Prognostic Utility of 90Y Radioembolization Dosimetry Based on Fusion 99mTc-Macroaggregated Albumin-99mTc-Sulfur Colloid SPECT
Prognostic Utility of 90Y Radioembolization Dosimetry Based on Fusion 99mTc-Macroaggregated Albumin-99mTc-Sulfur Colloid SPECT
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DOI：
10.2967/jnumed.113.123257
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发表时间：
2013-12-01
影响因子：
9.3
通讯作者：
Sze, Daniel Y.
中科院分区：
文献类型：
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作者：
Lam, Marnix G. E. H.;Goris, Michael L.;Sze, Daniel Y.
计划肝脏Y-90放射栓塞术需要在毒性和有效性之间取得平衡。我们开发了一种双示踪剂SPECT融合成像方案，将放射性分布数据与生理性肝脏标测相结合。方法：对25例结直肠癌和胆管转移癌患者按常规处方的树脂微球行全肝放射栓塞术，平均活度1.69GBq。作为标准治疗计划的一部分，所有患者在动脉内注射37MBq的99m-大聚集性白蛋白(TC-99m-MAA)后进行SPECT成像，以模拟随后的Y-90分布。随后，患者接受185MBq的标记硫胶(TC-99m-SC)静脉注射，作为正常肝网状内皮功能的生物标志物，并重复SPECT。对SPECT图像进行配准和融合。采用基于区域的方法，通过计算~(99m)Tc-SC摄取区域的~(99)m-MAA活度，预测~(90)Y对功能性肝组织的辐射吸收剂量。同样，肿瘤吸收剂量(D-T)是通过计算不摄取~(99)Tc-SC的体素中的~(99)m-MAA活性来预测的。测量3个月的实验室数据和放射学反应，并记录患者的生存情况。基于SPECT的D-T和D-FL与毒性和疗效参数相关。结果：以血清肝酶升高衡量的毒性与所有时间点基于SPECT的D-FL计算显著相关(P<；0.05)(平均D-FL为27.9GY)。广泛的生化毒性(>；所有肝酶增加50%)发生在24.5 GY及以上的D-FL照射下。此外，在单变量和多变量分析中，基于SPECT的D-T(平均D-T，44.2Gy值)的计算与放射学反应(P<；0.001)、血清癌胚抗原下降(P<；0.05)和总存活率(P<；0.01)相关。D-T预测1年生存率的临界值为55GY(受试者工作特性曲线下面积=0.86；P<；0.01)。接受超过55GyD-T的患者的中位生存期为32.8mo，而接受较少DT的患者的中位生存期为7.2mo(P<；0.05)。结论：双示踪剂~(99m)Tc-MAA-~(99m)Sc融合SPECT是一种基于生理学的显像工具，具有显著的预测能力，可用于改善个性化活动计划。
Planning hepatic Y-90 radioembolization activity requires balancing toxicity with efficacy. We developed a dual-tracer SPECT fusion imaging protocol that merges data on radioactivity distribution with physiologic liver mapping. Methods: Twenty-five patients with colorectal carcinoma and bilobar liver metastases received whole-liver radioembolization with resin microspheres prescribed as per convention (mean administered activity, 1.69 GBq). As part of standard treatment planning, all patients underwent SPECT imaging after intraarterial injection of 37 MBq of Tc-99m-macroaggregated albumin (Tc-99m-MAA) to simulate subsequent Y-90 distribution. Immediately afterward, patients received 185 MBq of labeled sulfur colloid (Tc-99m-SC) intravenously as a biomarker for normal hepatic reticuloendothelial function and SPECT was repeated. The SPECT images were coregistered and fused. A region-based method was used to predict the Y-90 radiation absorbed dose to functional liver tissue (D-FL) by calculation of Tc-99m-MAA activity in regions with Tc-99m-SC uptake. Similarly, the absorbed dose to tumor (D-T) was predicted by calculation of Tc-99m-MAA activity in voxels without Tc-99m-SC uptake. Laboratory data and radiographic response were measured for 3 mo, and the survival of patients was recorded. SPECT-based D-T and D-FL were correlated with parameters of toxicity and efficacy. Results: Toxicity, as measured by increase in serum liver enzymes, correlated significantly with SPECT-based calculation of D-FL at all time points (P < 0.05) (mean D-FL, 27.9 Gy). Broad biochemical toxicity (>50% increase in all liver enzymes) occurred at a D-FL of 24.5 Gy and above. In addition, in uni- and multivariate analysis, SPECT-based calculation of D-T (mean D-T, 44.2 Gy) correlated with radiographic response (P < 0.001), decrease in serum carcinoembryonic antigen (P < 0.05), and overall survival (P < 0.01). The cutoff value of D-T for prediction of 1-y survival was 55 Gy (area under the receiver-operating-characteristic curve = 0.86; P < 0.01). Patients who received a D-T of more than 55 Gy had a median survival of 32.8 mo, compared with 7.2 mo in patients who received less (P < 0.05). Conclusion: Dual-tracer Tc-99m-MAA-Tc-99m-SC fusion SPECT offers a physiology-based imaging tool with significant prognostic power that may lead to improved personalized activity planning.