在肝转移患者中，与锝-聚合白蛋白相比，钬标记微球放射栓塞术前Ho-scout具有更高的预测价值。
The superior predictive value of Ho-scout compared with Tc-macroaggregated albumin prior to Ho-microspheres radioembolization in patients with liver metastases.
作者信息
Smits Maarten L J, Dassen Mathijs G, Prince Jip F, Braat Arthur J A T, Beijst Casper, Bruijnen Rutger C G, de Jong Hugo W A M, Lam Marnix G E H
机构信息
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
出版信息
Eur J Nucl Med Mol Imaging. 2020 Apr;47(4):798-806. doi: 10.1007/s00259-019-04460-y. Epub 2019 Aug 9.
PURPOSE
As an alternative to technetium-99m-macroaggregated albumin (Tc-MAA), a scout dose of holmium-166 (Ho) microspheres can be used prior to Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between Ho-scout and Ho-therapeutic dose in comparison with the agreement between Tc-MAA and Ho-therapeutic dose.
METHODS
Two separate scout dose procedures were performed (Tc-MAA and Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the Tc-MAA, Ho-scout, and Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on Tc-MAA and Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT.
RESULTS
A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, Ho-scout was superior with a median score of 4 vs. 2.5 for Tc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for Ho-scout in comparison with Tc-MAA when evaluating lesion absorbed dose (- 90.3 and 105.3 Gy vs. - 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and Ho-therapeutic dose (- 2.9 and 5.5 Gy vs - 3.6 and 4.1 Gy for Tc-MAA and Ho-scout, respectively).
CONCLUSIONS
In this study, Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with Tc-MAA.
目的
作为锝-99m-大聚合白蛋白（Tc-MAA）的替代方法，钬-166（Ho）微球的预扫描剂量可在Ho放射栓塞术前使用。在预处理和治疗过程中使用相同的颗粒可能会提高分布预处理分析的预测价值。本研究的目的是分析Ho预扫描与Ho治疗剂量之间的一致性，并与Tc-MAA和Ho治疗剂量之间的一致性进行比较。
方法
对53例患者在治疗前进行了两种独立的预扫描剂量程序（Tc-MAA和Ho预扫描）。首先，由两名不知情的核医学医生进行定性评估，他们在5分制量表上直观地评估Tc-MAA、Ho预扫描和Ho治疗剂量SPECT扫描（即均在同一患者身上进行）之间的一致性。其次，通过在FDG-PET/CT上勾勒病变和正常肝脏来进行定量一致性测量。这些感兴趣体积（VOIs）与SPECT/CT图像进行配准。将基于Tc-MAA和Ho预扫描的预测吸收剂量与治疗后SPECT上的实际吸收剂量进行比较。
结果
共纳入23例程序（71个病变，22例患者）进行分析。在定性分析中，Ho预扫描更优，中位数分数为4，而Tc-MAA为2.5（p＜0.001）。定量分析显示，在评估病变吸收剂量时，与Tc-MAA相比，Ho预扫描的95%一致性界限明显更窄（分别为-90.3和105.3 Gy与-164.1和197.0 Gy）。对正常肝脏吸收剂量的评估未显示两种预扫描剂量与Ho治疗剂量之间在一致性上存在差异（Tc-MAA和Ho预扫描分别为-2.9和5.5 Gy与-3.6和4.1 Gy）。
结论
在本研究中，与Tc-MAA相比，Ho预扫描对肝内分布具有更高的预测价值。
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