Intraarterial hepatic SPECT/CT imaging using 99mTc-macroaggregated albumin in preparation for radioembolization

Vanessa L. Gates, Nimarta Singh, Robert J. Lewandowski, Stewart Spies, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Current standard practice for radioembolization treatment planning makes use of nuclear medicine imaging (NMI) of 99mTc-macroaggregated albumin (99mTc-MAA) arterial distributions for the assessment of lung shunting and extrahepatic uptake. Our aim was to retrospectively compare NMI with mapping angiography in the detection and localization of extrahepatic 99mTc-MAA and to evaluate the typical and atypical findings of NMI in association with catheter placement. Methods: One hundred seventy-four patients underwent diagnostic angiography in preparation for radioembolization. 99mTc-MAA was administered to the liver via a microcatheter positioned in the desired hepatic artery. Planar scintigraphy imaging followed by SPECT/CT imaging was obtained within 2 h. All images were reviewed for hepatic and extrahepatic 99mTc-MAA deposition and compared with the mapping angiogram. Results: Intrahepatic lobe shunting was present on NMI in only 2.9% of the cases but was present in 62.5% of the patients with portal vein thrombosis. Extrahepatic distributions included lungs (100%), the gallbladder (49%) if present, and locations involving hepaticoenteric arterial anatomy recognized on angiograms (16%). Free pertechnetate was identified on 38% of the nuclear medicine images. Three percent of nuclear medicine images showed alternative findings such as a thyroid nodule or metallic artifact. Conclusion: Patients being considered for radioembolization should undergo both angiography and scintigraphy for the assessment of hepaticoenteric arterial anatomy, hepatopulmonary shunting, and appropriate dosimetry considerations. Knowledge of the expected distribution of 99mTc-MAA with normal variants and potential nontarget delivery to adjacent structures is critical in improving clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1157-1162
Number of pages6
JournalJournal of Nuclear Medicine
Volume56
Issue number8
DOIs
StatePublished - Aug 1 2015

Keywords

  • <sup>90</sup>Y-microspheres
  • <sup>99m</sup>Tc-macroaggregated albumin
  • Liver neoplasms
  • Radioembolization
  • Radiotherapy
  • SPECT/CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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