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. 2021 Mar 4;11(1):23.
doi: 10.1186/s13550-021-00764-z.

The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

Macarena Rodríguez-Fraile  1 , Ana Ezponda  2 , Fabiana Grisanti  3 , Verónica Morán  4 , Marta Calvo  2 , Pablo Berián  2 , Antonio Martínez de la Cuesta  2 , Lidia Sancho  5 , Mercedes Iñarrairaegui  6 , Bruno Sangro  6 , José Ignacio Bilbao  2
Affiliations

The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

Macarena Rodríguez-Fraile et al. EJNMMI Res. .

Abstract

Purpose: To determine which imaging method used during radioembolization (RE) work-up: contrast-enhanced computed tomography (CECT), 99mTc-MAA-SPECT/CT or cone beam-CT (CBCT), more accurately predicts the final target volume (TgV) as well as the influence that each modality has in the dosimetric calculation.

Methods: TgVs from 99mTc-MAA-SPECT/CT, CECT and CBCT were consecutively obtained in 24 patients treated with RE and compared with 90Y PET/CT TgV. Using the TgVs estimated by each imaging modality and a fictitious activity of 1 GBq, the corresponding absorbed doses by tumor and non-tumoral parenchyma were calculated for each patient. The absorbed doses for each modality were compared with the ones obtained using 90Y PET/CT TgV.

Results: 99mTc-MAA-SPECT/CT predicted 90Y PET/CT TgV better than CBCT or CECT, even for selective or superselective administrations. Likewise, 99mTc-MAA-SPECT/CT showed dosimetric values more similar to those obtained with 90Y PET/CT. Nevertheless, CBCT provided essential information for RE planning, such as ensuring the total coverage of the tumor and, in cases with more than one feeding artery, splitting the activity according to the volume of tumor perfused by each artery.

Conclusion: The joint use of 99mTc-MAA-SPECT/CT and CBCT optimizes dosimetric planning for RE procedures, enabling a more accurate personalized approach.

Keywords: CBCT; Dosimetry; MAA; PET; Radioembolization (RE); Target volume.

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Conflict of interest statement

Macarena Rodríguez-Fraile, Antonio Martínez de la Cuesta and José Ignacio Bilbao have received consultation fees and speaker honoraria from Sirtex Medical Europe. Lidia Sancho has received speaker honoraria from Sirtex Medical Europe. Bruno Sangro received scientific grants consultation fees and speaker honoraria from Sirtex Medical Europe.

Figures

Fig. 1
Fig. 1
a Contrast-enhanced computed tomography (CECT) image in a patient with HCC located between segments IV and VIII. b Volumetric assessment of the target volume in SPECT/CT fusion images after the injection of 99mTc-MAA through IV and VIII segments arteries. The volume was obtained using a “volume of interest and isocontour” tool, drawn in purple. c C-arm cone-beam CT (CBCT) showing contrast uptake in the tumoral lesion with no perfusion in non-tumoral parenchyma. d Volumetric assessment of the final target volume in the 90Y PET/CT fusion images
Fig. 2
Fig. 2
Correlation (blue line) between the target volume obtained with 90Y PET/CT and CECT (a), CBCT (b) and 99mTc-MAA SPECT/CT in all patients (c) and excluding patients with changes between MAA and 90Y-microspheres administrations (d). Diagonal black line indicates perfect correlation between both variables
Fig. 3
Fig. 3
Correlation (blue lines) between the target volume obtained with 90Y PET/CT and CECT (a), CBCT (b) and 99mTc-MAA SPECT/CT (c) in patients with segmental and subsegmental administrations. When patients with changes between 99mTc-MAA and 90Y-microspheres administrations were excluded, 99mTc-MAA correlation slightly improved (d). Diagonal black line indicates perfect correlation between both variables
Fig. 4
Fig. 4
Same patient as Fig. 1. a Contrast-enhanced computed tomography (CECT) image: HCC located between segments IV and VIII. b 99mTc-MAA SPECT/CT fusion image shows low uptake in the lateral part of the tumoral nodule. 99mTc-MAA activity was split in two doses of 50% each by IR decision, based on liver and tumoral volumes. c, c1 and c2 C-arm cone-Beam CT (CBCT) volumetric assessment of the tumoral territory perfused by each artery. VIII segments artery (in green) fed only 32% of the tumoral volume while IV segment artery fed most of it (in orange). d 90Y PET/CT fusion image after splitting the activity according to CBCT volumes shows the adequate distribution of the microspheres throughout the lesion
See this image and copyright information in PMC

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