PT  - JOURNAL ARTICLE
AU  - Vanessa L Gates
AU  - Nimarta Singh
AU  - Robert Lewandowski
AU  - Stewart M. Spies
AU  - Riad Salem
TI  - INTRA-ARTERIAL HEPATIC SPECT/CT IMAGING USING TECHNETIUM-99M MACRO-AGGREGATED ALBUMIN IN PREPARATION FOR RADIOEMBOLIZATION
AID  - 10.2967/jnumed.114.153346
DP  - 2015 Jun 01
TA  - Journal of Nuclear Medicine
PG  - jnumed.114.153346
4099  - http://jnm.snmjournals.org/content/early/2015/06/17/jnumed.114.153346.short
4100  - http://jnm.snmjournals.org/content/early/2015/06/17/jnumed.114.153346.full
AB  - Current standard practice for radioembolization (RE) treatment planning makes use of nuclear medicine imaging (NMI) of technicium-99m macro-aggregated albumin (MAA) arterial distributions for the assessment of lung shunting and extra-hepatic uptake. Our aim was to retrospectively compare NMI with that of mapping angiography in the detection and localization of extra-hepatic MAA and to evaluate the typical and atypical findings of NMI in association of catheter placement. Methods: 174 patients underwent diagnostic angiography in preparation for radioembolization. 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 hours. All images were reviewed for hepatic and extra-hepatic MAA deposition and compared to the mapping angiogram. Results: Intrahepatic lobe shunting on was present on NMI in only 2.9% of the cases but was present in 62.5% of the patients with PVT. Extra-hepatic 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 NMI. 3% of NMI showed alternative findings such as a thyroid nodule or metallic artifact. Conclusion: Patients who are being considered for RE should undergo both angiographic and scintigraphic for assessment of hepaticoenteric arterial anatomy, hepatopulmonary shunting, and appropriate dosimetry considerations. Knowledge of the expected distribution of MAA with normal variants and potential non-target delivery to adjacent structures is critical in improving clinical outcomes.