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SIRT of liver metastases: physiological and pathophysiological considerations

European Journal of Nuclear Medicine and Molecular Imaging volume 39, pages 1646–1655 (2012)Cite this article

Abstract

Available literature on the differences in circulation and microcirculation of normal liver and liver metastases as well as in rheology of the different radiolabelled microspheres [99mTc-labelled macroaggregates of albumin (MAA), 90Y-TheraSpheres and 90Y-SIR-spheres] used in selective internal radiation therapy (SIRT) are reviewed and implications thereof on the practice of SIRT discussed. As a result of axial accumulation and skimming, large microspheres are preferentially deposited in regions of high flow, whereas smaller microspheres are preferentially diverted to regions of low flow. As flow to normal liver tissue is considerably variable between segments and also within one segment, microspheres will be delivered heterogeneously within the microvasculature of normal liver tissue. This non-uniformity in microsphere distribution in normal liver tissue has a significant “liver-sparing” effect on the dose distribution of 90Y-labelled microspheres. Arterial flow to liver metastases is most pronounced in the hypervascular rim of metastases, followed by the smaller metastases and finally by the central hypoperfused region of the larger metastases. Because of the wide variability in size of labelled MAAs and because of the skimming effect, existing differences in flow between metastatic lesions of variable size are likely exaggerated on 99mTc-MAA scintigraphy when compared to 90Y-TheraSpheres and 90Y-SIR-spheres (smaller variability in size and probably also in specific activity). Ideally, labelled MAAs would contain a size range similar to that of 90Y-SIR-spheres or 90Y-TheraSpheres. Furthermore, the optimal number of MAA particles to inject for the pretreatment planning scintigraphy warrants further exploration as it was shown that concentrated suspensions of microspheres produce more optimal tumour to normal liver distribution ratios. Finally, available data suggest that the flow-based heterogeneous distribution of microspheres to metastatic lesions of variable size might be optimized, that is rendered more homogeneous, through the combined use of angiotensin II and degradable starch microspheres.

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Authors and Affiliations

  1. Department of Nuclear Medicine (P7), University Hospital Ghent, De Pintelaan 185B, 9000, Ghent, Belgium

    Christophe Van de Wiele, Yves D’Asseler & Gilles Mees

  2. Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium

    Alex Maes

  3. Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium

    Alex Maes

  4. Department of Radiology, AZ Groeninge, Kortrijk, Belgium

    Eddy Brugman

  5. Department of Analytical Chemistry, University Ghent, Ghent, Belgium

    Bart De Spiegeleer

  6. Department of Radiotherapy and Medical Oncology, AZ Groeninge, Kortrijk, Belgium

    Karin Stellamans

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  1. Christophe Van de Wiele
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Van de Wiele, C., Maes, A., Brugman, E. et al. SIRT of liver metastases: physiological and pathophysiological considerations. Eur J Nucl Med Mol Imaging 39, 1646–1655 (2012). https://doi.org/10.1007/s00259-012-2189-6

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  • DOI: https://doi.org/10.1007/s00259-012-2189-6

Keywords

  • Selective internal radiation therapy
  • Liver metastases
  • Radiolabelled microspheres