PT  - JOURNAL ARTICLE
AU  - Hojjat Ahmadzadehfar
AU  - Amir Sabet
AU  - Kim Biermann
AU  - Marianne Muckle
AU  - Holger Brockmann
AU  - Christiane Kuhl
AU  - Kai Wilhelm
AU  - Hans-Jürgen Biersack
AU  - Samer Ezziddin
TI  - The Significance of <sup>99m</sup>Tc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for <sup>90</sup>Y-Microsphere Selective Internal Radiation Treatment
AID  - 10.2967/jnumed.109.074559
DP  - 2010 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 1206--1212
VI  - 51
IP  - 8
4099  - http://jnm.snmjournals.org/content/51/8/1206.short
4100  - http://jnm.snmjournals.org/content/51/8/1206.full
SO  - J Nucl Med2010 Aug 01; 51
AB  - Selective internal radiation therapy (SIRT), a catheter-based liver-directed modality for treating primary and metastatic liver cancer, requires appropriate planning to maximize its therapeutic response and minimize its side effects. 99mTc-macroaggregated albumin (MAA) scanning should precede the therapy to detect any extrahepatic shunting to the lung or gastrointestinal tract. Our aim was to compare the ability of SPECT/CT with that of planar imaging and SPECT in the detection and localization of extrahepatic 99mTc-MAA accumulation and to evaluate the impact of SPECT/CT on SIRT treatment planning and its added value to angiography in this setting. Methods: Ninety diagnostic hepatic angiograms with 99mTc-MAA were obtained for 76 patients with different types of cancer. All images were reviewed retrospectively for extrahepatic MAA deposition in the following order: planar, non–attenuation-corrected SPECT, and SPECT/CT. Review of angiograms and follow-up of patients with abdominal shunting served as reference standards. Results: Extrahepatic accumulation was detected by planar imaging, SPECT, and SPECT/CT in 12%, 17%, and 42% of examinations, respectively. The sensitivity for detecting extrahepatic shunting with planar imaging, SPECT, and SPECT/CT was 32%, 41%, and 100%, respectively; specificity was 98%, 98%, and 93%, respectively. The respective positive predictive values were 92%, 93%, and 89%, and the respective negative predictive values were 71%, 73%, and 100%. The therapy plan was changed according to the results of planar imaging, SPECT, and SPECT/CT in 7.8%, 8.9%, and 29% of patients, respectively. Conclusion: In pre-SIRT planning, 99mTc-MAA SPECT/CT is valuable for identifying extrahepatic visceral sites at risk for postradioembolization complications.