Research ArticleClinical Investigations

Predictive Value of Intratumoral 99mTc-Macroaggregated Albumin Uptake in Patients with Colorectal Liver Metastases Scheduled for Radioembolization with 90Y-Microspheres

Gerhard Ulrich, Oliver Dudeck, Christian Furth, Juri Ruf, Oliver S. Grosser, Daniela Adolf, Marvin Stiebler, Jens Ricke and Holger Amthauer
Journal of Nuclear Medicine April 2013, 54 (4) 516-522; DOI: https://doi.org/10.2967/jnumed.112.112508

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Sixty-six-year-old patient with hepatic metastases of colorectal carcinoma. Pretherapeutic contrast-enhanced MR imaging of liver (A) revealed in this axial slice intrahepatic lesion in segment 5 (arrow) and larger one in segment 4 (*). Perfusion scintigraphy using nonselective application of 99mTc-MAA by proper hepatic artery (B) revealed heterogeneous intrahepatic distribution of administered nuclide without intratumoral accumulation in both hepatic metastases (B). After selective 90Y radioembolization in right hepatic artery in sequential treatment plan, Bremsstrahlung scintigraphy was performed and fused with MR imaging. Pattern of 90Y-labeled microspheres showed relatively homogeneous distribution in right liver lobe with accumulation in metastasis in segment 5 (arrow) and no accumulation in metastasis in segment 4 (*) (C). On follow-up MR image (D), 6 wk after 90Y radioembolization there was clear decrease in size of treated metastasis in segment 5 (arrow) and stable situation of metastasis in segment 4 (*).

Tables

  • TABLE 1

    99mTc-MAA Uptake and Catheter Position in Relation to Lesion-Based Therapy Response

    Tumor diameter after 6 wk (lesion total, n = 377)Tumor diameter after 3 mo (lesion total, n = 290)
    ParameterRL (n = 211)NRL (n = 166)RL (n = 144)NRL (n = 146)
    99mTc-MAA uptake
     Low
      Group 153 (14.1)33 (8.8)29 (10.0)45 (15.5)
      Group 248 (12.7)34 (9.0)32 (11.0)38 (13.1)
     High MAA
      Group 351 (13.5)66 (17.5)35 (12.1)49 (16.9)
      Group 459 (15.6)33 (8.8)48 (16.6)14 (4.8)
    Catheter position
     Identical134 (35.5)115 (30.5)87 (30.0)100 (34.5)
     Different77 (20.4)51 (13.5)57 (19.7)46 (15.9)

    • Data in parentheses are percentages.

  • TABLE 2

    99mTc-MAA Uptake and Catheter Position in Relation to Lesion-Based Therapy Response According to RECIST 1.1 After 6 Weeks and 3 Months

    RECIST 1.1 after 6 wk (lesion total, n = 377)RECIST 1.1 after 3 mo (lesion total, n = 290)
    ParameterPR (n = 28)SD (n = 278)PD (n = 71)PR (n = 32)SD (n = 164)PD (n = 94)
    99mTc-MAA uptake
     Low
      Group 16 (1.6)65 (17.2)14 (3.7)2 (0.7)44 (15.2)28 (9.7)
      Group 24 (1.1)65 (17.2)14 (3.7)8 (2.8)36 (12.4)26 (9.0)
     High
      Group 310 (2.7)72 (19.1)35 (9.3)9 (3.1)44 (15.2)31 (10.7)
      Group 48 (2.1)76 (20.2)8 (2.1)13 (4.5)40 (13.8)9 (3.1)
    Catheter position
     Identical22 (5.8)176 (46.7)51 (13.5)22 (7.6)104 (35.9)61 (21.0)
     Different6 (1.6)102 (27.1)20 (5.3)10 (3.4)60 (20.7)33 (11.4)

    • Data in parentheses are percentages.

  • TABLE 3

    Patient Demographics and Tumor Response Are Assessed by MR Imaging in Previously Treated Liver Lobe 6 Weeks After 90Y Radioembolization

    RECIST 1.1
    DemographicPR (n = 3)Stable disease (n = 49)PD (n = 6)
    Age (y)65.7 ± 1.260.4 ± 11.059.5 ± 11.2
    Sex
     Female (n)2 (3.4)19 (32.8)2 (3.4)
     Male (n)1 (1.7)30 (51.7)4 (6.9)
    Dose of 99mTc-MAA given (MBq)153.3 ± 7.6152.4 ± 34.1158.0 ± 32.3
    Liver-to-lung shunt (%)6.2 ± 4.56.6 ± 3.47.7 ± 3.7
    Dose of 90Y given (MBq)1,266.7 ± 208.21,144.6 ± 203.71,000.0 ± 298.3
    Low 99mTc-MAA
     Group 105 (8.6)0
     Group 21 (1.7)17 (29.3)2 (3.4)
    High 99mTc-MAA
     Group 31 (1.7)20 (34.5)3 (5.2)
     Group 41 (1.7)7 (12.1)1 (1.7)
    Catheter position
     Identical3 (5.2)30 (51.7)3 (5.2)
     Different019 (32.8)3 (5.2)

    • Data are mean ± SD or n, with percentages in parentheses. Total number of patients was 58.

  • TABLE 4

    Patient Demographics and Tumor Response Are Assessed by MR Imaging in Previously Treated Liver Lobe 3 Months After 90Y Radioembolization

    RECIST 1.1
    DemographicPR (n = 5)Stable disease (n = 26)PD (n = 17)
    Age (y)59.6 ± 7.961.0 ± 12.558.8 ± 9.7
    Sex
     Female (n)2 (4.2)10 (20.8)8 (16.7)
     Male (n)3 (6.3)16 (33.3)9 (18.8)
    Dose of 99mTc-MAA given (MBq)131.4 ± 31.1152.6 ± 29.2153.9 ± 30.9
    Liver-to-lung shunt (%)7.0 ± 2.45.9 ± 2.76.1 ± 2.4
    Dose of 90Y given (MBq)1,242.0 ± 181.21,179.2 ± 175.31,132.9 ± 278.3
    Low MAA
     Group 104 (8.3)1 (2.1)
     Group 209 (18.8)9 (18.8)
    High MAA
     Group 33 (6.3)9 (18.8)4 (8.3)
     Group 42 (4.2)4 (8.3)3 (6.3)
    Catheter position
     Identical3 (6.3)14 (29.2)10 (20.8)
     Different2 (4.2)12 (25.0)7 (14.6)

    • Data are mean ± SD or n, with percentages in parentheses. Total number of patients was 48.

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