Quantitative Comparison of Yttrium-90 ( 90 Y)-Microspheres and Technetium-99m ( 99m Tc)-Macroaggregated Albumin SPECT Images for Planning 90 Y Therapy of Liver Cancer

Abstract

Yttrium-90 (⁹⁰ Y)-microspheres administered via the hepatic artery has been used for the treatment of unresectable primary or metastatic cancer in the liver. Prior to ⁹⁰ Y therapy, however, the ⁹⁰ Y administered activity and the percent shunting to lungs must be determined, most commonly by gamma camera imaging of technetium-99m (^99m Tc)-macroaggregated albumin (MAA). The purpose of the current study was to identify and evaluate an objective measure of the correlation of ⁹⁰ Y and MAA activity distributions and thus assess the reliability of MAA imaging for evaluation of ⁹⁰ Y administered activity and tumor and liver radiation doses. The MAA study consisted of two acquisitions. After administration of 185 MBq of MAA, a partial-body or so-called breakthrough scan was performed in order to determine the percent shunting to lungs. Immediately after a breakthrough scan, a combined single-photon emission computed tomography (SPECT)/transmission computed tomography (CT) scanner was used to image MAA distribution in order to derived the prescribed ⁹⁰ Y administered activity based on tumor and liver dosimetry. ⁹⁰ Y SPECT/CT was performed 2–4 weeks later and activities used were in the range of 777–2,442 MBq. In order to compare ⁹⁰ Y and MAA SPECT images, first the respective CT image sets were registered using a transform based on normalized mutual information. The transform thus derived was used to align the ⁹⁰ Y and MAA SPECT image sets, and the Spearman's (rho) rank correlation as well as image distance (L2-norm) between the registered SPECT images were then calculated. The Spearman's rank correlation values ranged from 0.451 to 0.818 and the L2 distances from 0.626 to 2.889. Based on visual inspection, the registration of the ⁹⁰ Y and MAA SPECT images appeared reasonably accurate. The regression coefficient (r) between visual scoring and the Spearman's rank correlation was 0.65 and between visual scoring and L2 distance 0.61. The Spearman's rank correlation thus appears to be more reliable than the image distance for assessing the correlation of the ⁹⁰ Y and MAA images.

Keywords

Radiomicrosphere treatment Microspheres Image correlation.

References

Ariel

I. M.

Pack

G. T.

Treatment of inoperable cancer of the liver by intra-arterial radioactive isotopes and chemotherapy. Cancer 20, 793–804 (1967).

Harbert

J. C.

Robertson

J. S.

Held

K. D.

Nuclear Medicine Therapy. New York, NY: Thieme Medical Publishers. 239–256 (1987).

Gray

Van Hazel

Hope

Burton

Moroz

Anderson

Randomized trial of SIR-spheres plus chemotherapy vs chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12, 1711–1720 (2001).

Salem

Thurston

K. G.

Radioembolization with yttrium-90 microspheres: A state-of-the-art brachytherapy treatment for primary and secondary liver malignancies: part 3—comprehensive literature review and future direction. J Vasc Interv Radiol 17, 1571–593 (2006).

Gulec

S. A.

Fong

Yttrium 90 microsphere selective internal radiation treatment of hepatic colorectal metastases. Arch Surg 142, 675–682 (2007).

Gulec

S. A.

Siegel

J. A.

Posttherapy Radiation Safety Considerations in Radiomicrosphere Treatment with ⁹⁰ Y-Microspheres. J Nucl Med 48, 2080–2086 (2007).

Wong

C. O.

Salem

Qing

Wong

K. T.

Barker

Gates

Metabolic Response After Intraarterial ⁹⁰ Y-Glass Microsphere Treatment for Colorectal Liver Metastases, Comparison of Quantitative and Visual Analyses by ¹⁸F-FDG PET. J Nucl Med 45, 1892–1897 (2004).

Sirtex Medical. SIR-Spheres (yttrium-90 microspheres) (package insert). Available at, http://www.sirtex.com/files/US20Package20Insert1.pdf. Accessed 1 December 2009.

Sirtex Medical. SIR-Spheres training program for physicians and institutions. Available at http://www.sirtex.com/files/TRN-US-0320for20US1.pdf. Accessed 1 December 2009.

10.

Shen

DeNardo

G. L.

Yuan

DeNardo

D. A.

DeNardo

S. J.

Planar gamma camera imaging quantitation of Yttrium-90 bremsstrahlung. J Nucl Med 35, 1381–1389 (1994).

11.

Mansberg

Sorensen

Mansberg

Van der Wall

Yttrium 90 Y bremsstrahlung SPECT/CT scan demonstrating areas of tracer/tumor uptake. Eur J Nucl Med Mol Imaging 34, 1887 (2007).

12.

Viola

Wells

Alignment by Maximization of Mutual Information. Inter J Comp Vision 24, 137–154 (1997).

13.

PMOD Technologies Ltd, http://www.pmod.com/technologies/index.html . Accessed 15 April 2009.

14.

Myers

J. L.

Well

A. D.

Research Design and Statistical Analysis (second edition ed.). Lawrence Erlbaum. pp. 508 (2003).

15.

Machac

Weintraub

Nowakowski

F. S.

Mobley

Zhang

Warner

R. P.

Variations in liver perfusion patterns with liver tumors undergoing therapy with yttrium-90 microspheres studied with SPECT/CT (abstract). J Nucl Med 48 (Suppl), 396–397 P (2007).

16.

Machac

Weintraub

Nowakowski

F. S.

Mobley

Zhang

Warner

R. P.

Does the perfusion imaging of the liver with Tc-99m MAA reliably predict the pattern of therapeutic deposition of Yttrium-90 SirSpheres? (abstract). J Nucl Med 48 (Suppl), 399–400 P (2007).