Login Register Cart 0
Generic placeholder image

Current Radiopharmaceuticals

Editor-in-Chief

ISSN (Print): 1874-4710
ISSN (Online): 1874-4729

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Hepatopulmonary Shunt Ratio Verification Model for Transarterial Radioembolization

Author(s): Nami Yeyin, Fahrettin Fatih Kesmezacar, Duygu Tunçman, Özge Demir, Lebriz Uslu-Beşli, Osman Günay and Mustafa Demir*

Volume 17, Issue 3, 2024

Published on: 26 January, 2024

Page: [276 - 284] Pages: 9

DOI: 10.2174/0118744710284130240108053733

Price: $65

Abstract

Introduction: The most important toxicity of transarterial radioembolization therapy applied in liver malignancies is radiation pneumonitis and fibrosis due to hepatopulmonary shunt of Yttrium-90 (90Y) microspheres. Currently, Technetium-99m macroaggregated albumin (99mTc-MAA) scintigraphic images are used to estimate lung shunt fraction (LSF) before treatment. The aim of this study was to create a phantom to calculate exact LFS rates according to 99mTc activities in the phantom and to compare these rates with LSF values calculated from scintigraphic images.

Materials and Methods: A 3D-printed lung and liver phantom containing two liver tumors was developed from Polylactic Acid (PLA) material, which is similar to the normal-sized human body in terms of texture and density. Actual %LSFs were calculated by filling phantoms and tumors with 99mTc radionuclide. After the phantoms were placed in the water tank made of plexiglass material, planar, SPECT, and SPECT/CT images were obtained. The actual LSF ratio calculated from the activity amounts filled into the phantom was used for the verification of the quantification of scintigraphic images and the results obtained by the Simplicity90YTM method.

Results: In our experimental model, LSFs calculated from 99mTc activities filled into the lungs, normal liver, small tumor, and large tumor were found to be 0%, 6.2%, 10.8%, and 16.9%. According to these actual LSF values, LSF values were calculated from planar, SPECT/CT (without attenuation correction), and SPECT/CT (with both attenuation and scatter correction) scintigraphic images of the phantom. In each scintigraphy, doses were calculated for lung, small tumor, large tumor, normal liver, and Simplicity90YTM. The doses calculated from planar and SPECT/CT (NoAC+NoSC) images were found to be higher than the actual doses. The doses calculated from SPECT/CT (with AC+with SC) images and Simplicity90YTM were found to be closer to the real dose values.

Conclusion: LSF is critical in dosimetry calculations of 90Y microsphere therapy. The newly introduced hepatopulmonary shunt phantom in this study is suitable for LSF verification for all models/brands of SPECT and SPECT/CT devices.

« Previous Next »
Graphical Abstract

[1]
Saini, A.; Wallace, A.; Alzubaidi, S.; Knuttinen, M.G.; Naidu, S.; Sheth, R.; Albadawi, H.; Oklu, R. History and evolution of Yttrium-90 radioembolization for hepatocellular carcinoma. J. Clin. Med., 2019, 8(1), 55.
[http://dx.doi.org/10.3390/jcm8010055] [PMID: 30621040]
[2]
Garin, E.; Rolland, Y.; Laffont, S.; Edeline, J. Clinical impact of 99mTc-MAA SPECT/CT-based dosimetry in the radioembolization of liver malignancies with 90Y-loaded microspheres. Eur. J. Nucl. Med. Mol. Imaging, 2016, 43(3), 559-575.
[http://dx.doi.org/10.1007/s00259-015-3157-8] [PMID: 26338177]
[3]
Weber, M.; Lam, M.; Chiesa, C.; Konijnenberg, M.; Cremonesi, M.; Flamen, P.; Gnesin, S.; Bodei, L.; Kracmerova, T.; Luster, M.; Garin, E.; Herrmann, K. EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur. J. Nucl. Med. Mol. Imaging, 2022, 49(5), 1682-1699.
[http://dx.doi.org/10.1007/s00259-021-05600-z]
[4]
Elsayed, M.; Martin, J.G.; Dabrowiecki, A.; Goldman, D.T.; Faraj, R.; McMahon, J.T.; Kokabi, N.; Duszak, R., Jr; Newsome, J.; Bercu, Z.L. Tc-99m-MAA lung shunt fraction before Y-90 radioembolization is low among patients with non-hepatocellular carcinoma malignancies. Nucl. Med. Commun., 2019, 40(11), 1154-1157.
[http://dx.doi.org/10.1097/MNM.0000000000001089] [PMID: 31568192]
[5]
Kallini, J.R.; Gabr, A.; Kulik, L.; Salem, R.; Lewandowski, R.J. The utility of unilobar technetium-99m macroaggregated albumin to predict pulmonary toxicity in bilobar hepatocellular carcinoma prior to yttrium-90 radioembolization. J. Vasc. Interv. Radiol., 2016, 27(9), 1453-1456.
[http://dx.doi.org/10.1016/j.jvir.2016.06.004] [PMID: 27566430]
[6]
Levillain, H.; Bagni, O.; Deroose, CH.; Dieudonne, A.; Gnesin, S.; Grosser, OS.; Kappadath, C.; Kennedy, A.; Kokabi, N.; Liu, DM.; Madoff, DC.; Mahvash, A.; Cuesta, AM de la.; David, CE Ng.; Paprottka, PM.; Pettinato, C.; Fraile, MR.; Salem, R.; Sangro, B.; Strigari, L.; Sze, DY.; Wit; van der veen, BJ.; Flamen, P. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. Eur. J. Nucl. Med. Mol. Imaging, 2021, 48, 1570-1584.
[7]
Lopez, B.; Mahvash, A.; Lam, M.G.E.H.; Kappadath, S.C. Calculation of lung mean dose and quantification of error for 90 Ymicrosphere radioembolization using 99m Tc-MAA SPECT/CT and diagnostic chest CT. Med. Phys., 2019, 46(9), 3929-3940.
[http://dx.doi.org/10.1002/mp.13575] [PMID: 31063600]
[8]
Kim, S.P.; Cohalan, C.; Kopek, N.; Enger, S.A. A guide to 90Y radioembolization and its dosimetry. Phys. Med., 2019, 68, 132-145.
[http://dx.doi.org/10.1016/j.ejmp.2019.09.236] [PMID: 31785502]
[9]
Uliel, L.; Royal, H.D.; Darcy, M.D.; Zuckerman, D.A.; Sharma, A.; Saad, N.E. From the angio suite to the γ-camera: Vascular mapping and 99mTc-MAA hepatic perfusion imaging before liver radioembolization--a comprehensive pictorial review. J. Nucl. Med., 2012, 53(11), 1736-1747.
[http://dx.doi.org/10.2967/jnumed.112.105361] [PMID: 23124868]
[10]
Kao, Y.H.; Magsombol, B.M.; Toh, Y.; Tay, K.H.; Chow, P.; Goh, A.S.W.; David, C.E. Ng. Personalized predictive lung dosimetry by technetium- 99m macroaggregated albumin SPECT/BT for yttrium -90 radioembolization. EJNMMI Pic., 2014, 4, 1-12.
[11]
Yu, N.; Srinivas, S.M.; DiFilippo, F.P.; Shrikanthan, S.; Levitin, A.; McLennan, G.; Spain, J.; Xia, P.; Wilkinson, A. Lung dose calculation with SPECT/CT for 90Yittrium radioembolization of liver cancer. Int. J. Radiat. Oncol. Biol. Phys., 2013, 85(3), 834-839.
[http://dx.doi.org/10.1016/j.ijrobp.2012.06.051] [PMID: 22871239]
[12]
Dittmann, H.; Kopp, D.; Kupferschlaeger, J.; Feil, D.; Groezinger, G.; Syha, R.; Weissinger, M.; la Fougère, C. A prospective study of quantitative SPECT/CT for evaluation of lung shunt fraction before SIRT of liver tumors. J. Nucl. Med., 2018, 59(9), 1366-1372.
[http://dx.doi.org/10.2967/jnumed.117.205203] [PMID: 29371406]
[13]
Allred, J.D.; Niedbala, J.; Mikell, J.K.; Owen, D.; Frey, K.A.; Dewaraja, Y.K. The value of 99mTc-MAA SPECT/CT for lung shunt estimation in 90Y radioembolization: A phantom and patient study. EJNMMI Res., 2018, 8(1), 50.
[http://dx.doi.org/10.1186/s13550-018-0402-8] [PMID: 29904808]
[14]
Dezarn, W.A.; Cessna, J.T.; DeWerd, L.A.; Feng, W.; Gates, V.L.; Halama, J.; Kennedy, A.S.; Nag, S.; Sarfaraz, M.; Sehgal, V.; Selwyn, R.; Stabin, M.G.; Thomadsen, B.R.; Williams, L.E.; Salem, R. Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90 Y microsphere brachytherapy in the treatment of hepatic malignancies. Med. Phys., 2011, 38(8), 4824-4845.
[http://dx.doi.org/10.1118/1.3608909] [PMID: 21928655]
[15]
Chiristopher, A. Sturucture of the respiratory system lower respiratory tract. In: Pediatric Critical Care, 4th edition; Elsevier health Science, 2011, p. 490.
[16]
Netter, F.H. Atlas of human anatomy. PA; Saunders/Elsevier: Philadelphia, 2014, p. 193.
[17]
Rhee, S.; Kim, S.; Cho, J.; Park, J.; Eo, J.S.; Park, S.; Lee, E.; Kim, Y.H.; Choe, J.G. 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, 2016, 50(1), 63-69.
[http://dx.doi.org/10.1007/s13139-015-0366-9] [PMID: 26941861]
[18]
Villalobos, A.; Cheng, B.; Wagstaff, W.; Sethi, I. Tumor - to -normal ratio relationship between planning Technetium-99 macroaggregated albumin and posttherapy Yttrium-90 Bremsstrahlung SPECT/CT. J. Vasc. Interv. Radiol., 2021, 32(5), 752-760.
[http://dx.doi.org/10.1016/j.jvir.2020.12.023] [PMID: 33642158]
[19]
Demino, L.; Ferreira, P.; Oliveira, F.P.M.; Costa, D.C. Comparison of the 90Y-labelled glass microspheres liver radioembolisation dosimetry with the estimated dosimetry obtained from pre-treatment 99mTc-MAA SPECT images reconstructed with and without attenuation correction. Comput. Methods Biomech. Biomed. Eng. Imaging Vis., 2019, 7(5-6), 651-659.
[http://dx.doi.org/10.1080/21681163.2018.1542348]
[20]
Kunnen, B.; van der Velden, S.; Bastiaannet, R.; Lam, M.G.E.H.; Viergever, M.A.; de Jong, H.W.A.M. Radioembolization lung shunt estimation based on a 90 Y pretreatment procedure: A phantom study. Med. Phys., 2018, 45(10), 4744-4753.
[http://dx.doi.org/10.1002/mp.13168] [PMID: 30179259]
[21]
Gulec, S.A.; Mesoloras, G.; Dezarn, W.A.; McNeillie, P.; Kennedy, A.S. Safety and efficacy of Y-90 microsphere treatment in patients with primary and metastatic liver cancer: The tumor selectivity of the treatment as a function of tumor to liver flow ratio. J. Transl. Med., 2007, 5(1), 15.
[http://dx.doi.org/10.1186/1479-5876-5-15] [PMID: 17359531]
[22]
Son, M.H.; Ha, L.N.; Bang, M.H.; Bae, S.; Giang, D.T.; Thinh, N.T.; Paeng, J.C. Diagnostic and prognostic value of 99mTc-MAA SPECT/CT for treatment planning of 90Y-resin microsphere radioembolization for hepatocellular carcinoma: comparison with planar image. Sci. Rep., 2021, 11(1), 3207.
[http://dx.doi.org/10.1038/s41598-021-82887-w] [PMID: 33547398]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy