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European Journal of Nuclear Medicine and Molecular Imaging

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01-10-2012 | Review Article

SIRT of liver metastases: physiological and pathophysiological considerations

Authors: Christophe Van de Wiele, Alex Maes, Eddy Brugman, Yves D’Asseler, Bart De Spiegeleer, Gilles Mees, Karin Stellamans

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2012

Abstract

Available literature on the differences in circulation and microcirculation of normal liver and liver metastases as well as in rheology of the different radiolabelled microspheres [^99mTc-labelled macroaggregates of albumin (MAA), ⁹⁰Y-TheraSpheres and ⁹⁰Y-SIR-spheres] used in selective internal radiation therapy (SIRT) are reviewed and implications thereof on the practice of SIRT discussed. As a result of axial accumulation and skimming, large microspheres are preferentially deposited in regions of high flow, whereas smaller microspheres are preferentially diverted to regions of low flow. As flow to normal liver tissue is considerably variable between segments and also within one segment, microspheres will be delivered heterogeneously within the microvasculature of normal liver tissue. This non-uniformity in microsphere distribution in normal liver tissue has a significant “liver-sparing” effect on the dose distribution of ⁹⁰Y-labelled microspheres. Arterial flow to liver metastases is most pronounced in the hypervascular rim of metastases, followed by the smaller metastases and finally by the central hypoperfused region of the larger metastases. Because of the wide variability in size of labelled MAAs and because of the skimming effect, existing differences in flow between metastatic lesions of variable size are likely exaggerated on ^99mTc-MAA scintigraphy when compared to ⁹⁰Y-TheraSpheres and ⁹⁰Y-SIR-spheres (smaller variability in size and probably also in specific activity). Ideally, labelled MAAs would contain a size range similar to that of ⁹⁰Y-SIR-spheres or ⁹⁰Y-TheraSpheres. Furthermore, the optimal number of MAA particles to inject for the pretreatment planning scintigraphy warrants further exploration as it was shown that concentrated suspensions of microspheres produce more optimal tumour to normal liver distribution ratios. Finally, available data suggest that the flow-based heterogeneous distribution of microspheres to metastatic lesions of variable size might be optimized, that is rendered more homogeneous, through the combined use of angiotensin II and degradable starch microspheres.

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Title: SIRT of liver metastases: physiological and pathophysiological considerations
Authors: Christophe Van de Wiele
Alex Maes
Eddy Brugman
Yves D’Asseler
Bart De Spiegeleer
Gilles Mees
Karin Stellamans
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2012
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-012-2189-6

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SIRT of liver metastases: physiological and pathophysiological considerations

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