Heying Duan1, Mohamed H Khalaf2, Valentina Ferri1, Lucia Baratto1, Shyam M Srinivas3, Daniel Y Sze2, Andrei Iagaru4. 1. Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305, USA. 2. Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, CA, USA. 3. Department of Radiology, Division of Nuclear Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305, USA. aiagaru@stanford.edu.
Abstract
PURPOSE: Transarterial radioembolization (TARE) with yttrium-90 (90Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from 99mTc macroaggregated albumin (MAA) SPECT/CT with post-treatment 90Y PET/CT for absorbed dose values, and to evaluate image quality of 90Y SiPM-based PET/CT. METHODS: Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning 99mTc-MAA SPECT/CT and post-therapy 90Y PET/CT were assessed. 90Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS: The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from 99mTc-MAA SPECT/CT and 90Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from 99mTc-MAA SPECT/CT and 90Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of 90Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS: 99mTc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of 90Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
PURPOSE: Transarterial radioembolization (TARE) with yttrium-90 (90Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from 99mTc macroaggregated albumin (MAA) SPECT/CT with post-treatment 90Y PET/CT for absorbed dose values, and to evaluate image quality of 90Y SiPM-based PET/CT. METHODS: Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning 99mTc-MAA SPECT/CT and post-therapy 90Y PET/CT were assessed. 90Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS: The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from 99mTc-MAA SPECT/CT and 90Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from 99mTc-MAA SPECT/CT and 90Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of 90Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS: 99mTc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of 90Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
Authors: Maurits Wondergem; Maarten L J Smits; Mattijs Elschot; Hugo W A M de Jong; Helena M Verkooijen; Maurice A A J van den Bosch; Johannes F W Nijsen; Marnix G E H Lam Journal: J Nucl Med Date: 2013-06-07 Impact factor: 10.057
Authors: W E Bolch; L G Bouchet; J S Robertson; B W Wessels; J A Siegel; R W Howell; A K Erdi; B Aydogan; S Costes; E E Watson; A B Brill; N D Charkes; D R Fisher; M T Hays; S R Thomas Journal: J Nucl Med Date: 1999-01 Impact factor: 10.057
Authors: William A Dezarn; Jeffery T Cessna; Larry A DeWerd; Wenzheng Feng; Vanessa L Gates; James Halama; Andrew S Kennedy; Subir Nag; Mehrdad Sarfaraz; Varun Sehgal; Reed Selwyn; Michael G Stabin; Bruce R Thomadsen; Lawrence E Williams; Riad Salem Journal: Med Phys Date: 2011-08 Impact factor: 4.071
Authors: Nicholas Voutsinas; Safet Lekperic; Sharon Barazani; Joseph J Titano; Sherif I Heiba; Edward Kim Journal: J Nucl Med Date: 2018-08-02 Impact factor: 10.057
Authors: Bruno Sangro; Livio Carpanese; Roberto Cianni; Rita Golfieri; Daniele Gasparini; Samer Ezziddin; Philipp M Paprottka; Francesco Fiore; Mark Van Buskirk; Jose Ignacio Bilbao; Giuseppe Maria Ettorre; Rita Salvatori; Emanuela Giampalma; Onelio Geatti; Kai Wilhelm; Ralf Thorsten Hoffmann; Francesco Izzo; Mercedes Iñarrairaegui; Carlo Ludovico Maini; Carlo Urigo; Alberta Cappelli; Alessandro Vit; Hojjat Ahmadzadehfar; Tobias Franz Jakobs; Secondo Lastoria Journal: Hepatology Date: 2011-06-30 Impact factor: 17.425
Authors: Marta Cremonesi; Carlo Chiesa; Lidia Strigari; Mahila Ferrari; Francesca Botta; Francesco Guerriero; Concetta De Cicco; Guido Bonomo; Franco Orsi; Lisa Bodei; Amalia Di Dia; Chiara Maria Grana; Roberto Orecchia Journal: Front Oncol Date: 2014-08-19 Impact factor: 6.244