Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
EJNMMI Research
Published in: EJNMMI Research 1/2013

Open Access 01-12-2013 | Original research

Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

Authors: Yung-Hsiang Kao, Jeffrey D Steinberg, Young-Soon Tay, Gabriel KY Lim, Jianhua Yan, David W Townsend, Angela Takano, Mark C Burgmans, Farah G Irani, Terence KB Teo, Tow-Non Yeow, Apoorva Gogna, Richard HG Lo, Kiang-Hiong Tay, Bien-Soo Tan, Pierce KH Chow, Somanesan Satchithanantham, Andrew EH Tan, David CE Ng, Anthony SW Goh

Published in: EJNMMI Research | Issue 1/2013

Login to get access

Abstract

Background

Yttrium-90 (90Y) positron emission tomography with integrated computed tomography (PET/CT) represents a technological leap from 90Y bremsstrahlung single-photon emission computed tomography with integrated computed tomography (SPECT/CT) by coincidence imaging of low abundance internal pair production. Encouraged by favorable early experiences, we implemented post-radioembolization 90Y PET/CT as an adjunct to 90Y bremsstrahlung SPECT/CT in diagnostic reporting.

Methods

This is a retrospective review of all paired 90Y PET/CT and 90Y bremsstrahlung SPECT/CT scans over a 1-year period. We compared image resolution, ability to confirm technical success, detection of non-target activity, and providing conclusive information about 90Y activity within targeted tumor vascular thrombosis. 90Y resin microspheres were used. 90Y PET/CT was performed on a conventional time-of-flight lutetium-yttrium-oxyorthosilicate scanner with minor modifications to acquisition and reconstruction parameters. Specific findings on 90Y PET/CT were corroborated by 90Y bremsstrahlung SPECT/CT, 99mTc macroaggregated albumin SPECT/CT, follow-up diagnostic imaging or review of clinical records.

Results

Diagnostic reporting recommendations were developed from our collective experience across 44 paired scans. Emphasis on the continuity of care improved overall diagnostic accuracy and reporting confidence of the operator. With proper technique, the presence of background noise did not pose a problem for diagnostic reporting. A counter-intuitive but effective technique of detecting non-target activity is proposed, based on the pattern of activity and its relation to underlying anatomy, instead of its visual intensity. In a sub-analysis of 23 patients with a median follow-up of 5.4 months, 90Y PET/CT consistently outperformed 90Y bremsstrahlung SPECT/CT in all aspects of qualitative analysis, including assessment for non-target activity and tumor vascular thrombosis. Parts of viscera closely adjacent to the liver remain challenging for non-target activity detection, compounded by a tendency for mis-registration.

Conclusions

Adherence to proper diagnostic reporting technique and emphasis on continuity of care are vital to the clinical utility of post-radioembolization 90Y PET/CT. 90Y PET/CT is superior to 90Y bremsstrahlung SPECT/CT for the assessment of target and non-target activity.
Appendix
Available only for authorised users
Literature
1.
Salem R, Thurston KG: Radioembolization with yttrium-90 microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3: comprehensive literature review and future direction. J Vasc Interv Radiol 2006, 17: 1571–1593. 10.1097/01.RVI.0000236744.34720.73CrossRef
2.
Sirtex Technology Pty Ltd, Lane Cove: Pilot study of Selective Internal Radiation Therapy (SIRT) with yttrium-90 resin microspheres (SIR-Spheres microspheres) in patients with renal cell carcinoma (STX0110, “RESIRT”). New South Wales, Australia: Australiancancertrials.gov.au; 2010. Trial ID ACTRN12610000690055
3.
Muylle K, Nguyen J, de Wind A, Meuleman N, Delatte P, Vanderlinden B, Roelandts M, Van der Stappen A, Bron D, Flamen P: Radioembolization of the spleen: a revisited approach for the treatment of malignant lymphomatous splenomegaly. Cardiovasc Intervent Radiol 2013, 36: 1155–1160. 10.1007/s00270-012-0484-zCrossRef
4.
Hamoui N, Gates VL, Gonzalez J, Lewandowski RJ, Salem R: Radioembolization of renal cell carcinoma using yttrium-90 microspheres. J Vasc Interv Radiol 2013, 24: 298–300. 10.1016/j.jvir.2012.10.027CrossRef
5.
Ricke J, Großer O, Amthauer H: Y90-radioembolization of lung metastases via the bronchial artery: a report of 2 cases. Cardiovasc Intervent Radiol 2013,  : . 10.1007/s00270-013-0690-3
6.
Riaz A, Lewandowski RJ, Kulik LM, Mulcahy MF, Sato KT, Ryu RK, Omary RA, Salem R: Complications following radioembolization with yttrium-90 microspheres: a comprehensive literature review. J Vasc Interv Radiol 2009, 20: 1121–1130. 10.1016/j.jvir.2009.05.030CrossRef
7.
Wang SC, Bester L, Burnes JP, Clouston JE, Hugh TJ, Little AF, Padbury RTA, Price D: Clinical care and technical recommendations for 90yttrium microsphere treatment of liver cancer. J Med Imaging Radiat Oncol 2010, 54: 178–187. 10.1111/j.1754-9485.2010.02167.xCrossRef
8.
Salem R, Lewandowski RJ, Gates VL, Nutting CW, Murthy R, Rose SC, Soulen MC, Geschwind JF, Kulik L, Kim YH, Spreafico C, Maccauro M, Bester L, Brown DB, Ryu RK, Sze DY, Rilling WS, Sato KT, Sangro B, Bilbao JI, Jakobs TF, Ezziddin S, Kulkarni S, Kulkarni A, Liu DM, Valenti D, Hilgard P, Antoch G, Muller SP, Alsuhaibani H, et al.: Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol 2011, 22: 265–278. 10.1016/j.jvir.2010.10.029PubMedCentralCrossRef
9.
Sangro B, Iñarrairaegui M, Bilbao JI: Radioembolization for hepatocellular carcinoma. J Hepatol 2012, 56: 464–473.CrossRef
10.
Lau WY, Kennedy AS, Kim YH, Lai HK, Lee RC, Leung TW, Liu CS, Salem R, Sangro B, Shuter B, Wang SC: Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys 2012, 82: 401–407. 10.1016/j.ijrobp.2010.08.015CrossRef
11.
Kao YH, Hock Tan AE, Burgmans MC, Irani FG, Khoo LS, Gong Lo RH, Tay KH, Tan BS, Chow PKH, Eng Ng DC, Whatt Goh AS: Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modeling for safe and effective 90Y radioembolization. J Nucl Med 2012, 53: 559–566. 10.2967/jnumed.111.097469CrossRef
12.
Kao YH, Tan EH, Teo TK, Ng CE, Goh SW: Imaging discordance between hepatic angiography versus Tc-99m-MAA SPECT/CT: a case series, technical discussion and clinical implications. Ann Nucl Med 2011, 25: 669–676. 10.1007/s12149-011-0516-9CrossRef
13.
Kleinstreuer C, Basciano CA, Childress EM, Kennedy AS: A new catheter for tumor targeting with radioactive microspheres in representative hepatic artery systems. Part I: impact of catheter presence on local blood flow and microsphere delivery. J Biomech Eng 2012, 134: 051004. 10.1115/1.4006684CrossRef
14.
Jiang M, Fischman A, Nowakowski FS, Heiba S, Zhang Z, Knesaurek K, Weintraub J, Machac J: Segmental perfusion differences on paired Tc-99m macroaggregated albumin (MAA) hepatic perfusion imaging and yttrium-90 (Y-90) bremsstrahlung imaging studies in SIR-sphere radioembolization: associations with angiography. J Nucl Med Radiat Ther 2012, 3: 122.CrossRef
15.
Shen S, DeNardo GL, Yuan A, DeNardo DA, DeNardo SJ: Planar gamma camera imaging and quantitation of yttrium-90 bremsstrahlung. J Nucl Med 1994, 35: 1381–1389.
16.
Rault E, Clementel E, Vandenberghe S, D’Asseler Y, Van Holen R, De Beenhouwer J, Staelens S: Comparison of yttrium-90 SPECT and PET images. J Nucl Med 2010,51(suppl):125.
17.
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: e26174. 10.1371/journal.pone.0026174PubMedCentralCrossRef
18.
Minarik D, Sjögreen Gleisner K, Ljungberg M: Evaluation of quantitative (90)Y SPECT based on experimental phantom studies. Phys Med Biol 2008, 53: 5689–5703. 10.1088/0031-9155/53/20/008CrossRef
19.
Fabbri C, Sarti G, Cremonesi M, Ferrari M, Di Dia A, Agostini M, Botta F, Paganelli G: Quantitative analysis of 90Y Bremsstrahlung SPECT-CT images for application to 3D patient-specific dosimetry. Cancer Biother Radiopharm 2009, 24: 145–154. 10.1089/cbr.2008.0543CrossRef
20.
Ito S, Kurosawa H, Kasahara H, Teraoka S, Ariga E, Deji S, Hirota M, Saze T, Minamizawa T, Nishizawa K: (90)Y bremsstrahlung emission computed tomography using gamma cameras. Ann Nucl Med 2009, 23: 257–267. 10.1007/s12149-009-0233-9CrossRef
21.
Selwyn RG, Nickles RJ, Thomadsen BR, DeWerd LA, Micka JA: A new internal pair production branching ratio of 90Y: the development of a non-destructive assay for 90Y and 90Sr. Appl Radiat Isot 2007, 65: 318–327. 10.1016/j.apradiso.2006.08.009CrossRef
22.
Lhommel R, van Elmbt L, Goffette P, Van den Eynde M, Jamar F, Pauwels S, Walrand S: Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-spheres. Eur J Nucl Med Mol Imaging 2010, 37: 1654–1662. 10.1007/s00259-010-1470-9CrossRef
23.
Van Elmbt L, Vandenberghe S, Walrand S, Pauwels S, Jamar F: Comparison of yttrium-90 quantitative imaging by TOF and non-TOF PET in a phantom of liver selective internal radiotherapy. Phys Med Biol 2011, 56: 6759–6777. 10.1088/0031-9155/56/21/001CrossRef
24.
Walrand S, Flux GD, Konijnenberg MW, Valkema R, Krenning EP, Lhommel R, Pauwels S, Jamar F: Dosimetry of yttrium-labelled radiopharmaceuticals for internal therapy: 86Y or 90Y imaging? Eur J Nucl Med Mol Imaging 2011,38(suppl):S57-S68.CrossRef
25.
Bettinardi V, Presotto L, Rapisarda E, Picchio M, Gianolli L, Gilardi MC: Physical performance of the new hybrid PET/CT Discovery-690. Med Phys 2011, 38: 5394–5411. 10.1118/1.3635220CrossRef
26.
Bendriem B, Soussaline F, Campagnolo R, Verrey B, Wajnberg P, Syrota A: A technique for the correction of scattered radiation in a PET system using time-of-flight information. J Comput Assist Tomogr 1986, 10: 287–295.CrossRef
27.
Werner ME, Surti S, Karp JS: Implementation and evaluation of a 3D PET single scatter simulation with TOF modeling. Proc IEEE Nuclear Science Symp Conf Rec 2006, 3: 1768–1773.
28.
Watson CC: Extension of single scatter simulation to scatter correction of time-of-flight PET. IEEE Trans Nucl Sci 2007, 54: 1679–1686.CrossRef
29.
Lhommel R, Goffette P, Van den Eynde M, Jamar F, Pauwels S, Bilbao JI, Walrand S: Yttrium-90 TOF PET scan demonstrates high-resolution biodistribution after liver SIRT. Eur J Nucl Med Mol Imaging 2009, 36: 1696. 10.1007/s00259-009-1210-1CrossRef
30.
Kao YH, Tan EH, Ng CE, Goh SW: Yttrium-90 time-of-flight PET/CT is superior to Bremsstrahlung SPECT/CT for postradioembolization imaging of microsphere biodistribution. Clin Nucl Med 2011, 36: 186–187. 10.1097/RLU.0b013e318208f0e6CrossRef
31.
Wissmeyer M, Heinzer S, Majno P, Buchegger F, Zaidi H, Garibotto V, Viallon M, Becker CD, Ratib O, Terraz S: 90 Y Time-of-flight PET/MR on a hybrid scanner following liver radioembolisation (SIRT). Eur J Nucl Med Mol Imaging 2011, 38: 1744–1745. 10.1007/s00259-011-1792-2CrossRef
32.
Carlier T, Eugène T, Bodet-Milin C, Garin E, Ansquer C, Rousseau C, Ferrer L, Barbet J, Schoenahl F, Kraeber-Bodéré F: Assessment of acquisition protocols for routine imaging of Y-90 using PET/CT. EJNMMI Res 2013, 3: 11. 10.1186/2191-219X-3-11PubMedCentralCrossRef
33.
Willowson K, Forwood N, Jakoby BW, Smith AM, Bailey DL: Quantitative (90)Y image reconstruction in PET. Med Phys 2012, 39: 7153–7159. 10.1118/1.4762403CrossRef
34.
Goedicke A, Berker Y, Verburg F, Behrendt F, Winz O, Mottaghy F: Study-parameter impact in quantitative 90-Yttrium PET imaging for radioembolization treatment monitoring and dosimetry. IEEE Trans Med Imaging 2013, 32: 485–492.CrossRef
35.
Elschot M, Vermolen BJ, Lam MG, de Keizer B, van den Bosch MA, de Jong HW: Quantitative comparison of PET and bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One 2013, 8: e55742. 10.1371/journal.pone.0055742PubMedCentralCrossRef
36.
Walrand S, Lhommel R, Goffette P, Van den Eynde M, Pauwels S, Jamar F: Hemoglobin level significantly impacts the tumor cell survival fraction in humans after internal radiotherapy. EJNMMI Res 2012, 2: 20. 10.1186/2191-219X-2-20PubMedCentralCrossRef
37.
D'Arienzo M, Chiaramida P, Chiacchiararelli L, et al.: 90Y PET-based dosimetry after selective internal radiotherapy treatments. Nucl Med Commun 2012, 33: 633–640. 10.1097/MNM.0b013e3283524220CrossRef
38.
Kao YH, Steinberg JD, Tay YS, Lim GKY, Yan J, Townsend DW, Takano A, Burgmans MC, Irani FG, Teo TKB, Yeow TN, Gogna A, Lo RHG, Tay KH, Tan BS, Chow PKH, Satchithanantham S, Tan AEH, Ng DCE, Goh ASW: Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res 2013, 3: 57. 10.1186/2191-219X-3-57PubMedCentralCrossRef
Metadata
Title
Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting
Authors
Yung-Hsiang Kao
Jeffrey D Steinberg
Young-Soon Tay
Gabriel KY Lim
Jianhua Yan
David W Townsend
Angela Takano
Mark C Burgmans
Farah G Irani
Terence KB Teo
Tow-Non Yeow
Apoorva Gogna
Richard HG Lo
Kiang-Hiong Tay
Bien-Soo Tan
Pierce KH Chow
Somanesan Satchithanantham
Andrew EH Tan
David CE Ng
Anthony SW Goh
Publication date
01-12-2013
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2013
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/2191-219X-3-56

Other articles of this Issue 1/2013

EJNMMI Research 1/2013 Go to the issue

Original research

No difference in striatal dopamine transporter availability between active smokers, ex-smokers and non-smokers using [123I]FP-CIT (DaTSCAN) and SPECT

Original research

Gating, enhanced gating, and beyond: information utilization strategies for motion management, applied to preclinical PET

Original research

Evaluation of androgen-induced effects on the uptake of [18F]FDG, [11C]choline and [11C]acetate in an androgen-sensitive and androgen-independent prostate cancer xenograft model

Original research

[18 F]FDG-PET imaging is an early non-invasive pharmacodynamic biomarker for a first-in-class dual MEK/Raf inhibitor, RO5126766 (CH5126766), in preclinical xenograft models

Original research

Optimizing statistical parametric mapping analysis of 18F-FDG PET in children

Original research

Automated computer quantification of breast cancer in small-animal models using PET-guided MR image co-segmentation