Planning transarterial radioembolization of colorectal liver metastases with Yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques.
The purpose of the study was to establish a diagnostic approach to the preparation of patients with colorectal liver metastases considered for transarterial radioembolization (RE). Twenty-two patients sequentially underwent computed tomography (CT; thorax/abdomen), magnetic resonance imaging (MRI; liver; hepatocyte-specific contrast), positron emission tomography (PET/PET-CT; F18-fluoro-desoxy-glucose), and angiography with perfusion scintigraphy [planar imaging; tomography with integrated CT (SPECT-CT)]. The algorithm was continued when no contraindication or alternative treatment option was found. The impact of each test on the therapy decision and RE management was recorded. Patient evaluation using CT revealed contraindications for RE in 4/22 patients (18%). Of the remaining 18 patients, 2 were excluded and 3 were assigned to locally ablative treatment based on MRI and PET results (28%). The remaining 13 patients entered the planning algorithm: SPECT-CT revealed gastrointestinal tracer accumulations in 4 (31%) patients [SPECT, 2 (15%)], making a modified application necessary. In five patients (38%), planar scintigraphy revealed relevant hepatopulmonary shunting. Therapy was finally administered to all 13 patients without therapy-related pulmonary or gastrointestinal morbidity. Each part of the diagnostic algorithm showed a relevant impact on patient management. The sequential approach appears to be suitable and keeps the number of unnecessary treatments and therapy risks to a minimum.
Denecke
Timm
T
Klinik für Strahlenheilkunde, Bereiche Radiologie und Nuklearmedizin, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. timm.denecke@charite.de
Rühl
Ricarda
R
Hildebrandt
Bert
B
Stelter
Lars
L
Grieser
Christian
C
Stiepani
Heiner
H
Werk
Michael
M
Podrabsky
Pietr
P
Plotkin
Michail
M
Amthauer
Holger
H
Ricke
Jens
J
Lopez Hänninen
Enrique
E
D000465:Algorithms; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy* / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011880:Radiotherapy Planning, Computer-Assisted; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D003287:Contrast Media; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; C073590:gadolinium ethoxybenzyl DTPA; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA