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. 2011:2011:398051.
doi: 10.1155/2011/398051. Epub 2011 Jul 28.

Utility of Quantitative Tc-MAA SPECT/CT for yttrium-Labelled Microsphere Treatment Planning: Calculating Vascularized Hepatic Volume and Dosimetric Approach

Etienne Garin  1 , Yan Rolland, Laurence Lenoir, Marc Pracht, Habiba Mesbah, Philippe Porée, Sophie Laffont, Bruno Clement, Jean-Luc Raoul, Eveline Boucher
Affiliations

Utility of Quantitative Tc-MAA SPECT/CT for yttrium-Labelled Microsphere Treatment Planning: Calculating Vascularized Hepatic Volume and Dosimetric Approach

Etienne Garin et al. Int J Mol Imaging. 2011.

Abstract

Objectives. The aim of this study was to assess the effectiveness of SPECT/CT for volume measurements and to report a case illustrating the major impact of SPECT/CT in calculating the vascularized liver volume and dosimetry prior to injecting radiolabelled yttrium-90 microspheres (Therasphere). Materials and Methods. This was a phantom study, involving volume measurements carried out by two operators using SPECT and SPECT/CT images. The percentage of error for each method was calculated, and interobserver reproducibility was evaluated. A treatment using Therasphere was planned in a patient with three hepatic arteries, and the quantitative analysis of SPECT/CT for this patient is provided. Results. SPECT/CT volume measurements proved to be accurate (mean error <6% for volumes ≥16 cm(3)) and reproductive (interobserver agreement = 0.9). In the case report, (99m)Tc-MAA SPECT/CT identified a large liver volume, not previously identified with angiography, which was shown to be vascularized after selective MAA injection into an arterial branch, resulting in a large modification in the activity of Therasphere used. Conclusions. MAA SPECT/CT is accurate for vascularized liver volume measurements, providing a valuable contribution to the therapeutic planning of patients with complex hepatic vascularization.

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Figures

Figure 1
Figure 1
Delineation of VOIs used for quantitative analysis of SPECT and SPECT/CT analysis (a, b): VOI defined on SPECT hot spot alone. Fused SPECT/CT image with the VOI matching with the hot spot ((a), SPECT/CT scale); CT scale showing that the VOI is not accurate and larger than the sphere (b). (c): VOI defined with SPECT/CT and using the CT scale: the isocontour was fitted by superposition on the boundaries of the internal wall of the sphere.
Figure 2
Figure 2
case report: patient with a large HCC Contrast enhanced CT evidencing a large infiltrative tumor of the left liver (a) with a portal vein thrombosis (b).
Figure 3
Figure 3
Case report: delineation of the tumoral and injected lover VOI on SPECT/CT whole; injected liver VOI with SPECT/CT color scale (a), whole injected liver VOI with CT scale and visualisation of SPECT isocontour (b), tumoral VOI with SPECT/CT color scale (c) and tumoral VOI with CT scale and visualisation of SPECT isocontour (d).
Figure 4
Figure 4
Case report: angiographic and scintigraphic data; right selective angiography (a), selective angiography of the common hepatic artery vascularizing segment IV and the left liver (b), SPECT (c) and SPECT/CT (d) after injection of the MAA at the level of the central hepatic artery revealing an unexpected uptake in the right liver, in addition to the expected uptake of segment IV and left liver (whole liver distribution, volume 1829cc).
Figure 5
Figure 5
Case report: follow-up CT scan 4 months after injection of 5 GBq of in the central branch: major response.
See this image and copyright information in PMC

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