Imaging HCC treated with radioembolization: review of the literature and clinical examples of choline PET utility
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Imaging HCC treated with radioembolization: review of the literature and clinical examples of choline PET utility Angelo Castello1 · Egesta Lopci1 Received: 15 June 2020 / Accepted: 17 August 2020 © Italian Association of Nuclear Medicine and Molecular Imaging 2020
Abstract Purpose In this review we summarize the current evidence on the role of PET/CT with different probes for radioembolization therapy monitoring in HCC patients. Typical clinical examples are also provided to underline the utility of choline PET in this context. Methods PubMed database was searched from 2000 until March 2020. Results Overall, 11C-acetate and radiolabeled choline PET have a higher sensitivity in the diagnosis of primary or recurrent HCC as compared to 18F-FDG. On the other hand, 18F-FDG PET/CT can provide useful prognostic information, especially for palliative treatments. Radiolabeled choline better predicts response to loco-regional treatment and provides a better differentiation of disease recurrence from treatment-related changes, as compared to other morphological imaging. Conclusion HCC staging is better performed with PET/CT, thus allowing for a more adequate selection of patients candidate to transarterial radioembolization. Keywords TARE · Radioembolization · 18F-FDG · 11C-acetate · 11C-choline · 18F-fluorocholine · 18F-fluoroethylcholine · PET/CT
Introduction Internal radioembolization using yttrium-90 (90Y) microspheres, also called transarterial radioembolization (TARE), has become over the past decade an attractive therapeutic option for advanced or unresectable hepatocellular carcinoma (HCC). The procedure consists of the selective intra-arterial administration of microspheres loaded with the radioactive compound via a percutaneous access, thus assuring the delivery of an intense dose to tumor lesions (from 50 to > 1000 Gy), while limiting the radiation exposure of normal liver [1]. So far, two different types of yttrium-90 microspheres have been produced, the glassmade TheraSphere® and the resin-made Sir-Spheres®. These two types of TARE differ principally on the size and number
* Egesta Lopci [email protected]; [email protected] 1
Department of Nuclear Medicine, Humanitas Clinical and Research Hospital - IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy
of injected microspheres, leading to major differences in the embolic effect and radioactive concentration. Commonly, resin microspheres are smaller in size (22 ± 10 μm versus 32 ± 10 μm), higher in number (60 million/3 GBq versus 1.2 million/3 GBq), have a smaller density (1.6 g/ dl versus 3.6 g/dl), and have a significantly smaller average activity per microsphere (50 Bq versus 2500 Bq) compared to T heraSphere®, but maintain a higher embolic power (Table 1). Consequently, Sir-Spheres® could be more suitable for the treatment of larger lesions, while glass-microspheres should be preferred in case of prevention of vascular stasis and reflux [2, 3]. This sort of therapeutic approach has resulted particularly adequate for
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