Research ArticleClinical Investigations

Safety of a Scout Dose Preceding Hepatic Radioembolization with 166Ho Microspheres

Jip F. Prince, Rob van Rooij, Gijsbert H. Bol, Hugo W.A.M. de Jong, Maurice A.A.J. van den Bosch and Marnix G.E.H. Lam
Journal of Nuclear Medicine June 2015, 56 (6) 817-823; DOI: https://doi.org/10.2967/jnumed.115.155564

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Volume estimation in phantom study of 6 spheres of different volumes (0.5–26.5 mL). Estimate of volume on SPECT is number of all voxels from threshold up to voxel with maximum value, multiplied by voxel volume; it decreases as threshold increases. True, known, volume of each sphere is indicated by black dot. Higher threshold leads to underestimation whereas lower threshold leads to overestimation. For all spheres, a threshold of 40% leads to underestimation of volume.

  • FIGURE 2.
    FIGURE 2.

    Absorbed dose estimation in phantom study using 6 spheres of different volumes (0.5–26.5 mL). Absorbed dose is displayed as ratio of true absorbed dose in sphere. Threshold needed to estimate true absorbed dose (dotted line) differs per sphere. Absorbed dose is overestimated in all spheres using threshold of 40% (▲).

  • FIGURE 3.
    FIGURE 3.

    Flowchart of study design.

  • FIGURE 4.
    FIGURE 4.

    (A) Box plot and density plot of extrahepatic activity relative to total activity (liver and extrahepatic deposition). Distribution is right-skewed. Each vertical indicates observation. (B) Box plot and density plot of absorbed dose to extrahepatic tissue from 250-MBq 166Ho scout dose, plotted on log-scale (in Gy). Boundary from which complications occurred in study by Kao et al. of 49 Gy is displayed (17).

  • FIGURE 5.
    FIGURE 5.

    Extrahepatic deposition of 8.7% of administered activity near duodenum after injection in proper hepatic artery (A and B), which was corrected after selective lobar injection in right (C) and left (D) hepatic artery (E). Had 250-MBq 166Ho scout dose been injected, theoretic extrahepatic absorbed dose would have been 112 Gy.

  • FIGURE 6.
    FIGURE 6.

    Extrahepatic deposition in a patient, who previously received right hemihepatectomy, after injection in right (A) and left (B) hepatic artery. Deposition (C, white arrow) represents 19.5% of total activity (little activity is seen in liver). During repeated angiography, culprit vessel originated from gastroduodenal artery (D, white arrow). After coil embolization and single injection in proper hepatic artery, no deposition was seen (E, white arrow). Had 250-MBq 166Ho scout dose been injected, theoretic absorbed dose would have been 374 Gy.

Tables

  • TABLE 1

    Baseline Characteristics

    Characteristicn (%) or median (range)
    Patients/# cases32/34
    Sex
     Male25 (78%)
     Female7 (22%)
    Age (y)67 (36–80)
    Primary tumor
     Colorectal carcinoma19 (59%)
     Cholangiocellular carcinoma3 (9%)
     Hepatocellular carcinoma3 (9%)
     Ocular melanoma2 (6%)
     Adenocarcinoma of unknown primary1 (3%)
     Breast carcinoma1 (3%)
     Gastric carcinoma1 (3%)
     Neuroendocrine tumor1 (3%)
     Ampullary carcinoma1 (3%)
    Coil embolization
     Gastroduodenal and right gastric17 (53%)
     Gastroduodenal6 (19%)
     Gastroduodenal and cystic1 (3%)
     Gastroduodenal and pancreatic1 (3%)
     Gastroduodenal and duodenal1 (3%)
     None6 (19%)
    No. of injection positions
     117 (53%)
      Common4
      Proper11
      Right1
      Replaced left1
     214 (44%)
      Common + replaced right1
      Common + replaced left1
      Right + left9
      Right + replaced left1
      Replaced right + left1
      Replaced right + left (from superior mesenteric artery)1
     31 (3%)
      Replaced right and selective (2×) left1

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