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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 4/2020

Open Access 01-04-2020 | Original Article

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

Authors: Maarten L. J. Smits, Mathijs G. Dassen, Jip F. Prince, Arthur J. A. T. Braat, Casper Beijst, Rutger C. G. Bruijnen, Hugo W. A. M. de Jong, Marnix G. E. H. Lam

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2020

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Abstract

Purpose

As an alternative to technetium-99m-macroaggregated albumin (99mTc-MAA), a scout dose of holmium-166 (166Ho) microspheres can be used prior to 166Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between 166Ho-scout and 166Ho-therapeutic dose in comparison with the agreement between 99mTc-MAA and 166Ho-therapeutic dose.

Methods

Two separate scout dose procedures were performed (99mTc-MAA and 166Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the 99mTc-MAA, 166Ho-scout, and 166Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on 99mTc-MAA and 166Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT.

Results

A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, 166Ho-scout was superior with a median score of 4 vs. 2.5 for 99mTc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for 166Ho-scout in comparison with 99mTc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and 166Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for 99mTc-MAA and 166Ho-scout, respectively).

Conclusions

In this study, 166Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with 99mTc-MAA.
Literature
1.
Dhabuwala A, Lamerton P, Stubbs R. Relationship of 99mtechnetium labelled macroaggregated albumin (99mTc-MAA) uptake by colorectal liver metastases to response following selective internal radiation therapy (SIRT). BMC Nucl Med. 2005;5(7).
2.
Wondergem M, Smits ML, Elschot M, et al. 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic Radioembolization. J Nucl Med. 2013;54(8):1294–301.CrossRef
3.
Ulrich G, Dudeck O, Furth C, et al. Predictive value of Intratumoral 99mTc-macroaggregated albumin uptake in patients with colorectal liver metastases scheduled for Radioembolization with 90Y-microspheres. J Nucl Med. 2013;54(4):516–22.CrossRef
4.
Ilhan H, Goritschan A, Paprottka P, et al. Predictive value of 99mTc-MAA SPECT for 90Y-labeled resin microsphere distribution in Radioembolization of primary and secondary hepatic tumors. J Nucl Med. 2015;56(11):1654–60.CrossRef
5.
Seevinck PR, van de Maat GH, de Wit TC, et al. Magnetic resonance imaging-based radiation-absorbed dose estimation of 166Ho microspheres in liver radioembolization. Int J Radiat Oncol Biol Phys. 2012;83(3):437–44.CrossRef
6.
van de Maat GH, Seevinck PR, Elschot M, et al. MRI-based biodistribution assessment of holmium-166 poly(L-lactic acid) microspheres after radioembolisation. Eur Radiol. 2012;23(3):827–35.CrossRef
7.
Elschot M, Nijsen JF, Dam AJ, de Jong HW. Quantitative evaluation of scintillation camera imaging characteristics of isotopes used in liver radioembolization. PLoS One. 2011;6(11):e26174.CrossRef
8.
Prince JF, van Rooij R, Bol GH, de Jong HW, van den Bosch MA, Lam MG. Safety of a scout dose preceding hepatic radioembolization with 166Ho microspheres. J Nucl Med. 2015;56:817–23.CrossRef
9.
Smits ML, Nijsen JF, van den Bosch MA, et al. Holmium-166 radioembolization for the treatment of patients with liver-metastases: design of the phase I HEPAR trial. J Exp Clin Cancer Res. 2010;29:70.CrossRef
10.
Smits ML, Nijsen JF, van den Bosch MA, et al. Holmium-166 radioembolisation in patients with unresectable, chemorefractory liver metastases (HEPAR trial) a phase 1, dose-escalation study. Lancet Oncol. 2012;13:1025–34.CrossRef
11.
Prince JF, van den Bosch MA, Nijsen JF, et al. Efficacy of radioembolization with holmium-166 microspheres in salvage patients with liver metastases: a phase 2 study. J Nucl Med. 2017.
12.
Elschot M, Smits ML, Nijsen JF, et al. Quantitative Monte Carlo-based holmium-166 SPECT reconstruction. Med Phys. 2013;40(11):112502–12.CrossRef
13.
Bol GH, Kotte AN, van der Heide UA, Lagendijk JJ. Simultaneous multi-modality ROI delineation in clinical practice. Comput Methods Prog Biomed. 2009;96(2):133–40.CrossRef
14.
Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as a measure of reliability. Educ Psychol Meas. 1973;33(3):613–9.CrossRef
15.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRef
16.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRef
17.
Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet. 1995;346(8982):1085–7.CrossRef
18.
Boas FE, Bodei L, Sofocleus CT. Radioembolization of colorectal liver metastases: indications, technique, and outcomes. J Nucl Med. 2017;9(58):104S–11S.CrossRef
19.
Elschot M, Nijsen JF, Lam MG, et al. 99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with 166Ho-microspheres. Eur J Nucl Med Mol Imaging. 2014;41(10):1965–75.CrossRef
20.
Braat AJ, Prince JF, van Rooij R, et al. Safety analysis of holmium-166 microsphere scout dose imaging during radioembolisation work-up: a cohort study. Eur Radiol. 2018;28(3):920–8.CrossRef
21.
Kafrouni M, Allimant C, Fourcade M, et al. Retrospective voxel-based dosimetry for assessing the body surface area model ability to predict delivered dose and radioembolization outcome. J Nucl Med. 2018;59(8):1289–95.CrossRef
22.
Reinders MT, Mees E, Powerski MJ, et al. Radioembolisation in Europe: a survey amongst CIRSE members. Cardiovasc Intervent Radiol. 2018;41(10):1579–89.CrossRef
Metadata
Title
The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases
Authors
Maarten L. J. Smits
Mathijs G. Dassen
Jip F. Prince
Arthur J. A. T. Braat
Casper Beijst
Rutger C. G. Bruijnen
Hugo W. A. M. de Jong
Marnix G. E. H. Lam
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2020
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-019-04460-y

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