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European Journal of Nuclear Medicine and Molecular Imaging

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01-10-2014 | Original Article

^99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with ¹⁶⁶Ho-microspheres

Authors: Mattijs Elschot, Johannes F. W. Nijsen, Marnix G. E. H. Lam, Maarten L. J. Smits, Jip F. Prince, Max A. Viergever, Maurice A. A. J. van den Bosch, Bernard A. Zonnenberg, Hugo W. A. M. de Jong

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2014

Abstract

Purpose

Radiation pneumonitis is a rare but serious complication of radioembolic therapy of liver tumours. Estimation of the mean absorbed dose to the lungs based on pretreatment diagnostic ^99mTc-macroaggregated albumin (^99mTc-MAA) imaging should prevent this, with administered activities adjusted accordingly. The accuracy of ^99mTc-MAA-based lung absorbed dose estimates was evaluated and compared to absorbed dose estimates based on pretreatment diagnostic ¹⁶⁶Ho-microsphere imaging and to the actual lung absorbed doses after ¹⁶⁶Ho radioembolization.

Methods

This prospective clinical study included 14 patients with chemorefractory, unresectable liver metastases treated with ¹⁶⁶Ho radioembolization. ^99mTc-MAA-based and ¹⁶⁶Ho-microsphere-based estimation of lung absorbed doses was performed on pretreatment diagnostic planar scintigraphic and SPECT/CT images. The clinical analysis was preceded by an anthropomorphic torso phantom study with simulated lung shunt fractions of 0 to 30 % to determine the accuracy of the image-based lung absorbed dose estimates after ¹⁶⁶Ho radioembolization.

Results

In the phantom study, ¹⁶⁶Ho SPECT/CT-based lung absorbed dose estimates were more accurate (absolute error range 0.1 to −4.4 Gy) than ¹⁶⁶Ho planar scintigraphy-based lung absorbed dose estimates (absolute error range 9.5 to 12.1 Gy). Clinically, the actual median lung absorbed dose was 0.02 Gy (range 0.0 to 0.7 Gy) based on posttreatment ¹⁶⁶Ho-microsphere SPECT/CT imaging. Lung absorbed doses estimated on the basis of pretreatment diagnostic ¹⁶⁶Ho-microsphere SPECT/CT imaging (median 0.02 Gy, range 0.0 to 0.4 Gy) were significantly better predictors of the actual lung absorbed doses than doses estimated on the basis of ¹⁶⁶Ho-microsphere planar scintigraphy (median 10.4 Gy, range 4.0 to 17.3 Gy; p < 0.001), ^99mTc-MAA SPECT/CT imaging (median 2.5 Gy, range 1.2 to 12.3 Gy; p < 0.001), and ^99mTc-MAA planar scintigraphy (median 5.5 Gy, range 2.3 to 18.2 Gy; p < 0.001).

Conclusion

In clinical practice, lung absorbed doses are significantly overestimated by pretreatment diagnostic ^99mTc-MAA imaging. Pretreatment diagnostic ¹⁶⁶Ho-microsphere SPECT/CT imaging accurately predicts lung absorbed doses after ¹⁶⁶Ho radioembolization.

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Title: 99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with 166Ho-microspheres
Authors: Mattijs Elschot
Johannes F. W. Nijsen
Marnix G. E. H. Lam
Maarten L. J. Smits
Jip F. Prince
Max A. Viergever
Maurice A. A. J. van den Bosch
Bernard A. Zonnenberg
Hugo W. A. M. de Jong
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-014-2784-9

At a glance: The STEP trials

Springer Medicine

^99mTc-MAA overestimates the absorbed dose to the lungs in radioembolization: a quantitative evaluation in patients treated with ¹⁶⁶Ho-microspheres

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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