Fusion imaging using a hybrid SPECT-CT camera improves port perfusion scintigraphy for control of hepatic arterial infusion of chemotherapy in colorectal cancer patients.
OBJECTIVE
Exclusive and homogeneous perfusion of the liver is considered essential for the efficacy of hepatic arterial infusion of chemotherapy (HAI). The aim of this study was to evaluate port perfusion scintigraphy in colorectal cancer patients using a hybrid SPECT-CT system for control of minimally invasive intra-arterial port systems within the scope of a phase II trial.


METHODS
In 24 consecutive patients, the perfusion territories of intra-arterial hepatic port systems were assessed by port scintigraphy with( 99m)Tc-labelled macroaggregated albumin employing planar imaging, SPECT and SPECT-CT (acquired with a hybrid SPECT-CT camera). The results of blinded reading of the scintigraphic modalities concerning the intra- and extrahepatic perfusion pattern were compared with combined image analysis (angiography and contrast-enhanced dedicated CT) and patient history for validation.


RESULTS
Extrahepatic perfusion was correctly seen in three patients, while suspected extrahepatic perfusion could be excluded in one. In 46 liver lobes, perfusion patterns were correctly visualised by SPECT-CT in 100% of cases (planar, 67%; SPECT, 86%). Assessing the perfusion pattern inside the liver on a segmental basis (segments, n=138), SPECT-CT revealed correct segmental assignment of tracer distribution in 100% and was significantly superior to SPECT alone (accuracy, 84%; p<0.001). The scintigraphic findings resulted in changes in therapeutic management in 8/24 patients (33%); in two of these the relevant findings were visualised only by SPECT-CT.


CONCLUSIONS
In patients receiving HAI, port perfusion scintigraphy by fusion imaging with a hybrid SPECT-CT system provides important information for therapy optimisation and appears to be superior to SPECT alone.
Denecke
Timm
T
Campus Virchow-Klinikum, Charite-Universitatsmedizin Berlin-Klinik fur Strahlenheilkunde und PET-Zentrum Berlin, Augustenburger Platz 1 Berlin, 13353 Berlin, Germany. timm.denecke@charite.de
Hildebrandt
Bert
B
Lehmkuhl
Lukas
L
Peters
Nils
N
Nicolaou
Annett
A
Pech
Maciej
M
Riess
Hanno
H
Ricke
Jens
J
Felix
Roland
R
Amthauer
Holger
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007261:Infusions, Intra-Arterial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D000970:Antineoplastic Agents