Kheruka Subhash Chand, ALSukaiti Rashid, Jain Anjali, Al Riyami Khulood, Al-Balushi Anas, Al-Maymani Naema, Al-Makhmari Noura, Al-Saidi Huda, Al-Rashdi Sana, Jayakrishnan Vipin
Department of Radiology & Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care, and Research Center, Muscat, Oman.
Nucl Med Rev Cent East Eur. 2024;27(0). doi: 10.5603/nmr.102284.
In radioembolization therapy for hepatic malignancies, the accurate estimation of lung shunt fraction (LSF) is crucial to minimize the risk of radiation-induced pneumonitis and fibrosis due to hepatopulmonary shunting of yttrium-90 (90Y)-microspheres. This study aimed to compare the accuracy and precision of LSF estimation using technetium-99m macroaggregated albumin single photon emission computed tomography ([99mTc]Tc-MAA SPECT) LSF, [99mTc]Tc-MAA planar LSF, and 90Y PET LSF in patients undergoing 90Y-radioembolization.
A retrospective study was conducted involving 15 patients diagnosed with hepatocellular carcinoma (HCC) or liver metastases and planned to undergo transarterial radioembolization with 90Y SirSpheres after multidisplinary team discussion. LSF values were calculated using [99mTc]Tc-MAA SPECT LSF, [99mTc]Tc-MAA planar LSF, and 90Y PET LSF. The accuracy of these methods was assessed through paired t-tests and correlation analysis.
The paired t-test revealed a statistically significant difference between SPECT LSF and planar LSF (t-statistic = -4.81, p-value = 0.0003), indicating that planar imaging tends to overestimate LSF values. However, no significant difference was observed between [99mTc]Tc-MAA SPECT LSF and 90Y PET LSF (t-statistic = -0.98, p-value = 0.343), suggesting a high degree of agreement between these two methods. Correlation analysis showed a very strong positive correlation between [99mTc]Tc-MAA SPECT LSF and 90Y PET LSF (r = 0.999), while strong correlations were also found between SPECT LSF and planar LSF, and between planar LSF and 90Y PET LSF (r = 0.841).
The findings suggest that 90Y PET LSF aligns closely with [99mTc]Tc-MAA SPECT LSF, making them both reliable for LSF estimation in radioembolization therapy. In contrast, planar imaging tends to overestimate LSF, potentially leading to inaccurate dosimetric planning. Incorporating [99mTc]Tc-MAA SPECT/CT and 90Y PET/CT into routine clinical practice could enhance the accuracy of LSF estimation, thereby improving patient outcomes. Further research with larger cohorts is recommended to validate these findings.
在肝恶性肿瘤的放射性栓塞治疗中，准确估计肺分流分数（LSF）对于将因钇-90（90Y）微球肝肺分流导致的放射性肺炎和纤维化风险降至最低至关重要。本研究旨在比较使用锝-99m大聚合白蛋白单光子发射计算机断层扫描（[99mTc]Tc-MAA SPECT）LSF、[99mTc]Tc-MAA平面LSF和90Y PET LSF对接受90Y放射性栓塞治疗患者的LSF估计的准确性和精确性。
进行了一项回顾性研究，纳入15例诊断为肝细胞癌（HCC）或肝转移瘤且计划在多学科团队讨论后接受90Y SirSpheres经动脉放射性栓塞治疗的患者。使用[99mTc]Tc-MAA SPECT LSF、[99mTc]Tc-MAA平面LSF和90Y PET LSF计算LSF值。通过配对t检验和相关性分析评估这些方法的准确性。
配对t检验显示SPECT LSF和平面LSF之间存在统计学显著差异（t统计量=-4.81，p值=0.0003），表明平面成像倾向于高估LSF值。然而，[99mTc]Tc-MAA SPECT LSF和90Y PET LSF之间未观察到显著差异（t统计量=-0.98，p值=0.343），这表明这两种方法之间具有高度一致性。相关性分析显示[99mTc]Tc-MAA SPECT LSF和90Y PET LSF之间存在非常强的正相关（r=0.999），同时在SPECT LSF与平面LSF之间以及平面LSF与90Y PET LSF之间也发现了强相关性（r=0.841）。
研究结果表明90Y PET LSF与[99mTc]Tc-MAA SPECT LSF密切相关，这使得它们在放射性栓塞治疗中对LSF估计均可靠。相比之下，平面成像倾向于高估LSF，可能导致剂量学规划不准确。将[99mTc]Tc-MAA SPECT/CT和90Y PET/CT纳入常规临床实践可提高LSF估计的准确性，从而改善患者预后。建议进行更大样本量的进一步研究以验证这些发现。
