title: 99mTc-MAA/ 90Y-Bremsstrahlung SPECT/CT after simultaneous Tc-MAA/90Y-microsphere injection for immediate treatment monitoring and further therapy planning for radioembolization.
abstract: OBJECTIVE
  An angiographic evaluation combined with (99m)Tc-macroaggregated albumin (Tc-MAA) scanning should precede the treatment of any selected candidates for radioembolization (RE) of the liver. If the tumours in one liver lobe have not been targeted in the test angiogram, it should be repeated. However, in a few cases treatment of one liver lobe or at least some segments is safe and feasible and performing a repeated test angiogram with Tc-MAA (Re-MAA) in a separate session leads to more radiation exposure and could be time consuming. Our aim was to evaluate the feasibility of concurrent RE of a part of the liver and therapy planning for another region by simultaneous injection of the Tc-MAA and (90)Y-microspheres in two different locations in the therapy session. Tc-MAA and bremsstrahlung (BS) single photon emission computed tomography (SPECT)/CT were performed separately in an effort to distinguish between the distributions of these two different radiopharmaceuticals.
  
  
  METHODS
  RE was combined with a simultaneous second test angiogram of another lobe or segments in the same session in six patients [44-70 years; five women (83%)]. Five patients suffered from colorectal carcinoma (CRC) and one from ovarian cancer. Tc-MAA and BS SPECT/CT were performed for all cases.
  
  
  RESULTS
  Post-therapeutic Tc-MAA SPECT/CT showed in all patients only the distribution of Tc-MAA without any detectable BS. Evaluation of (90)Y-microsphere distribution was not always possible in the post-therapeutic BS scan performed 24 h later due to remaining Tc-MAA radiation. However, scans performed at 48 h post-intervention no longer showed any Tc-MAA "contamination".
  
  
  CONCLUSIONS
  Combining RE and Re-MAA is feasible in appropriately selected patients.
authors.affiliation: Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str 25, 53127 Bonn, Germany. hojjat.ahmadzadehfar@ukb.uni-bonn.de
authors.forename: Hojjat
authors.initials: H
authors.lastname: Ahmadzadehfar
authors.forename: Amir
authors.initials: A
authors.lastname: Sabet
authors.forename: Marianne
authors.initials: M
authors.lastname: Muckle
authors.forename: Kai
authors.initials: K
authors.lastname: Wilhelm
authors.forename: Karl
authors.initials: K
authors.lastname: Reichmann
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Biersack
authors.forename: Samer
authors.initials: S
authors.lastname: Ezziddin
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007267:Injections; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D013438:Sulfhydryl Compounds / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use*; D013668:Technetium Tc 99m Aggregated Albumin / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use*; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D013438:Sulfhydryl Compounds; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes; C082426:technetium Tc99m-mercaptoacetyl albumin