Comparison of Positron Emission Tomography and Bremsstrahlung Imaging to Detect Particle Distribution in Patients Undergoing Yttrium-90 Radioembolization for Large Hepatocellular Carcinomas or Associated Portal Vein Thrombosis |
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| Authors: | Siddharth A Padia Adam Alessio Sharon W Kwan David H Lewis Sandeep Vaidya Satoshi Minoshima |
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| Institution: | 1. Section of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119;2. Section of Nuclear Medicine, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119;3. Department of Radiology, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119 |
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| Abstract: | PurposeTo compare positron emission tomography/computed tomography (PET/CT) imaging with bremsstrahlung single photon emission computed tomography (SPECT) in patients after yttrium-90 (90Y) microsphere radioembolization to assess particle uptake.Materials and MethodsThis prospective study comprised patients with large (> 5 cm) hepatocellular carcinoma (HCC) or tumor-associated portal vein thrombus (PVT), or both. After radioembolization for HCC, patients underwent bremsstrahlung SPECT/CT and time-of-flight PET/CT imaging of 90Y without additional tracer administration. Follow-up imaging and toxicity was analyzed. Imaging analyses of PET/CT and bremsstrahlung SPECT/CT were independently performed.ResultsThere were 13 patients enrolled in the study, including 7 with PVT. Median tumor diameter was 7 cm. PET/CT demonstrated precise localization of 90Y particles in the liver, with specific patterns of uptake in large tumors. In cases of PVT, PET/CT showed activity within the PVT. When correlated to short-term follow-up imaging, areas of necrosis correlated with regions of uptake seen on PET/CT. Compared with bremsstrahlung imaging, PET/CT demonstrated at least comparable spatial resolution with less scatter. Quantitative uptake in nontreated regions of interest showed significantly reduced scatter with PET/CT versus SPECT/CT (1% vs 14%, P < .001).ConclusionsEvaluation of 90Y particle uptake with PET/CT potentially demonstrates high spatial resolution and low scatter compared with bremsstrahlung SPECT/CT. Confirmation of particles within PVT on PET/CT correlates with response on follow-up imaging and may account for the efficacy of radioembolization in patients with PVT. |
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| Keywords: | HCC"} {"#name":"keyword" "$":{"id":"key0010"} "$$":[{"#name":"text" "_":"hepatocellular carcinoma PET"} {"#name":"keyword" "$":{"id":"key0020"} "$$":[{"#name":"text" "_":"positron emission tomography PVT"} {"#name":"keyword" "$":{"id":"key0030"} "$$":[{"#name":"text" "_":"portal vein thrombus ROI"} {"#name":"keyword" "$":{"id":"key0040"} "$$":[{"#name":"text" "_":"region of interest SPECT"} {"#name":"keyword" "$":{"id":"key0050"} "$$":[{"#name":"text" "_":"single photon emission computed tomography yttrium-90 |
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