Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA, 94305, USA.
Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, CA, USA.
Eur J Nucl Med Mol Imaging. 2021 Jul;48(8):2426-2436. doi: 10.1007/s00259-021-05188-4. Epub 2021 Jan 14.
PURPOSE: Transarterial radioembolization (TARE) with yttrium-90 (Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from Tc macroaggregated albumin (MAA) SPECT/CT with post-treatment Y PET/CT for absorbed dose values, and to evaluate image quality of Y SiPM-based PET/CT. METHODS: Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning Tc-MAA SPECT/CT and post-therapy Y PET/CT were assessed. Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS: The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from Tc-MAA SPECT/CT and Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from Tc-MAA SPECT/CT and Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS: Tc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
目的：钇-90（Y）微球经动脉放射性栓塞（TARE）是一种针对原发性和继发性肝恶性肿瘤的肝脏定向治疗方法。个体化剂量旨在实现最大治疗效果和降低毒性。我们旨在比较 Tc 聚合白蛋白（MAA）单光子发射计算机断层扫描（SPECT）/CT 与 Y 正电子发射断层扫描（PET）/CT 治疗前后的基于体素的剂量值，并评估 Y 基于硅光电倍增管（SiPM）的 PET/CT 的图像质量。 方法：前瞻性纳入 42 例（28 名男性，14 名女性，平均年龄：67 ± 11 岁）晚期肝恶性肿瘤患者。20 例患者接受玻璃微球治疗，22 例患者接受树脂微球治疗。评估计划 Tc-MAA SPECT/CT 和治疗后 Y PET/CT 的辐射吸收剂量。Y PET/CT 图像采集 20 分钟，重建产生 5 分钟、10 分钟、15 分钟和 20 分钟数据集，然后使用 5 分李克特量表进行评估。 结果：玻璃微球的平均给药活度为 3.44 ± 1.5GBq，树脂微球的平均给药活度为 1.62 ± 0.7GBq。Tc-MAA SPECT/CT 和 Y PET/CT 计算的平均肿瘤吸收剂量分别为玻璃微球的 175.69 ± 113.76Gy 和 193.58 ± 111.09Gy（P = 0.61）；树脂微球分别为 60.18 ± 42.20Gy 和 70.98 ± 49.65Gy（P = 0.37）。Tc-MAA SPECT/CT 和 Y PET/CT 计算的平均正常肝脏吸收剂量分别为玻璃微球的 32.70 ± 22.25Gy 和 30.62 ± 20.09Gy（P = 0.77）；树脂微球分别为 18.33 ± 11.08Gy 和 24.32 ± 15.58Gy（P = 0.17）。5 分钟、10 分钟、15 分钟和 20 分钟扫描时间的 Y PET/CT 图像质量评分分别为 3.6 ± 0.54、4.57 ± 0.58、4.84 ± 0.37 和 4.9 ± 0.3。 结论：Tc-MAA SPECT/CT 为治疗计划剂量学提供了很好的准确性。基于 SiPM 的 PET/CT 扫描仪在 10 分钟扫描时间显示出良好的图像质量，仅需一个床位位置采集。5 分钟的 PET/CT 扫描时间可获得可接受的图像质量，足以进行剂量测定和治疗验证。这使得 Y PET/CT 可以纳入繁忙的常规临床工作流程。需要更大的患者队列研究来证实这些发现。
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