Dataset Information

A Pilot Study on Hepatobiliary Scintigraphy to Monitor Regional Liver Function in ⁹⁰Y Radioembolization.

ABSTRACT: Radioembolization is increasingly used as a bridge to resection (i.e., radiation lobectomy). It combines ipsilateral tumor control with the induction of contralateral hypertrophy to facilitate lobar resection. The aim of this pilot study was to investigate the complementary value of hepatobiliary scintigraphy (HBS) before and after radioembolization in the assessment of the future remnant liver. Methods: Consecutive patients with liver tumors who underwent HBS before and after ⁹⁰Y radioembolization were included. Regional (treated/nontreated) and whole liver function and volume were determined on HBS and CT. Changes in regional liver function and volume were correlated with the functional liver absorbed doses, determined on ⁹⁰Y PET/CT. In addition, the correlation between liver volume and function change was evaluated. Results: Thirteen patients (10 hepatocellular carcinoma, 3 metastatic colorectal carcinoma) were included. Liver function of the treated part declined after radioembolization (HBS-pre, 4.0%/min/m²; HBS-post, 1.9%/min/m²; P = 0.001), whereas the function of the nontreated part increased (HBS-pre, 1.4%/min/m²; HBS-post, 2.8%/min/m²; P = 0.009). Likewise, treated volume decreased (pretreatment, 1,118.7 cm³; posttreatment, 870.7 cm³; P = 0.003), whereas the nontreated volume increased (pretreatment, 412.7 cm³; posttreatment, 577.6 cm³; P = 0.005). Bland-Altman analysis revealed a large bias (29%) between volume decrease and function decrease in the treated part and wide limits of agreement (-7.7%-65.6%). The bias between volume and function change was smaller (±6.0%) in the nontreated part of the liver, but limits of agreement were still wide (-117.9%-106.7%). Conclusion: Radioembolization induces regional changes in liver function that are accurately detected by HBS. Limits of agreement between function and volume changes were wide, showing large individual differences. This finding indicates that HBS may have a complementary role in the management of patients for radiation lobectomy.

SUBMITTER: van der Velden S

PROVIDER: S-EPMC6785787 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Pilot Study on Hepatobiliary Scintigraphy to Monitor Regional Liver Function in 90Y Radioembolization.

van der Velden Sandra S Braat Manon N G J A MNGJA Labeur Tim A TA Scholten Mike V MV van Delden Otto M OM Bennink Roelof J RJ de Jong Hugo W A M HWAM Lam Marnix G E H MGEH

Journal of nuclear medicine : official publication, Society of Nuclear Medicine 20190406 10

Radioembolization is increasingly used as a bridge to resection (i.e., radiation lobectomy). It combines ipsilateral tumor control with the induction of contralateral hypertrophy to facilitate lobar resection. The aim of this pilot study was to investigate the complementary value of hepatobiliary scintigraphy (HBS) before and after radioembolization in the assessment of the future remnant liver. Methods: Consecutive patients with liver tumors who underwent HBS before and after 90</su ...[more]

PMID: 30954942

Similar Datasets

Project description:ObjectivesTo compare Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) with 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) as quantitative liver function tests for the preoperative assessment of patients undergoing liver resection.MethodsPatients undergoing liver surgery and preoperative assessment of future remnant liver (FRL) function using 99mTc-mebrofenin HBS were included. Patients underwent DHCE-MRI. Total liver uptake function was calculated for both modalities: mebrofenin uptake rate (MUR) and Ki respectively. The FRL was delineated with both SPECT-CT and MRI to calculate the functional share. Blood samples were taken to assess biochemical liver parameters.ResultsA total of 20 patients were included. The HBS-derived MUR and the DHCE-MRI-derived mean Ki correlated strongly for both total and FRL function (Pearson r?=?0.70, p?=?0.001 and r?=?0.89, p?<?0.001 respectively). There was a strong agreement between the functional share determined with both modalities (ICC?=?0.944, 95% CI 0.863-0.978, n?=?20). There was a significant negative correlation between liver aminotransferases and bilirubin for both MUR and Ki.ConclusionsAssessment of liver function with DHCE-MRI is comparable with that of 99mTc-mebrofenin HBS and has the potential to be combined with diagnostic MRI imaging. This can therefore provide a one-stop-shop modality for the preoperative assessment of patients undergoing liver surgery.Key points• Quantitative assessment of liver function using hepatobiliary scintigraphy is performed in the preoperative assessment of patients undergoing liver surgery in order to prevent posthepatectomy liver failure. • Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) is an emerging method to quantify liver function and can serve as a potential alternative to hepatobiliary scintigraphy. • Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging.

Project description:BackgroundThe purpose was to validate 90Y PET gradient-based tumor segmentation in phantoms and to evaluate the impact of the segmentation method on reported tumor absorbed dose (AD) and biological effective dose (BED) in 90Y microsphere radioembolization (RE) patients. A semi-automated gradient-based method was applied to phantoms and patient tumors on the 90Y PET with the initial bounding volume for gradient detection determined from a registered diagnostic CT or MR; this PET-based segmentation (PS) was compared with radiologist-defined morphologic segmentation (MS) on CT or MRI. AD and BED volume histogram metrics (D90, D70, mean) were calculated using both segmentations and concordance/correlations were investigated. Spatial concordance was assessed using Dice similarity coefficient (DSC) and mean distance to agreement (MDA). PS was repeated to assess intra-observer variability.ResultsIn phantoms, PS demonstrated high accuracy in lesion volumes (within 15%), AD metrics (within 11%), high spatial concordance relative to morphologic segmentation (DSC?>?0.86 and MDA?<?1.5 mm), and low intra-observer variability (DSC?>?0.99, MDA?<?0.2 mm, AD/BED metrics within 2%). For patients (58 lesions), spatial concordance between PS and MS was degraded compared to in-phantom (average DSC = 0.54, average MDA = 4.8 mm); the average mean tumor AD was 226?±?153 and 197?±?138 Gy, respectively for PS and MS. For patient AD metrics, the best Pearson correlation (r) and concordance correlation coefficient (ccc) between segmentation methods was found for mean AD (r?=?0.94, ccc?=?0.92), but worsened as the metric approached the minimum dose (for D90, r?=?0.77, ccc?=?0.69); BED metrics exhibited a similar trend. Patient PS showed low intra-observer variability (average DSC = 0.81, average MDA = 2.2 mm, average AD/BED metrics within 3.0%).Conclusions90Y PET gradient-based segmentation led to accurate/robust results in phantoms, and showed high concordance with MS for reporting mean tumor AD/BED in patients. However, tumor coverage metrics such as D90 exhibited worse concordance between segmentation methods, highlighting the need to standardize segmentation methods when reporting AD/BED metrics from post-therapy 90Y PET. Estimated differences in reported AD/BED metrics due to segmentation method will be useful for interpreting RE dosimetry results in the literature including tumor response data.

Project description:The aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient-relative calibration method for activity quantification.The identity of 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments.Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative 90Y bremsstrahlung SPECT can be used if dedicated correction methods are available.The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.

Project description:Our purpose was to identify baseline imaging features in patients with liver cancer that correlate with 90Y distribution on postprocedural SPECT and predict tumor response to transarterial radioembolization (TARE). Methods: This retrospective study was approved by the institutional review board and included 38 patients with hepatocellular carcinoma (HCC) (n = 23; 18/23 men; mean age, 62.39 ± 8.62 y; 34 dominant tumors) and non-HCC hepatic malignancies (n = 15; 9/15 men; mean age, 61.13 ± 11.51 y; 24 dominant tumors) who underwent 40 resin-based TARE treatments (August 2012 to January 2018). Multiphasic contrast-enhanced MRI or CT was obtained before and Bremsstrahlung SPECT within 2 h after TARE. Total tumor volume (cm3) and enhancing tumor volume (ETV [cm3] and % of total tumor volume), and total and enhancing tumor burden (%), were volumetrically assessed on baseline imaging. Up to 2 dominant tumors per treated lobe were analyzed. After multimodal image registration of baseline imaging and SPECT/CT, 90Y distribution was quantified on SPECT as tumor-to-normal-liver ratio (TNR). Response was assessed according to RECIST1.1 and quantitative European Association for the Study of the Liver criteria. Clinical parameters were also assessed. Statistical tests included Mann-Whitney U, Pearson correlation, and linear regression. Results: In HCC patients, high baseline ETV% significantly correlated with high TNR on SPECT, demonstrating greater 90Y uptake in the tumor relative to the liver parenchyma (P < 0.001). In non-HCC patients, a correlation between ETV% and TNR was observed as well (P = 0.039). Follow-up imaging for response assessments within 1-4 mo after TARE was available for 23 patients with 25 treatments. The change of ETV% significantly correlated with TNR in HCC (P = 0.039) but not in non-HCC patients (P = 0.886). Additionally, Child-Pugh class B patients demonstrated significantly more 90Y deposition in nontumorous liver than Child-Pugh A patients (P = 0.021). Conclusion: This study identified ETV% as a quantifiable imaging biomarker on preprocedural MRI and CT to predict 90Y distribution on postprocedural SPECT in HCC and non-HCC. However, the relationship between the preferential uptake of 90Y to the tumor and tumor response after radioembolization could be validated only for HCC.

Dataset Information

A Pilot Study on Hepatobiliary Scintigraphy to Monitor Regional Liver Function in ⁹⁰Y Radioembolization.

Publications

A Pilot Study on Hepatobiliary Scintigraphy to Monitor Regional Liver Function in <sup>90</sup>Y Radioembolization.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets