Comparison of Tc-99m MAA Planar Versus SPECT/CT Imaging for Lung Shunt Fraction Evaluation Prior to Y-90 Radioembolizati
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CLINICAL INVESTIGATION
INTERVENTIONAL ONCOLOGY
Comparison of Tc-99m MAA Planar Versus SPECT/CT Imaging for Lung Shunt Fraction Evaluation Prior to Y-90 Radioembolization: Are We Overestimating Lung Shunt Fraction? Mohammad Elsayed1 • Bernard Cheng2 • Minzhi Xing1 • Ila Sethi3 • David Brandon3 • David M. Schuster3 • Zachary Bercu1 • James Galt3 Bruce Barron3 • Nima Kokabi1
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Received: 9 April 2020 / Accepted: 27 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To compare lung shunt fraction (LSF) prior to Y-90 radioembolization calculated using planar imaging versus SPECT/CT in patients with hepatocellular carcinoma (HCC). Methods A single institution retrospective analysis of technetium-99m macroaggregated albumin (Tc-99m MAA) LSF studies for 293 consecutive patients with HCC between 2013 and 2018 was performed. LSF using planar imaging (PLSF) was compared to retrospectively calculated LSF using SPECT/CT (SLSF) via semiautomated segmentation using MIM v.6.9. Sub-analyses of patients were performed based on PLSF range, tumor size, BCLC stage, and Child–Pugh (C–P) score. Mean LSF absolute discrepancy between sub-groups was analyzed. Comparisons were performed using paired t tests and linear regression analysis. Results Mean PLSF, 8.27%, was greater than mean SLSF, 3.27% (p \ 0.001). When categorizing patients by PLSF ranges of \ 10%, 10–19.9%, and C 20%, PLSF remained greater than SLSF in all subgroups (p’s \ 0.001). Patients with PLSF C 20% had a greater absolute discrepancy with SLSF (13.31%) compared to patients with PLSF \ 20% & Mohammad Elsayed [email protected] 1
Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Suite BG03, Atlanta, GA 30322, USA
2
Morehouse School of Medicine, Atlanta, GA, USA
3
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
(4.74%; p \ 0.0001). LSF absolute discrepancy was greater for patients with a maximum liver tumor size C 5.0 cm (5.59%) compared to a liver tumor size\ 5.0 cm (4.40%; p = 0.0076). For all BCLC grades and C–P scores, PLSF was greater than SLSF. A greater LSF discrepancy existed for patients with a worse C–P score (C–P A: 4.78%, C–P B/C: 6.12%; p = 0.0081), but not BCLC stage (0/A/B: 4.87%, C: 4.56%; p = 0.5993). Conclusion In patients with HCC, SLSF is significantly lower compared to PLSF, with a greater discrepancy among patients with a PLSF C 20%, tumor size C 5 cm, and worse C–P score. Level of Evidence Level 3, Retrospective Study.
Introduction Yttrium-90 (Y-90) radioembolization (RE) is a procedure performed in patients with hepatic malignancies in which radiolabeled Y-90 microspheres are injected into a hepatic artery feeding tumor [1]. In carefully selected patients with unresectable hepatocellular carcinoma (HCC), Y-
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