title: Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT.
abstract: OBJECTIVE
  To evaluate whether technetium-99 (99mTc)-labeled macroaggregated albumin (MAA) can predict subsequent yttrium-90 (90Y) distribution and imaging response in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Retrospective review was performed of records of 83 patients with HCC who underwent90Y glass microsphere radioembolization with99mTc-MAA single photon emission computed tomography (SPECT) and90Y positron emission tomography (PET)/CT between January 2013 and December 2014. Images were fused to segment the whole liver normal tissue (WLNT) and the largest tumors. Fused images were reviewed and analyzed for comparison of absorbed dose (AD) to tumors and WLNT as calculated from99mTc-MAA SPECT and from90Y PET/CT, subjective imaging comparison of99mTc-MAA SPECT and90Y PET for tumors and WLNT, and correlation of tumoral AD with response on follow-up CT.
  
  
  RESULTS
  Final analysis included 73 and 63 patients for WLNT and tumor99mTc-MAA/90Y correlation, respectively, and 62 patients for AD vs response.99mTc-MAA/90Y limit of agreement for each reviewer was viewed as clinically acceptable only for WLNT (-15 to 15 Gy). AD interreviewer variability was clinically acceptable for WLNT but was too broad for tumor. Mean tumor AD for objective response (78%) was 313 Gy vs 234 Gy for nonresponders. No threshold was found between tumor AD and response (P > .1). Catheter mismatch between99mTc-MAA and90Y had a direct impact on AD mismatch between the 2 image sets.
  
  
  CONCLUSIONS
  99mTc-MAA was found to be a poor surrogate to quantitatively predict subsequent90Y AD to hepatocellular tumors.99mTc-MAA distribution correlated with90Y distribution in the normal hepatic parenchyma.
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202. Electronic address: pmhaste@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Haste
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202.
authors.forename: Mark
authors.initials: M
authors.lastname: Tann
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202.
authors.forename: Scott
authors.initials: S
authors.lastname: Persohn
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202.
authors.forename: Thomas
authors.initials: T
authors.lastname: LaRoche
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202.
authors.forename: Vasantha
authors.initials: V
authors.lastname: Aaron
authors.affiliation: Biocompatibles UK Ltd, a BTG International group company, Camberley, Surrey, United Kingdom.
authors.forename: Thibault
authors.initials: T
authors.lastname: Mauxion
authors.affiliation: Biocompatibles UK Ltd, a BTG International group company, Camberley, Surrey, United Kingdom.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Chauhan
authors.affiliation: Biocompatibles UK Ltd, a BTG International group company, Camberley, Surrey, United Kingdom.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Dreher
authors.affiliation: Department of Radiology, Indiana University School of Medicine, 550 N. University Boulevard, Room 0663, Indianapolis, IN 46202.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics*; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon; D015021:Yttrium Radioisotopes / Q000493:pharmacokinetics*
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D015021:Yttrium Radioisotopes