Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9.
Cancer Center Amsterdam.
Nucl Med Commun. 2020 Aug;41(8):740-749. doi: 10.1097/MNM.0000000000001224.
Studies assessing the impact of selective internal radiation therapy (SIRT) on the regional liver function in patients with hepatocellular carcinoma (HCC) are sparse. This study assessed the changes in total and regional liver function using hepatobiliary scintigraphy (HBS) and investigated the utility of HBS to predict post-SIRT liver dysfunction.
Patients treated with SIRT for HCC between 2011 and 2019, underwent Tc-mebrofenin HBS with single-photon emission computed tomography/computed tomography (SPECT/CT) before and 6 weeks after SIRT. The corrected mebrofenin uptake rate (cMUR) and corresponding volume was measured in the total liver, and in treated and nontreated liver regions. Patients with and without post-SIRT liver dysfunction were compared.
A total of 29 patients, all Child-Pugh-A and mostly intermediate (72%) stage HCC were included in this study. Due to SIRT, the cMURtotal declined from 5.8 to 4.5%/min/m (P < 0.001). Twenty-two patients underwent a lobar SIRT, which induced a decline in cMUR (2.9-1.7%/min/m, P < 0.001) and volume (1228-1101, P = 0.002) of the treated liver region, without a change in cMUR (2.4-2.0%/min/m, P = 0.808) or volume (632-644 mL, P = 0.661) of the contralateral nontreated lobe. There were no significant pre-SIRT differences in total or regional cMUR or volume between patients with and without post-SIRT liver dysfunction.
In patients treated with SIRT for HCC, HBS accurately identified changes in total and regional liver function and may have a complementary role to personalize lobar or selective SIRT. In this pilot study, there were no pre-SIRT differences in cMUR or volume to aid in predicting post-SIRT liver dysfunction.
评估选择性内放射治疗（SIRT）对肝细胞癌（HCC）患者局部肝功能影响的研究较少。本研究通过肝胆闪烁扫描（HBS）评估总肝功能和局部肝功能的变化，并探讨 HBS 预测 SIRT 后肝功能障碍的作用。
2011 年至 2019 年间，29 例接受 SIRT 治疗的 HCC 患者在 SIRT 前后行 Tc-美罗芬宁 HBS 检查，并进行单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）检查。测量全肝及治疗和未治疗肝区的校正美罗芬宁摄取率（cMUR）和相应体积。比较 SIRT 后肝功能障碍患者与无肝功能障碍患者的差异。
共纳入 29 例患者，均为 Child-Pugh-A 级，且多为中期（72%）HCC。由于 SIRT，总 cMUR 从 5.8%/min/m 降至 4.5%/min/m（P<0.001）。22 例患者接受了叶间 SIRT，导致治疗肝区的 cMUR（2.9-1.7%/min/m，P<0.001）和体积（1228-1101，P=0.002）下降，而对侧未治疗叶的 cMUR（2.4-2.0%/min/m，P=0.808）或体积（632-644 mL，P=0.661）无变化。SIRT 前后，肝功能障碍患者与无肝功能障碍患者的总肝和肝区 cMUR 或体积均无显著差异。
在接受 HCC SIRT 治疗的患者中，HBS 准确识别总肝功能和局部肝功能的变化，可能具有补充作用，以实现肝叶或选择性 SIRT 的个体化治疗。在本初步研究中，cMUR 或体积在 SIRT 前无差异，无法帮助预测 SIRT 后肝功能障碍。
