Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization
Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization
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DOI：
10.1007/s00259-011-2033-4
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发表时间：
2012-05-01
影响因子：
9.1
通讯作者：
Garin, Etienne
中科院分区：
文献类型：
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作者：
Lenoir, Laurence;Edeline, Julien;Garin, Etienne
目的确定胃十二指肠摄取的Tc-99 m-大聚集白蛋白（MAA），这与溃疡疾病的风险增加，是一个关键的部分，病人接受放射性栓塞治疗肝肿瘤的治疗管理。鉴于这种情况，MAA单光子发射计算机断层扫描（SPECT）/CT的使用可能是必不可少的，但该程序尚未得到彻底的评价。这项回顾性研究的目的是确定MAA SPECT/CT在识别消化道肝外摄取的有效性，同时确定潜在的诊断pitfuls.Methods总体上，139 MAA SPECT/CT扫描进行了103例不同类型的肝脏肿瘤。患者随访至少6个月，根据标准requirements.Results消化道，或消化样，摄取以外的自由高锝酸盐被确定在5.7%的情况下，使用平面成像和36.6%的情况下，使用SPECT/CT。SPECT/CT显示的摄取部位包括胃十二指肠区（3.6%）、胆囊（12.2%）、门静脉血栓（6.5%）、肝动脉（6.5%）、弹簧圈栓塞部位（2.1%）以及镰状动脉（5.0%）。对于2.1%的探索，SPECT和CT成像之间的配准错误可能会导致错误的诊断错误归因于摄取网站胃或胆囊，当摄取实际上发生在liver.Conclusion SPECT/CT是更有效的平面成像在确定消化肝外摄取网站，与肝外摄取观察到的三分之一的扫描使用前程序。然而，在我们的研究中，超过一半的摄取部位是血管性的，没有治疗意义。还必须牢记配准错误的风险。
Purpose Identifying gastroduodenal uptake of Tc-99m-macroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls.Methods Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements.Results Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver.Conclusion SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind.