multimodality imaging can predict the metabolic response of unresectable colorectal liver metastases to radioembolization therapy with yttrium-90 labeled resin microspheres. Phys Med Biol 2008;53:6591–603.

    Article  PubMed  Google Scholar 

  8. Sangro B, Bilbao JI, Boan J, Martinez-Cuesta A, Benito A, Rodriguez J, et al. Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2006;66:792–800.

    CAS  PubMed  Google Scholar 

  9. Hamami ME, Poeppel TD, Müller S, Heusner T, Bockisch A, Hilgard P, et al. SPECT/CT with 99mTc-MAA in radioembolization with 90Y microspheres in patients with hepatocellular cancer. J Nucl Med 2009;50:688–92.

    CAS  Article  PubMed  Google Scholar 

  10. Garin E, Rolland Y, Boucher E, Ardisson V, Laffont S, Boudjema K, et al. First experience of hepatic radioembolization using microspheres labelled with yttrium-90 (TheraSphere): practical aspects concerning its implementation. Eur J Nucl Med Mol Imaging 2010;37:453–61.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Bieke Lambert.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lambert, B., Mertens, J., Sturm, E.J. et al. 99mTc-labelled macroaggregated albumin (MAA) scintigraphy for planning treatment with 90Y microspheres. Eur J Nucl Med Mol Imaging 37, 2328–2333 (2010).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • 90Y
  • Microspheres
  • Radionuclide therapy
  • Colorectal cancer
  • Liver metastasis
  • Hepatocellular carcinoma