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J Nucl Med. 2008; 49 (Supplement 1):323P
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Oncology-Basic Science: Therapy, Metrics & Intervention

Therapy, Metrics & Intervention Posters

Prediction of yttrium-90 Sir Sphere deposition by Tc-99m MAA SPECT/CT liver perfusion imaging

Josef Machac1, Sherif Heiba1, Zhuangyu Zhang1, Joshua Weintraub1, Francis Nowakowski1, Anondo Stangl1, Myron Schwartz1 and Richard Warner1

1 Mount Sinai School of Medicine, New York, New York

1371

Objectives: Tc-99m MAA imaging is used for dosimetry and evaluation of lung shunting prior to therapy (Rx) of liver tumors with yttrium-90 Sir Spheres (Y-90). We wished to determine the frequency of MAA and Y-90 mismatch (M-M) and relate it to site of injection or changes therein.

Methods: We studied 79 Y-90 Rx for 16 hepatocellular, 53 neuroendocrine (mostly carcinoid), 7 colon and 3 lung cancers. MAA was injected in the proper hepatic artery (PHA), the right (RHA), or the left (LHA) hepatic artery in 19, 48 and 12 Rx, respectively, imaged with a GE Infinia SPECT/CT, followed by Y-90 Rx a mean 25 days later, and reimaged using the Y-90 bremsstrahlung. Segmental uptake was graded on a 0-3 subjective scale. A summed M-M Score (MMScore) and number of M-M segments (MMSegs) between MAA and Y-90 were calculated for each pt and related to infusion artery and small changes in catheter position.

Results: There were 30 Rx with significant M-M between MAA and Y-90 in 9/19 PHA, 19/48 RHA, and 2/12 LHA injections, of which only 7 (28%) could be due to catheter position changes. There were a mean 2.6±1.7 MMSegs with a mean MMScore of 3.3±2.6. MAA did not predict the 16 Y-90 Rx with early stasis.

Conclusions: There is frequent variation in liver segment perfusion patterns for any artery injection, and frequent interlobar and intralobar M-M between MAA and Y-90 distributions. This may be due to interval change in flow, different particle numbers and rheology. This may place limitations on Y-90 therapy dosimetry and planning.

Research Support: Carcinoid Cancer Foundation


Figure 1
MAA Uptake in Liver Segments





This Article
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Right arrow Articles by Warner, R.
PubMed
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Right arrow Articles by Warner, R.