title: 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization.
abstract: In hepatic (90)Y radioembolization, pretreatment (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) nuclear imaging is used for lung shunt analysis, evaluation of extrahepatic deposition, and sometimes for treatment planning, using a partition model. A high level of agreement between pretreatment (99m)Tc-MAA distribution and final (90)Y-microsphere distribution is assumed. The aim of this study was to investigate the value of pretreatment (99m)Tc-MAA SPECT to predict intrahepatic posttreatment (90)Y-microsphere distribution.
  
  
  METHODS
  Volumes of interest (VOIs) were delineated on pretreatment contrast-enhanced CT or MR images according to Couinaud liver segmentation. All VOIs were registered to the (99m)Tc-MAA SPECT and (90)Y SPECT images. The (99m)Tc-MAA SPECT and (90)Y SPECT activity counts were normalized to the total administered activity of (90)Y. For each VOI, this practice resulted in a predictive amount of (90)Y (MBq/cm(3)) based on (99m)Tc-MAA SPECT in comparison with an actual amount of (90)Y based on (90)Y SPECT. Bland-Altman analysis was used to investigate the agreement of the activity distribution between (99m)Tc-MAA SPECT and (90)Y SPECT.
  
  
  RESULTS
  A total of 39 procedures (225 VOIs) in 31 patients were included for analysis. The overall mean difference between pretreatment and posttreatment distribution of activity concentration for all segments was -0.022 MBq/cm(3) with 95% limits of agreement of -0.581 to 0.537 MBq/cm(3) (-28.9 to 26.7 Gy absorbed dose). A difference of >10%, >20%, and >30% of the mean activity per milliliter was found in, respectively, 153 (68%), 97 (43%), and 72 (32%) of the 225 segments. In every (99m)Tc-MAA procedure, at least 1 segment showed an under- or overestimation of >10%. The position of the catheter tip during administrations, as well as the tumor load of the liver segments, significantly influenced the disagreement.
  
  
  CONCLUSIONS
  In current clinical practice, (99m)Tc-MAA distribution does not accurately predict final (90)Y activity distribution. Awareness of the importance of catheter positioning and adherence to specific recommendations may lead to optimization of individualized treatment planning based on pretreatment imaging.
authors.affiliation: Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands.
authors.forename: Maurits
authors.initials: M
authors.lastname: Wondergem
authors.forename: Maarten L J
authors.initials: ML
authors.lastname: Smits
authors.forename: Mattijs
authors.initials: M
authors.lastname: Elschot
authors.forename: Hugo W A M
authors.initials: HW
authors.lastname: de Jong
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.forename: Johannes F W
authors.initials: JF
authors.lastname: Nijsen
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000528:radiation effects*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D012117:Resins, Synthetic / Q000737:chemistry*; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D015899:Tomography, Emission-Computed, Single-Photon; D015021:Yttrium Radioisotopes / Q000737:chemistry / Q000627:therapeutic use
chemical_list: D012117:Resins, Synthetic; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes
keywords: 90Y microspheres; 99mTc-MAA; dosimetry; liver; radioembolization