1,295 results on '"Technetium Tc 99m Aggregated Albumin"'
Search Results
2. Tc99m-MAA Bronchial Artery Injection During Bronchial Embolization for Pulmonary Mass Induced Hemoptysis for Dosimetry Planning
- Author
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BTG International Inc. and Eric Wehrenberg-Klee, MD, Principal Investigator
- Published
- 2024
3. Yttrium Y-90 Radioembolization in Treating Patients With Metastatic Liver Cancer
- Author
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National Cancer Institute (NCI)
- Published
- 2024
4. FLARE RT for Patients With Stage IIB-IIIB Non-small Cell Lung Cancer: Personalizing Radiation Therapy Using PET/CT and SPECT/CT Imaging
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National Cancer Institute (NCI)
- Published
- 2023
5. SIR-Spheres Study to Calculate the Radiation-Absorbed Dose of 99mTc-MAA (MAApping)
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Bright Research Partners
- Published
- 2023
6. SPECT/CT in Measuring Lung Function in Patients With Cancer Undergoing Radiation Therapy
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National Cancer Institute (NCI) and Jing Zeng, Principal Investigator
- Published
- 2018
7. 4D-CT-based Ventilation Imaging for Adaptive Functional Guidance in Radiotherapy
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Billy W. Loo Jr., Associate Professor of Radiation Oncology
- Published
- 2017
8. The Added Value of Quantification of Lung Function in Patients Undergoing Radiotherapy, Using Tc-99m-MAA SPECT-CT
- Published
- 2017
9. ThoHSpEkt Thoracoscopic Ectomy of Radioactively Marked Pulmonary Nodules With Free-hand SPECT (ThoHSpEkt)
- Author
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Joachim Müller, Head of Department
- Published
- 2017
10. Comparison of absorbed doses to the tumoral and non-tumoral liver in HCC patients undergoing 99m Tc-MAA and 90 Y-microspheres radioembolization.
- Author
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Noipinit N, Sukprakun C, Siricharoen P, and Khamwan K
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- Male, Female, Humans, Middle Aged, Aged, Microspheres, Tomography, Emission-Computed, Single-Photon methods, Technetium Tc 99m Aggregated Albumin, Yttrium Radioisotopes therapeutic use, Retrospective Studies, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular radiotherapy, Carcinoma, Hepatocellular drug therapy, Liver Neoplasms diagnostic imaging, Liver Neoplasms radiotherapy, Liver Neoplasms drug therapy, Embolization, Therapeutic methods
- Abstract
Purpose: This study aimed to determine the absorbed doses in the tumoral-liver and non-tumoral liver of hepatocellular carcinoma (HCC) patients undergoing radioembolization with Yttrium-90 (
90 Y) resin microspheres, and compared with those derived from99m Tc-MAA using the partition model., Methods: A total of 42 HCC patients (28 males and 14 females, mean age 65 ± 11.51 years) who received 45 treatment sessions with90 Y-microspheres between 2016 and 2021 were included. Pre-treatment99m Tc-MAA and post-treatment90 Y-bremsstrahlung SPECT/CT were acquired for each patient. Semi-automated segmentation of regions of interest (ROIs) was performed using MIM Encore software to determine the tumor-liver ratio (TLR) encompassing the liver volume, tumoral-liver, and lungs, and verified by both nuclear medicine physician and interventional radiologist. A partition dosimetry model was used to estimate the administered activity of90 Y-microspheres and the absorbed doses to the tumoral-liver and non-tumoral liver. The student's paired t test and Bland-Altman plot were used for the statistical analysis., Results: The mean TLR values obtained from99m Tc-MAA SPECT/CT and90 Y-bremsstrahlung SPECT/CT were 4.78 ± 3.51 and 2.73 ± 1.18, respectively. The mean planning administered activity of90 Y-microspheres based on99m Tc-MAA SPECT/CT was 1.56 ± 0.80 GBq, while the implanted administered activity was 2.53 ± 1.23 GBq (p value < 0.001). The mean absorbed doses in the tumoral-liver estimated from99m Tc-MAA and90 Y-bremsstrahlung SPECT/CT were 127.44 ± 4.36 Gy and 135.98 ± 6.30 Gy, respectively. The corresponding mean absorbed doses in the non-tumoral liver were 34.61 ± 13.93 Gy and 55.04 ± 16.36 Gy., Conclusion: This study provides evidence that the administered activity of90 Y-microspheres, as estimated from90 Y-bremsstrahlung SPECT/CT, was significantly higher than that estimated from99m Tc-MAA SPECT/CT resulted in increased absorbed doses in both the tumoral-liver and non-tumoral liver. However,99m Tc-MAA SPECT/CT remains a valuable planning tool for predicting the distribution of90 Y-microspheres in liver cancer treatment., (© 2023. The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)- Published
- 2024
- Full Text
- View/download PDF
11. Hepatopulmonary syndrome: Case report of the evidence of intrapulmonary shunt on 99m Tc-MAA scintigraphy and contrast transthoracic echocardiography.
- Author
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Zhou P and Yang J
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- Humans, Female, Middle Aged, Radionuclide Imaging methods, Radiopharmaceuticals, Hepatopulmonary Syndrome diagnostic imaging, Hepatopulmonary Syndrome complications, Technetium Tc 99m Aggregated Albumin, Echocardiography methods
- Abstract
The hepatopulmonary syndrome (HPS) is characterized by arterial oxygenation defect induced by intrapulmonary vascular dilatations in the setting of liver disease. We report a 57-year-old woman with a history of liver cirrhosis presented with progressive cyanosis, exertional dyspnea and a dry cough. Oxyhemoglobin saturation was 88.5% on room air. Contrast transthoracic echocardiography (cTTE) and technetium-99m-macroaggregated albumin (
99m Tc-MAA) scintigraphy showed an intrapulmonary shunting and confirmed HPS.- Published
- 2024
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- View/download PDF
12. Imaging in hepatopulmonary syndrome-case report. A multicenter approach during the coronavirus pandemic.
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Ahmmed AA and Kulshrestha R
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- Female, Humans, Middle Aged, Technetium Tc 99m Aggregated Albumin, Pandemics, Albumins, Lung, Radiopharmaceuticals, Hepatopulmonary Syndrome diagnostic imaging, Hepatopulmonary Syndrome etiology, Coronavirus
- Abstract
A 60-year-old lady with alcoholic liver disease developed central cyanosis and orthodeoxia. A technetium-99m macro-aggregated albumin lung perfusion scan and contrast echocardiogram were performed. A 13% right to left shunt was calculated from the macro-aggregated albumin scan. There were more bubbles in the left heart than the right at the end of the contrast echocardiogram. Hepatopulmonary syndrome was therefore diagnosed. The patient had a liver transplant five days after these investigations. Further discussion about hepatopulmonary syndrome will be provided. Normally, macro-aggregated albumin scans are performed in few centers, however as this was at the height of the coronavirus pandemic, the scan needed to be performed locally to reduce the chance of the patient getting coronavirus. Local radiographers were remotely instructed on conducting the macro-aggregated albumin scan by a larger center to provide a timely and important investigation in a logistically difficult scenario., Competing Interests: DISCLOSURES: Neither author has any interest to declare. No funding was received for this work., (Copyright Journal of Radiology Case Reports.)
- Published
- 2023
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- View/download PDF
13. Review of diagnostic uses of shunt fraction quantification with technetium-99m macroaggregated albumin perfusion scan as illustrated by a case of Osler–Weber–Rendu syndrome
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Kabilan Chokkappan, Anbalagan Kannivelu, Sivasubramanian Srinivasan, and Suresh Balasubramanian Babu
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Hepatopulmonary syndrome ,perfusion imaging ,technetium Tc 99m aggregated albumin ,telangiectasia-hereditary hemorrhagic ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
Bilateral pulmonary arteriovenous malformations (AVMs) are rare and are often associated with the hereditary hemorrhagic telangiectasia (HHT/Osler–Weber–Rendu) syndrome. We present a woman who presented with neurological symptoms due to a cerebral abscess. On further evaluation, bilateral pulmonary AVMs were identified. The patient was diagnosed with HHT, based on positive family history and multiple cerebral AVMs recognized on subsequent catheter angiogram, in addition to the presence of bilateral pulmonary AVMs. Craniotomy with drainage of the brain abscess and endovascular embolization of the pulmonary AVMs was offered to the patient. As a preembolization work-up, the patient underwent nuclear lung perfusion scan with technetium-99m macroaggregated albumin (Tc-99m MAA) to assess the right-to-left shunt secondary to the pulmonary AVMs. Postembolization follow-up perfusion scan was also obtained to estimate the hemodynamic response. The case is presented to describe the role of Tc-99m MAA perfusion lung scan in preoperatively evaluating patients with pulmonary AVMs and to emphasize on the scan's utility in posttreatment follow-up. Various present day usages of the Tc-99m MAA lung perfusion scan, other than diagnosing pulmonary thromboembolism, are discussed. Providing background knowledge on the physiological and hemodynamic aspects of the Tc-99m MAA lung perfusion scan is also attempted. Various imaging pitfalls and necessary precautions while performing Tc-99m MAA lung perfusion scan are highlighted.
- Published
- 2016
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14. Radiochemical Feasibility of Mixing of
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Chang-Tong, Yang, Pei Ing, Ngam, Vanessa Jing Xin, Phua, Sidney Wing Kwong, Yu, Gogna, Apoorva, David Chee Eng, Ng, and Hian Liang, Huang
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Tomography, Emission-Computed, Single-Photon ,Iohexol ,Liver Neoplasms ,Humans ,Feasibility Studies ,Radiopharmaceuticals ,Technetium Tc 99m Aggregated Albumin ,Embolization, Therapeutic ,Microspheres - Abstract
Yttrium-90 (
- Published
- 2022
15. Optimization of the Clinical Effectiveness of Radioembolization in Hepatocellular Carcinoma with Dosimetry and Patient-Selection Criteria.
- Abstract
Selective internal radiation therapy (SIRT) is part of the treatment strategy for hepatocellular carcinoma (HCC). Strong clinical data demonstrated the effectiveness of this therapy in HCC with a significant improvement in patient outcomes. Recent studies demonstrated a strong correlation between the tumor response and the patient outcome when the tumor-absorbed dose was assessed by nuclear medicine imaging. Dosimetry plays a key role in predicting the clinical response and can be optimized using a personalized method of activity planning (multi-compartmental dosimetry). This paper reviews the main clinical results of SIRT in HCC and emphasizes the central role of dosimetry for improving it effectiveness. Moreover, some patient and tumor characteristics predict a worse outcome, and toxicity related to SIRT treatment of advanced HCC patient selection based on the performance status, liver function, tumor characteristics, and tumor targeting using technetium-99m macro-aggregated albumin scintigraphy can significantly improve the clinical performance of SIRT.
- Published
- 2022
16. Accurate non-tumoral 99mTc-MAA absorbed dose prediction to plan optimized activities in liver radioembolization using resin microspheres
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Stephan Walrand, Renaud Lhommel, Nadia Amini, Kiswendsida Sawadogo, François Jamar, Philippe D'Abadie, Michel Hesse, UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Service de radiologie, and UCL - (SLuc) Service de médecine nucléaire
- Subjects
Carcinoma, Hepatocellular ,Accurate estimation ,Biophysics ,General Physics and Astronomy ,Partition model ,Microsphere ,Dosimetry ,Albumins ,Positron Emission Tomography Computed Tomography ,otorhinolaryngologic diseases ,Humans ,Medicine ,Distribution (pharmacology) ,Yttrium Radioisotopes ,Radiology, Nuclear Medicine and imaging ,Radioembolization ,(99)Tc-MAA SPECT/CT ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies ,Tomography, Emission-Computed, Single-Photon ,business.industry ,Liver Neoplasms ,Albumin ,General Medicine ,99mtc maa ,Embolization, Therapeutic ,Microspheres ,Absorbed dose ,(90)Y PET/CT ,business ,Nuclear medicine - Abstract
AIM: The manufacturers' recommended methods to calculate delivered activities in liver radioembolization are simplistic and only slightly personalized. Activity planning could also be based on a 99mTc-macroaggregated albumin SPECT/CT (MAA) using the partition model but its accuracy is controversial. This study evaluates the dose parameters in the normal liver and in the tumor compartments using MAA SPECT/CT (pre-therapeutic imaging) and 90Y TOF-PET/CT (post-therapy imaging). Finally, we propose a prescription of the activity as a function of the normal liver MAA distribution. METHOD: 66 procedures of RE (with resin microspheres) corresponding to 171 lesions were analyzed. Tumor to normal targeted liver uptake (T/NTL), tumor absorbed dose (TD) and whole normal liver absorbed (WNLD) were assessed with MAA and 90Y imaging. Secondly, activities were recalculated using the MAA distribution in the normal liver compartment to reach the maximal tolerable liver dose. These Activities were compared to activities defined with the BSA method. RESULTS: Compared to 90Y imaging, our study demonstrated an accurate estimation of the WNLD using MAA imaging (Pearson's R = 0.97, p < 0.001). On the contrary, significant variations were found for TD (R = 0.65, p < 0.001). The MAA T/NTL ratio has a 85% positive predictive value in identifying patients who will get a 90Y T/NTL ratio above 1.5. Moreover, activities calculated using the MAA distribution in the normal liver compartment were significantly higher to activities defined with the BSA method. CONCLUSION: Whole normal liver absorbed doses are accurately predicted with MAA imaging and could be used to optimize the activity planning.
- Published
- 2021
17. 99m Tc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy.
- Author
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Tabotta F, Gnesin S, Dunet V, Ponti A, Digklia A, Boughdad S, Schaefer N, Prior JO, Villard N, Tsoumakidou G, Denys A, and Duran R
- Subjects
- Humans, Middle Aged, Positron Emission Tomography Computed Tomography, Retrospective Studies, Technetium Tc 99m Aggregated Albumin, Yttrium Radioisotopes therapeutic use, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed, Albumins, Microspheres, Liver Neoplasms diagnostic imaging, Liver Neoplasms radiotherapy, Liver Neoplasms drug therapy, Embolization, Therapeutic adverse effects
- Abstract
First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver's disease control. SIRT planning is essential and little is known about dosimetry. We investigated whether
99m Tc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on90 Y-PET/CT and assess the dose-response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43-82). Patients underwent MRI/CT,18 F-FDG-PET/CT before and 3-6 months post-SIRT, and90 Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from99m Tc-MAA-SPECT/CT and post-SIRT90 Y-PET/CT, and assessed with Lin's concordance correlation coefficients (ρc and Cb ), Pearson's coefficient correlation (ρ), and Bland-Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46-1586 Gy). Concordance between99m Tc-MAA-SPECT/CT and90 Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (ρ = 0.725, ρc = 0.703, Cb = 0.969) with good agreement (mean difference: - 4.93 ± 218.3 Gy, 95%LOA: - 432.8-422.9). Without RC correction, concordance was better for resin microspheres (ρ = 0.85, ρc = 0.998, Cb = 0.849) and agreement was very good between predictive99m Tc-MAA-SPECT/CT and90 Y-PET/CT dosimetry (mean difference: - 4.05 ± 55.9 Gy; 95%LOA: - 113.7-105.6). After RC correction,99m Tc-MAA-SPECT/CT dosimetry overestimated AD (- 70.9 ± 158.9 Gy; 95%LOA: - 382.3-240.6). For glass microspheres, concordance markedly improved with RC correction (ρ = 0.790, ρc = 0.713, Cb = 0.903 vs without correction: ρ = 0.395, ρc = 0.244, Cb = 0.617) and99m Tc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: - 375.4-673.2). For non-tumor liver, concordance was good between99m Tc-MAA-SPECT/CT and90 Y-PET/CT dosimetry (ρ = 0.942, ρc = 0.852, Cb = 0.904).99m Tc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose-response threshold could be identified.99m Tc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT., (© 2023. Springer Nature Limited.)- Published
- 2023
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18. Accuracy and Safety of Scout Dose Resin Yttrium-90 Microspheres for Radioembolization Therapy Treatment Planning: A Prospective Single-Arm Clinical Trial
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Nima Kokabi, Linzi A. Webster, Mohammad Elsayed, Jeffrey M. Switchenko, Bernard Chen, David Brandon, James Galt, Ila Sethi, Mircea Cristescu, S. Cheenu Kappadath, and David M. Schuster
- Subjects
Tomography, Emission-Computed, Single-Photon ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Embolization, Therapeutic ,Article ,Microspheres ,Humans ,Radiology, Nuclear Medicine and imaging ,Tissue Distribution ,Yttrium Radioisotopes ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies - Abstract
PURPOSE: To compare the accuracy and safety of 0.56 GBq resin yttrium-90 ((90)Y) (scout(90)Y) microspheres with those of technetium-99m macroaggregated albumin (MAA) in predicting the therapeutic (90)Y (Rx(90)Y) dose for patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This prospective single-arm clinical trial (Clinicaltrials.gov: NCT04172714) recruited patients with HCC. Patients underwent same-day mapping with MAA and scout(90)Y. Rx(90)Y activity was administered 3 days after mapping. Using paired t test and Pearson correlation, the tumor-to-normal ratio (TNR), lung shunt fraction (LSF), predicted mean tumor dose (TD), and nontumoral liver dose (NTLD) by MAA and scout(90)Y were compared with those by Rx(90)Y. Bland-Altman plots compared the level of agreement between the TNR and LSF of scout(90)Y and MAA with that of Rx(90)Y. The safety of scout(90)Y was evaluated by examining the discrepancy in extrahepatic activity between MAA and scout(90)Y. RESULTS: Thirty patients were treated using 19 segmental and 14 nonsegmental (ie, 2 contiguous segments or nonsegmental) therapies. MAA had weak LSF, moderate TNR, and moderate TD linear correlation with Rx(90)Y. Scout(90)Y had a moderate LSF, strong TNR, strong TD, and very strong NTLD in correlation with those of Rx(90)Y. Furthermore, the TNR and LSF of scout(90)Y had a stronger agreement with those of Rx(90)Y than with those of MAA. In the nonsegmental subgroup, MAA had no significant correlation with the TD and NTLD of Rx(90)Y, whereas scout(90)Y had a very strong correlation with both of these factors. In the segmental subgroup, both MAA and scout(90)Y had a strong linear correlation with the TD and NTLD of Rx(90)Y. CONCLUSIONS: Compared with MAA, scout(90)Y is a more accurate surrogate for Rx(90)Y biodistribution for nonsegmental therapies.
- Published
- 2022
19. Evaluation of the hybrid tracer indocyanine green-Tc-99m-nanocolloid for sentinel node biopsy in bladder cancer: a prospective pilot study
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Rietbergen, D.D.D., Gennep, E.J. van, KleinJan, G.H., Donswijk, M., Olmos, R.A.V., Rhijn, B.W. van, Poel, H.G. van der, and Leeuwen, F.W.B. van
- Subjects
Indocyanine Green ,Sentinel Lymph Node Biopsy ,Technetium ,Pilot Projects ,General Medicine ,Middle Aged ,Nanostructures ,Urinary Bladder Neoplasms ,ICG-Tc-99m-nanocolloid ,interventional nuclear medicine ,Humans ,bladder cancer ,Radiology, Nuclear Medicine and imaging ,Colloids ,Prospective Studies ,Sentinel Lymph Node ,Technetium Tc 99m Aggregated Albumin ,bimodal tracer ,fluorescence-guided surgery - Abstract
Rationale: In muscle-invasive bladder cancer (MIBC), lymph node invasion has proven to be an independent predictor of disease recurrence and cancer-specific survival. We evaluated the feasibility of targeting the sentinel node (SN) for biopsy in MIBC patients using the hybrid tracer indocyanine green (ICG)-Tc-99m-nanocolloid for simultaneous radioguidance and fluorescence guidance. Methods: Twenty histologically confirmed cN0M0 MIBC patients (mean age, 63.3 years; range, 30-82 years), scheduled for radical cystectomy with SN biopsy and extended pelvic lymph node dissection (ePLND), were prospectively included. Twelve patients were operated on following neoadjuvant chemotherapy. The patients received lymphoscintigraphy as well as SPECT/CT after 4 transurethral injections of ICG-Tc-99m-nanocolloid (mean, 208 MBq; range, 172-229 MBq) around the tumor/scar in the detrusor muscle of the bladder on the day before radical cystectomy. Sentinel node resection was performed under radioguidance and fluorescence guidance. Results: Nineteen patients could be analyzed. On preoperative imaging, SNs could be identified in 10 patients (53%; mean, 1.6 SN/patient), which revealed drainage pathways outside the ePLND in 20% of the patients. Interesting to note is that 2 patients (10%) with preoperative nonvisualization displayed fluorescent and radioactive SNs during surgery. Location of the primary tumor near the left lateral side of the bladder seemed to be a factor for nonvisualization. Nodal harvesting with ePLND varied among patients (mean, 23.3). Histopathology confirmed tumor-positive nodes in 4 (21%) of all patients. In the 2 patients where an SN could be identified, the ePLND specimens were tumor-negative. All patients with tumor-positive nodes had advanced disease (stage III). Conclusion: Sentinel node biopsy in bladder cancer using the hybrid tracer ICG-Tc-99m-nanocolloid is feasible, and preoperative imaging is predictive for the ability to perform SN biopsy in 83% of the patients who displayed an SN. In patients with a successful preoperative SN mapping using lymphoscintigraphy and SPECT/CT, the intraoperative SN guidance and detection were effective, even outside the ePLND area. As such, this study underscores the critical role that preoperative imaging plays in challenging image-guided surgery applications.
- Published
- 2022
20. Association of dysmorphic intratumoral vessel with high lung shunt fraction in patients with hepatocellular carcinoma
- Author
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Tae Won, Choi, Ijin, Joo, and Hyo-Cheol, Kim
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Carcinoma, Hepatocellular ,Multidisciplinary ,Liver Neoplasms ,Humans ,Yttrium Radioisotopes ,Embolization, Therapeutic ,Lung ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies - Abstract
To evaluate the role of dysmorphic intratumoral vessels as imaging marker for the prediction of high lung shunt fraction (LSF) in patients with hepatocellular carcinoma (HCC). This retrospective study included 403 patients with HCC who underwent a planning arteriography for transarterial radioembolization with administration of 99mTc-macroaggregated albumin to calculate LSF. The LSF was measured by using planar body scans. Two radiologists evaluated the pre-treatment contrast-enhanced CT findings, including tumor number, size, margin, distribution, tumor burden, portal and hepatic vein invasion, early hepatic vein enhancement, and dysmorphic intratumoral vessels. The logistic regression analysis was performed to determine significant predictors for high LSF > 20%. Using the identified predictors, diagnostic criteria for high LSF were proposed. Among 403 patients, 52 (13%) patients had high LSF > 20%, and dysmorphic tumor vessels were present in 115 (28.5%) patients. Predictors for LSF > 20% were tumor size > 11 cm, hepatic vein invasion, early hepatic vein enhancement, and dysmorphic intratumoral vessel. If the patient had three or more of the four predictors for LSF > 20% on imaging, the accuracy and specificity for diagnosing LSF > 20% were 88.8% and 96.3% respectively. Dysmorphic intratumoral vessel in HCC is an imaging marker suggesting a high LSF, which may be applicable to treatment modification or patient exclusion for radioembolization with combined interpretation of tumor size and hepatic vein abnormality.
- Published
- 2022
21. Tc-99m GSA scintigraphy within the first 3 days after admission as an early predictor of outcome in severe acute liver injury
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Hiroaki Abe, Tokio Sasaki, Ryouichi Mikami, Yuji Suzuki, Takuro Sato, Yasuhiro Takikawa, and Keisuke Kakisaka
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Science ,Liver transplantation ,Scintigraphy ,Gastroenterology ,Article ,Hepatitis ,03 medical and health sciences ,0302 clinical medicine ,Liver Function Tests ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Radionuclide Imaging ,Technetium Tc 99m Aggregated Albumin ,Hepatic encephalopathy ,Liver diseases ,Aged ,Acute liver injury ,Multidisciplinary ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Area under the curve ,Liver Failure, Acute ,Middle Aged ,Prognosis ,medicine.disease ,Liver Transplantation ,Liver ,Hepatic Encephalopathy ,030220 oncology & carcinogenesis ,Technetium Tc 99m Pentetate ,Medicine ,030211 gastroenterology & hepatology ,Tc-99m-GSA ,Radiopharmaceuticals ,business - Abstract
Patients with severe acute liver injury (SLI) usually recover spontaneously. However, some SLI patients progress to acute liver failure with varying degrees of hepatic encephalopathy. Acute liver failure is associated with high mortality and can be substantially reduced by liver transplantation. Therefore, distinguishing SLI patients who might progress to acute liver failure and are at a risk of death is important when evaluating patients needing liver transplantation. The present study aimed to determine whether technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) scintigraphy can predict the prognosis of patients with SLI. This prospective observational study included 69 SLI patients. The accuracy of Tc-99m GSA for predicting death or liver transplantation for 6 months was assessed. Between the two groups of patients stratified based on the cut-off values from the receiver operating characteristic curves, 6-month transplant-free survival was compared. Sixteen (23.2%) patients died or underwent liver transplantation from admission (poor outcome). The hepatic accumulation index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest at 15 min (i.e., LHL15). The LHL15 in the 16 patients (0.686) was significantly lower than that in survivors (0.836; P
- Published
- 2021
22. Can pretreatment hepatic artery perfusion scintigraphy in patients with liver malignancies predict the treatment response of the selective internal radiation therapy with 90Y resin microspheres?
- Author
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Isa Burak, Guney, Huseyin Tugsan, Balli, Kadir Alper, Kucuker, Ilker, Unal, and Mustafa, Kibar
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Tomography, Emission-Computed, Single-Photon ,Carcinoma, Hepatocellular ,Hepatic Artery ,Perfusion Imaging ,Positron Emission Tomography Computed Tomography ,Liver Neoplasms ,Humans ,Yttrium Radioisotopes ,Embolization, Therapeutic ,Technetium Tc 99m Aggregated Albumin ,Microspheres ,Retrospective Studies - Abstract
PURPOSE We aimed to evaluate whether the perfusion pattern from pretreatment hepatic artery perfusion scintigraphy (HAPS) in patients with liver malignancies can predict response to selective internal radiation therapy (SIRT). METHODS This retrospective study analyzed 152 consecutive patients treated with yttrium-90 (90Y) resin microspheres between April 2015 and July 2017. HAPS using single-photon emission computed tomography/computed tomography (SPECT/CT) with 99mtechnetium macroaggregated albumin (99mTc-MAA) was performed before SIRT. Investigators visually classified perfusion patterns of tumors as heterogeneous or diffuse in HAPS. Between diffuse and heterogeneous pattern group, positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) were performed in third and sixth month after SIRT, and tumor response assessed and compared by using RECIST 1.1 or mRECIST. Overall survival (OS) and progression-free survival (PFS) were also compared with Kaplan-Meier/log-rank analyses. RESULTS Of 216 SIRT procedures, 172 were classified as heterogeneous and 44 as diffuse. Diffuse 99mTc- MAA uptake was associated with longer median OS than heterogeneous (22.2 vs. 14.4 months, respectively; P = .047). Subsegmental infusion was associated with longer OS than either lobar or segmental infusion (P = .090). Mean estimated OS was longer in patients with hepatocellular carcinoma (HCC) (34.2 months) than with colorectal carcinoma (CRC) (16.4 months) (P = .044). Patients with both diffuse and heterogeneous patterns were able to show complete response after SIRT. No statistically significant differences were observed between perfusion patterns and PFS or response rates to SIRT. CONCLUSION Although tumor perfusion patterns from preplanning HAPS analyses are useful for estimating tumor uptake of 90Y, they may not reliably predict hepatic treatment response, as patients with different perfusion patterns can show clinical response to SIRT.
- Published
- 2022
23. Issues with the European Pharmacopoeia Quality Control Method for
- Author
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Svend Borup, Jensen, Lotte Studsgaard, Meyer, Nikolaj Schandorph, Nielsen, and Søren Steen, Nielsen
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Quality Control ,Albumins ,Humans ,Radiopharmaceuticals ,Lung ,Technetium Tc 99m Aggregated Albumin - Abstract
Technetium-99m macroaggregated albumin ([
- Published
- 2022
24. 3D image-based dosimetry for Yttrium-90 radioembolization of hepatocellular carcinoma: Impact of imaging method on absorbed dose estimates
- Author
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Andrei Todica, Harun Ilhan, J Brosch, Astrid Gosewisch, Max Seidensticker, Peter Bartenstein, Sibylle Ziegler, Guido Böning, Jens Ricke, Johannes Zellmer, and Lena Kaiser
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Carcinoma, Hepatocellular ,Biophysics ,General Physics and Astronomy ,Imaging data ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Positron Emission Tomography Computed Tomography ,Liver tissue ,medicine ,Humans ,Dosimetry ,Yttrium Radioisotopes ,Radiology, Nuclear Medicine and imaging ,Technetium Tc 99m Aggregated Albumin ,Tomography, Emission-Computed, Single-Photon ,Therapy Outcome ,business.industry ,Liver Neoplasms ,Selective internal radiation therapy ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Microspheres ,3d image ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Absorbed dose ,Nuclear medicine ,business - Abstract
Background To improve therapy outcome of Yttrium-90 selective internal radiation therapy (90Y SIRT), patient-specific post-therapeutic dosimetry is required. For this purpose, various dosimetric approaches based on different available imaging data have been reported. The aim of this work was to compare post-therapeutic 3D absorbed dose images using Technetium-99m (99mTc) MAA SPECT/CT, Yttrium-90 (90Y) bremsstrahlung (BRS) SPECT/CT, and 90Y PET/CT. Methods Ten SIRTs of nine patients with unresectable hepatocellular carcinoma (HCC) were investigated. The 99mTc SPECT/CT data, obtained from 99mTc-MAA-based treatment simulation prior to 90Y SIRT, were scaled with the administered 90Y therapy activity. 3D absorbed dose images were generated by dose kernel convolution with scaled 99mTc/90Y SPECT/CT, 90Y BRS SPECT/CT, and 90Y PET/CT data of each patient. Absorbed dose estimates in tumor and healthy liver tissue obtained using the two SPECT/CT methods were compared against 90Y PET/CT. Results The percentage deviation of tumor absorbed dose estimates from 90Y PET/CT values was on average −2 ± 18% for scaled 99mTc/90Y SPECT/CT, whereas estimates from 90Y BRS SPECT/CT differed on average by −50 ± 13%. For healthy liver absorbed dose estimates, all three imaging methods revealed comparable values. Conclusion The quantification capabilities of the imaging data influence 90Y SIRT tumor dosimetry, while healthy liver absorbed dose values were comparable for all investigated imaging data. When no 90Y PET/CT image data are available, the proposed scaled 99mTc/90Y SPECT/CT dosimetry method was found to be more appropriate for HCC tumor dosimetry than 90Y BRS SPECT/CT based dosimetry.
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- 2020
25. Optimization of the Clinical Effectiveness of Radioembolization in Hepatocellular Carcinoma with Dosimetry and Patient-Selection Criteria
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Philippe d’Abadie, Stephan Walrand, Renaud Lhommel, Michel Hesse, Ivan Borbath, François Jamar, UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Service de médecine nucléaire, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Service de gastro-entérologie, and UCL - (SLuc) Unité d'oncologie médicale
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Carcinoma, Hepatocellular ,dosimetry ,Patient Selection ,Liver Neoplasms ,hepatocellular carcinoma ,selective internal radiation therapy ,Microspheres ,Treatment Outcome ,liver radioembolization ,Humans ,Sirtuins ,Yttrium Radioisotopes ,Technetium Tc 99m Aggregated Albumin ,optimization - Abstract
Selective internal radiation therapy (SIRT) is part of the treatment strategy for hepatocellular carcinoma (HCC). Strong clinical data demonstrated the effectiveness of this therapy in HCC with a significant improvement in patient outcomes. Recent studies demonstrated a strong correlation between the tumor response and the patient outcome when the tumor-absorbed dose was assessed by nuclear medicine imaging. Dosimetry plays a key role in predicting the clinical response and can be optimized using a personalized method of activity planning (multi-compartmental dosimetry). This paper reviews the main clinical results of SIRT in HCC and emphasizes the central role of dosimetry for improving it effectiveness. Moreover, some patient and tumor characteristics predict a worse outcome, and toxicity related to SIRT treatment of advanced HCC patient selection based on the performance status, liver function, tumor characteristics, and tumor targeting using technetium-99m macro-aggregated albumin scintigraphy can significantly improve the clinical performance of SIRT.
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- 2022
26. Adaptive scan duration in SPECT: Evaluation for radioembolization
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Hugo W. A. M. de Jong, Britt Kunnen, Casper Beijst, and Martijn M A Dietze
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Scanner ,Time Factors ,Materials science ,patient‐specific scan duration ,Imaging phantom ,Mean difference ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,DIAGNOSTIC IMAGING (IONIZING AND NON‐IONIZING) ,Technetium Tc 99m Aggregated Albumin ,Research Articles ,adaptive scan ,Tomography, Emission-Computed, Single-Photon ,SPECT SCAN ,medicine.diagnostic_test ,business.industry ,Detector ,General Medicine ,Patient data ,Phantom data ,Embolization, Therapeutic ,Liver ,SPECT ,030220 oncology & carcinogenesis ,Feasibility Studies ,Nuclear medicine ,business ,Emission computed tomography ,Radiotherapy, Image-Guided ,Research Article - Abstract
PURPOSE It may be challenging to select the optimal scan duration for single-photon emission computed tomography (SPECT) protocols because the activity distribution characteristics can differ in every scan. Using simulations and experiments, we investigated whether the scan duration can be optimized for every scan separately by evaluating the activity distribution during scanning. We refer to this as adaptive scanning. METHODS The feasibility of adaptive scanning was evaluated for the detection of extrahepatic depositions in the pretreatment procedure of radioembolization, in which 99m Tc-labeled macroaggregated albumin (99m Tc-MAA) is injected into the liver. We simulated fast 1-min detector rotations and updated the reconstruction with the newly collected counts after every rotation. The scan was terminated when one of the two criteria was met: (a) when the mask difference of the detected extrahepatic deposition between two consecutive rotations was lower than 5%; or (b) when the reconstructed extrahepatic activity was negligible with respect to the total reconstructed activity (
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- 2020
27. A Novel Noninvasive Method for Predicting Liver Fibrosis by Quantifying the Estrangement of Indocyanine Green Retention Rate and Tc-99m-diethylenetriamine-penta-acetic Acid-galactosyl Human Serum Albumin Scintigraphy
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Manabu Yamamoto, Yoji Fukumoto, Takuki Yagyu, Kyoichi Kihara, Toshimichi Hasegawa, Teruhisa Sakamoto, Yoshiyuki Fujiwara, Shuichi Takano, Naruo Tokuyasu, Soichiro Honjo, Ei Uchinaka, Joji Watanabe, Takehiko Hanaki, Tomoyuki Matsunaga, Kozo Miyatani, and Masaki Morimoto
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Adult ,Indocyanine Green ,Liver Cirrhosis ,Male ,Cancer Research ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Scintigraphy ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,chemistry.chemical_compound ,Liver Function Tests ,Internal medicine ,medicine ,Humans ,Radionuclide Imaging ,Technetium Tc 99m Aggregated Albumin ,Aged ,Aged, 80 and over ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Retention rate ,Prognosis ,Human serum albumin ,medicine.disease ,ROC Curve ,chemistry ,Female ,Liver function ,Hepatectomy ,Liver function tests ,business ,Indocyanine green ,Biomarkers ,Research Article ,medicine.drug - Abstract
Background/Aim: Indocyanine green (ICG) clearance test is one of the most popular dynamic methods for evaluating preoperative liver function to avoid posthepatectomy liver failure (PHLF). Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin scintigraphy (GSA) also facilitates the direct estimation of functional hepatocytes and can estimate the ICG retention rate (R15); however, in some cases, there is a discrepancy between results of a preoperative examination of ICG-R15 and the estimated ICG-R15 obtained by 99mTc-GSA (GSA-R15). This study evaluated the gap between ICG-R15 and GSA-R15 (ΔICG) for predicting background liver fibrosis in patients who underwent hepatectomy. Patients and Methods: Sixty-four consecutive patients who underwent hepatectomy and preoperative ICG-R15 and GSA-R15 examinations from 2016 to 2019 were retrospectively evaluated. The gap between GSA-R15 and ICG-R15 was defined as ΔICG and the factors predicting liver fibrosis were investigated. Results: In the pathologically-proven cirrhotic group, platelet counts were significantly lower and ΔICG values were significantly larger than those in the non-/early-cirrhotic group. A multivariate analysis identified a higher total bilirubin level, a higher AST level, and a larger ΔICG level as significant predictive factors for liver cirrhosis. Conclusion: Larger ΔICG was found to be an independent preoperative predictor of liver fibrosis and may positively contribute to decision-making before hepatectomy to avoid PHLF.
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- 2020
28. Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres
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Nadia Amini, Renaud Lhommel, Aline Van Maanen, François Jamar, Philippe D'Abadie, Pierre Goffette, Stephan Walrand, UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Service de médecine nucléaire, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de radiologie, and UCL - (SLuc) Centre du cancer
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Carcinoma, Hepatocellular ,Catheters ,medicine.medical_treatment ,Single-photon emission computed tomography ,Microsphere ,Positron Emission Tomography Computed Tomography ,Interventional Radiology ,Carcinoma ,otorhinolaryngologic diseases ,Medicine ,Humans ,Yttrium Radioisotopes ,Embolization ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Albumin ,medicine.disease ,Embolization, Therapeutic ,Microspheres ,Catheter ,Hepatocellular carcinoma ,Tomography ,business ,Nuclear medicine - Abstract
PURPOSE: We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using (90)Y-resin microspheres. METHODS: Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For (90)Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). (90)Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. (99m)Tc-MAA SPECT and (90)Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL([MAA or 90Y])) and tumor dose (TD([MAA or 90Y])) for the planning and therapy. RESULTS: Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL(90Y) and TD(90Y) were significantly higher than T/NL(MAA) and TD(MAA). Median (IQR) T/NL(90Y) was 2.16 (2.15) versus 1.74 (1.43) for T/NL(MAA) (p < 0.001). Median (IQR) TD(90Y) was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TD(MAA) (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated. CONCLUSION: The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
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- 2021
29. Challenges in Preparation of Albumin Nanoparticle-Based Radiopharmaceuticals
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James R, Ballinger
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Sentinel Lymph Node Biopsy ,Organic Chemistry ,Pharmaceutical Science ,Analytical Chemistry ,Chemistry (miscellaneous) ,Albumins ,Drug Discovery ,Molecular Medicine ,Lymph Nodes ,Radiopharmaceuticals ,Physical and Theoretical Chemistry ,Coloring Agents ,Technetium Tc 99m Aggregated Albumin ,Lymphoscintigraphy - Abstract
Albumin nanocolloids have been used as radiopharmaceuticals for more than 40 years. Their main use is in lymphoscintigraphy and the detection of the sentinel lymph node as part of the surgical treatment of a variety of solid tumours. The main licensed products are labelled with the gamma emitter technetium-99m. Recently, two analogues labelled with positron emitters have been reported, using gallium-68 and zirconium-89. For about 10 years, there has been interest in dual-modal agents with both radioactive and fluorescent labels to improve the localisation of the sentinel lymph node. Indocyanine green (ICG) has been the most widely used fluorescent label, largely due to its availability as a licensed agent and its ease of application. The further development of alternative radiolabels or improved fluorescent tags will require investment in the development and licensing. There is also a vast potential for the targeting of albumin nanocolloids using existing strategies, which could be promising for the development of both diagnostic and therapeutic agents.
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- 2022
30. Antireflux catheter improves tumor targeting in liver radioembolization with resin microspheres.
- Abstract
PURPOSE: We aimed to determine whether antireflux (ARC) catheter may result in better tumor targeting in liver radioembolization using 90Y-resin microspheres. METHODS: Patients treated with resin microspheres for hepatocellular carcinoma (HCC) and secondary liver malignancies were retrospectively analyzed. All patients underwent a 99mTc-macroaggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) following the planning arteriography with a conventional end-hole catheter. For 90Y-microspheres injection, two groups were defined depending on the type of catheter used: an ARC group (n=38) and a control group treated with a conventional end-hole catheter (n=23). 90Y positron emission tomography computed tomography (PET/CT) was performed after the therapeutic arteriography. The choice of the catheter was not randomized, but left to the choice of the interventional radiologist. 99mTc-MAA SPECT and 90Y PET/CT were co-registered with the baseline imaging to determine a tumor to normal liver ratio (T/NL[MAA or 90Y]) and tumor dose (TD[MAA or 90Y]) for the planning and therapy. RESULTS: Overall, 38 patients (115 lesions) and 23 patients (75 lesions) were analyzed in the ARC and control groups, respectively. In the ARC group, T/NL90Y and TD90Y were significantly higher than T/NLMAA and TDMAA. Median (IQR) T/NL90Y was 2.16 (2.15) versus 1.74 (1.43) for T/NLMAA (p < 0.001). Median (IQR) TD90Y was 90.96 Gy (98.31 Gy) versus 73.72 Gy (63.82 Gy) for TDMAA (p < 0.001). In this group, the differences were highly significant for neuroendocrine metastases (NEM) and HCC and less significant for colorectal metastases (CRM). In the control group, no significant differences were demonstrated. CONCLUSION: The use of an ARC significantly improves tumor deposition in liver radioembolization with resin microspheres.
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- 2021
31. Accurate non-tumoral 99mTc-MAA absorbed dose prediction to plan optimized activities in liver radioembolization using resin microspheres.
- Abstract
AIM: The manufacturers' recommended methods to calculate delivered activities in liver radioembolization are simplistic and only slightly personalized. Activity planning could also be based on a 99mTc-macroaggregated albumin SPECT/CT (MAA) using the partition model but its accuracy is controversial. This study evaluates the dose parameters in the normal liver and in the tumor compartments using MAA SPECT/CT (pre-therapeutic imaging) and 90Y TOF-PET/CT (post-therapy imaging). Finally, we propose a prescription of the activity as a function of the normal liver MAA distribution. METHOD: 66 procedures of RE (with resin microspheres) corresponding to 171 lesions were analyzed. Tumor to normal targeted liver uptake (T/NTL), tumor absorbed dose (TD) and whole normal liver absorbed (WNLD) were assessed with MAA and 90Y imaging. Secondly, activities were recalculated using the MAA distribution in the normal liver compartment to reach the maximal tolerable liver dose. These Activities were compared to activities defined with the BSA method. RESULTS: Compared to 90Y imaging, our study demonstrated an accurate estimation of the WNLD using MAA imaging (Pearson's R = 0.97, p < 0.001). On the contrary, significant variations were found for TD (R = 0.65, p < 0.001). The MAA T/NTL ratio has a 85% positive predictive value in identifying patients who will get a 90Y T/NTL ratio above 1.5. Moreover, activities calculated using the MAA distribution in the normal liver compartment were significantly higher to activities defined with the BSA method. CONCLUSION: Whole normal liver absorbed doses are accurately predicted with MAA imaging and could be used to optimize the activity planning.
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- 2021
32. Lung Dose Measured on Postradioembolization
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Martina, Stella, Rob, van Rooij, Marnix G E H, Lam, Hugo W A M, de Jong, and Arthur J A T, Braat
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Radiation Pneumonitis ,Incidence ,Positron Emission Tomography Computed Tomography ,Liver Neoplasms ,Humans ,Yttrium Radioisotopes ,Pneumonia ,Clinical Investigation ,Embolization, Therapeutic ,Lung ,Technetium Tc 99m Aggregated Albumin ,Microspheres ,Retrospective Studies - Abstract
Radiation pneumonitis is a rare but possibly fatal side effect of (90)Y radioembolization. It may occur 1–6 mo after therapy, if a significant part of the (90)Y microspheres shunts to the lungs. In current clinical practice, a predicted lung dose greater than 30 Gy is considered a criterion to exclude patients from treatment. However, contrasting findings regarding the occurrence of radiation pneumonitis and lung dose were previously reported in the literature. In this study, the relationship between the lung dose and the eventual occurrence of radiation pneumonitis after (90)Y radioembolization was investigated. Methods: We retrospectively analyzed 317 (90)Y liver radioembolization procedures performed during an 8-y period (February 2012 to September 2020). We calculated the predicted lung mean dose (LMD) using (99m)Tc-MAA planar scintigraphy (LMD(MAA)) acquired during the planning phase and left LMD (LMD(Y-90)) using the (90)Y PET/CT acquired after the treatment. For the lung dose computation, we used the left lung as the representative lung volume, to compensate for scatter from the liver moving in the craniocaudal direction because of breathing and mainly affecting the right lung. Results: In total, 272 patients underwent (90)Y procedures, of which 63% were performed with glass microspheres and 37% with resin microspheres. The median injected activity was 1,974 MBq (range, 242–9,538 MBq). The median LMD(MAA) was 3.5 Gy (range, 0.2–89.0 Gy). For 14 procedures, LMD(MAA) was more than 30 Gy. Median LMD(Y-90) was 1 Gy (range, 0.0–22.1 Gy). No patients had an LMD(Y-90) of more than 30 Gy. Of the 3 patients with an LMD(Y-90) of more than 12 Gy, 2 patients (one with an LMD(Y-90) of 22.1 Gy and an LMD(MAA) of 89 Gy; the other with an LMD(Y-90) of 17.7 Gy and an LMD(MAA) of 34.1 Gy) developed radiation pneumonitis and consequently died. The third patient, with an LMD(Y-90) of 18.4 Gy (LMD(MAA), 29.1 Gy), died 2 mo after treatment, before the imaging evaluation, because of progressive disease. Conclusion: The occurrence of radiation pneumonitis as a consequence of a lung shunt after (90)Y radioembolization is rare (
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- 2021
33. Lung Shunt Reduction for Yttrium-90 Radioembolization: Chemoembolization Versus Radioembolization
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Jin Chul Paeng, Hyo Cheol Kim, Jin Woo Choi, Myungsu Lee, Jin Wook Chung, and Yoon Jun Kim
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Cancer Research ,Carcinoma, Hepatocellular ,General Biochemistry, Genetics and Molecular Biology ,Medicine ,Humans ,In patient ,Yttrium Radioisotopes ,Lung ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies ,Pharmacology ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Retrospective cohort study ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Hepatocellular carcinoma ,Angiography ,Shunt fraction ,Radiopharmaceuticals ,business ,Nuclear medicine ,Shunt (electrical) ,Research Article - Abstract
Aim: To evaluate the efficacy of chemoembolization versus radioembolization in reducing lung shunt fraction (LSF) in patients with hepatocellular carcinoma (HCC). Patients and Methods: In this retrospective study, from March 2012 to January 2021, 457 patients with HCC underwent planning angiography and (99m)Tc-macroaggregated albumin imaging for possible yttrium-90 radioembolization. Ten patients underwent radioembolization, and seven patients underwent conventional chemoembolization for LSF reduction, and a second (99m)Tc-macroaggregated albumin imaging was obtained approximately 1 month later. LSF under both procedures was compared with the Mann-Whitney U-test and the Wilcoxon signed-rank test. Results: In the radioembolization group, the mean first and second LSF were 13.0±6.9% and 20.9±9.6%, respectively (p=0.059); after radioembolization, LSF was lower in three patients but higher in seven patients. In the chemoembolization group, the mean first and second LSF were 26.1±17.3% and 8.7±5.5%, respectively (p=0.018); after chemoembolization, LSF was reduced in all seven patients. Conclusion: Chemoembolization appears to be more effective in reducing LSF within 1 month compared with radioembolization.
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- 2021
34. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres
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Arnaud Dieudonné, S. Cheenu Kappadath, Riad Salem, Macarena Rodríguez-Fraile, David Chee Eng Ng, Nima Kokabi, Lidia Strigari, Hugo Levillain, P Paprottka, Oreste Bagni, Patrick Flamen, Silvano Gnesin, Bruno Sangro, Cinzia Pettinato, David M. Liu, Andrew S. Kennedy, Armeen Mahvash, Daniel Y. Sze, Antonio Martínez de la Cuesta, Berlinda J. de Wit–van der Veen, Christophe Deroose, David C. Madoff, and Oliver S. Grosser
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medicine.medical_specialty ,medicine.medical_treatment ,Guidelines ,Recommendations ,Microsphere ,Positron Emission Tomography Computed Tomography ,Dosimetry ,medicine ,Humans ,Yttrium Radioisotopes ,SIRT ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Medical prescription ,Therapeutic intent ,Technetium Tc 99m Aggregated Albumin ,Imagerie médicale, radiologie, tomographie ,Liver tumours ,business.industry ,Liver Neoplasms ,Whole liver ,Selective internal radiation therapy ,General Medicine ,Treatment verification ,Embolization, Therapeutic ,Microspheres ,ddc ,Radiation therapy ,business - Abstract
Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 ( 90 Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90 Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99m Tc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90 Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90 Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations., info:eu-repo/semantics/published
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- 2021
35. Use of radioguided surgery in abdominal wall endometriosis: An innovative approach.
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Vitral, Geraldo, Salgado, Hakayna, and Rangel, João
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SURGERY , *ENDOMETRIOSIS , *ABDOMINAL wall - Abstract
Endometriosis is characterized by the presence of endometrial glands and stroma outside the uterine cavity. The occurrence of endometriosis in the anterior abdominal wall is often associated with previous cesarean section, once the spread of endometrial cells during the surgical procedure is a biologically fact possible. A 43-year-old patient, with cesarean section history and pelvic endometriosis diagnosed for over 10 years, presented with progressive abdominal pain. Tests showed cystic image with 1.6 cm of diameter and debris, located in mid-lower portion of the rectus abdominis left, suggesting abdominal wall endometriosis. This abdominal wall lesion was not identifiable in the clinical examination (impalpable), which is why we opted for the use of preoperative marking technique with radioisotope called Radioguided Occult Lesion Localization (ROLL™). The use of ROLL™ in this case allowed rapid surgical identification of endometriotic lesion and its complete excision. [ABSTRACT FROM AUTHOR]
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- 2018
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36. Assessing Spatial Concordance Between Theranostic Pairs Using Phantom and Patient-Specific Acceptance Criteria: Application to 99mTc-MAA SPECT/90Y-Microsphere PET
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Yuni K. Dewaraja, Kelly C. Paradis, Bill S. Majdalany, Dawn Owen, and Justin Mikell
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Cancer Research ,Normal Distribution ,Single-photon emission computed tomography ,computer.software_genre ,Article ,Statistics, Nonparametric ,Theranostic Nanomedicine ,Imaging phantom ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Voxel ,medicine ,Humans ,Dosimetry ,Yttrium Radioisotopes ,Radiology, Nuclear Medicine and imaging ,Chemoembolization, Therapeutic ,Technetium Tc 99m Aggregated Albumin ,Retrospective Studies ,Rank correlation ,Tomography, Emission-Computed, Single-Photon ,Radiation ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Concordance correlation coefficient ,Liver ,Oncology ,Positron emission tomography ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Tomography ,Radiopharmaceuticals ,business ,Nuclear medicine ,computer - Abstract
Purpose Predictive 3-dimensional dosimetry requires spatial concordance between diagnostic and therapeutic activity distributions. We assess similarity between theranostic pairs ( 99m Tc–macroaggregated albumin [MAA] single photon emission computed tomography [SPECT] and 90 Y microsphere positron emission tomography [PET]) in patients using criteria that account for spatial resolution differences and misregistration. Methods and Materials Phantom-based acceptance criteria were determined using a liver phantom filled with 99m Tc and 90 YCl 3 and scanned with SPECT/computed tomography [CT] and PET/CT, respectively. Gaussian blurring was applied to PET to match 99m Tc phantom scan image quality. After rigid registration between SPECT/CT and PET/CT, perturbations up to ±3 voxels were applied to determine the similarity metric (SM) sensitivity. 99m Tc-MAA SPECT/CT and 90 Y microsphere PET/CT image pairs/patients (n = 23) were processed analogously. SMs calculated included the Pearson correlation coefficient ( ρ r ), Lin's concordance correlation coefficient ( ρ c ), Spearman's rank correlation coefficient ( ρ s ), the mean squared difference, and the Dice similarity coefficient (DSC). Patient-specific acceptance criteria were determined by evaluating the SMs of the blurred PET compared with itself misregistered. Results After transforming PET to SPECT resolution, high similarity was found in phantom, with ρ c , ρ r , ρ s > 0.98 ± 0.01, a mean squared difference of (4.1 ± 0.3) × 10 −4 and DSC > 0.85 ± 0.01 for investigated thresholds (5%, 30%, and 50%). SMs for patients varied from poor to good. A small percentage (13%-30%) of patient scans were acceptable using phantom-based acceptance criteria. The percentage increased slightly (17%-35%) using patient-specific acceptance criteria. DSC for most patients were substantially lower (average 0.95 vs 0.61 for 5% threshold) than phantom values. Conclusions At best, 35% of patients had an SM within the acceptance criteria established to account for imaging-related effects impacting spatial concordance between 99m Tc-MAA SPECT and 90 Y PET. Additional clinical factors should be evaluated in the future. The procedure of accounting for image-related effects when assessing spatial concordance can be applied to other theranostic pairs.
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- 2019
37. Personalised radioembolization improves outcomes in refractory intra-hepatic cholangiocarcinoma: a multicenter study
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Ivan Duran Derijckere, Thomas Guiot, Bruno Vanderlinden, Christophe Deroose, Lieveke Ameye, Nick Reynaert, Alain Hendlisz, Patrick Flamen, Marnix G.E.H. Lam, Hojjat Ahmadzadehfar, Arthur J. A. T. Braat, Carsten Meyer, and Hugo Levillain
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Adult ,Male ,Yttrium-90 ,medicine.medical_specialty ,Multivariate analysis ,Liver tumor ,medicine.medical_treatment ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Internal medicine ,Journal Article ,Humans ,Medicine ,Yttrium Radioisotopes ,SIRT ,Radiology, Nuclear Medicine and imaging ,Precision Medicine ,Radioembolization ,Imagerie médicale, radiologie, tomographie ,Technetium Tc 99m Aggregated Albumin ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Liver Neoplasms ,Hazard ratio ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Radiation therapy ,Treatment Outcome ,Resin microspheres ,Radiology Nuclear Medicine and imaging ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Cohort ,Intra-hepatic cholangiocarcinoma ,Female ,business - Abstract
Purpose: Reported outcomes of patients with intra-hepatic cholangiocarcinoma (IH-CCA) treated with radioembolization are highly variable, which indicates differences in included patients’ characteristics and/or procedure-related variables. This study aimed to identify patient- and treatment-related variables predictive for radioembolization outcome. Methods: This retrospective multicenter study enrolled 58 patients with unresectable and chemorefractory IH-CCA treated with resin 90Y-microspheres. Clinicopathologic data were collected from patient records. Metabolic parameters of liver tumor(s) and presence of lymph node metastasis were measured on baseline 18F-FDG-PET/CT. 99mTc-MAA tumor to liver uptake ratio (TLRMAA) was computed for each lesion on the SPECT-CT. Activity prescription using body-surface-area (BSA) or more personalized partition-model was recorded. The study endpoint was overall survival (OS) starting from date of radioembolization. Statistical analysis was performed by the log-rank test and multivariate Cox’s proportional hazards model. Results: Median OS (mOS) post-radioembolization of the entire cohort was 10.3 months. Variables associated with significant differences in terms of OS were serum albumin (hazard ratio (HR) = 2.78, 95%CI:1.29–5.98, p = 0.002), total bilirubin (HR = 2.17, 95%CI:1.14–4.12, p = 0.009), aspartate aminotransferase (HR = 2.96, 95%CI:1.50–5.84, p < 0.001), alanine aminotransferase (HR = 2.02, 95%CI:1.05–3.90, p = 0.01) and γ-GT (HR = 2.61, 95%CI:1.31–5.22, p < 0.001). The presence of lymph node metastasis as well as a TLRMAA < 1.9 were associated with shorter mOS: HR = 2.35, 95%CI:1.08–5.11, p = 0.008 and HR = 2.92, 95%CI:1.01–8.44, p = 0.009, respectively. Finally, mOS was significantly shorter in patients treated according to the BSA method compared to the partition-model: mOS of 5.5 vs 14.9 months (HR = 2.52, 95%CI:1.23–5.16, p < 0.001). Multivariate analysis indicated that the only variable that increased outcome prediction above the clinical variables was the activity prescription method with HR of 2.26 (95%CI:1.09–4.70, p = 0.03). The average mean radiation dose to tumors was significantly higher with the partition-model (86Gy) versus BSA (38Gy). Conclusion: Radioembolization efficacy in patients with unresectable recurrent and/or chemorefractory IH-CCA strongly depends on the tumor radiation dose. Personalized activity prescription should be performed., SCOPUS: ar.j, info:eu-repo/semantics/published
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- 2019
38. Significance of the preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin in the future remnant liver
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Koichi Yano, Naoya Imamura, Yukinori Tanoue, Takeomi Hamada, Takashi Wada, Atsushi Nanashima, Yoshirou Fujii, Makoto Ikenoue, Toshinori Hirai, Yoichi Mizutani, and Masahide Hiyoshi
- Subjects
Adult ,Male ,Liver surgery ,medicine.medical_specialty ,Pilot Projects ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Remnant liver ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,Technetium Tc 99m Aggregated Albumin ,Aged ,Aged, 80 and over ,business.industry ,Whole liver ,Ascites ,Original Articles ,General Medicine ,Middle Aged ,Prognosis ,Human serum albumin ,Liver metabolism ,Liver ,030220 oncology & carcinogenesis ,Preoperative Period ,Technetium Tc 99m Pentetate ,Female ,business ,Technetium-99m ,medicine.drug - Abstract
The relationship between posthepatectomy complications and liver functional parameters was preliminary reported in a pilot study. The present study sequentially evaluated the clinical significance of maximal removal rate of technetium-99m-galactosyl human serum albumin (GSAR(max)) in the future remnant liver (rGSAR(max)) in patients to predict posthepatectomy complications. METHODS: Between 2010 and August 2017, GSAR(max), rGSAR(max), their difference (Dif), and the rGSAR(max) to GSAR(max) ratio were examined in 247 additional patients who underwent hepatectomy for liver and biliary diseases. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 73 (29.6%) patients. RESULTS: The median and mean preoperative GSAR(max) values were 0.477 and 0.498±0.166 mg/min, respectively; rGSAR(max) values were 0.341 and 0.366±0.145 mg/min, respectively; Dif values were 0.105 and 0.132±0.111 mg/min, respectively; and the rGSAR(max) to GSAR(max) ratio values were 0.774 and 0.746±0.177, respectively. Among these, the GSAR(max) and rGSAR(max) values were significantly correlated with the liver functional parameters ICGR15, LHL15, HH15, prothrombin activity, serum hyaluronic acid level, and platelet count (all P
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- 2019
39. Evaluation of technetium-99m metastable nanocolloid as an imaging agent for performing milk scans
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Mboyo Vangu, Khushica Purbhoo, Osayande Evbuomwan, and Jaleelat Momodu
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gastroesophageal reflux ,Population ,Technetium Tc 99m Aggregated Albumin ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,milk scan ,Child ,Radionuclide Imaging ,education ,education.field_of_study ,Gastric emptying ,business.industry ,Reflux ,Infant ,Original Articles ,General Medicine ,medicine.disease ,Imaging agent ,nanocolloid ,Pulmonary aspiration ,medicine.anatomical_structure ,Gastric Emptying ,030220 oncology & carcinogenesis ,Bone marrow ,business ,Nuclear medicine ,Technetium-99m - Abstract
Objective The aim of this study was to determine whether technetium-99m (99mTc) nanocolloid was a suitable alternative tracer for carrying out milk scan studies in pediatric patients. Participants and methods Twenty-seven milk scans performed with 99mTc nanocolloid were retrospectively assessed for identification of significant esophageal hold-up, gastroesophageal reflux, pulmonary aspiration, and gastric emptying (GE). Scans were also assessed for liver, spleen, and bone marrow uptake. GE results were compared with those of 27 randomly selected normal GE studies carried out using 99mTc tin colloid. Results None of the studies had liver, spleen, or bone marrow uptake, and all studies were interpretable. Significant esophageal hold-up and gastroesophageal reflux was observed in 11 and 48% of the patients, respectively. Only one patient had evidence of pulmonary aspiration, and all patients had normal GE at 2 h after radiolabeled milk ingestion. The average rate of GE at 2 h was faster in the 99mTc nanocolloid group compared with the 99mTc tin colloid group (8.85% retained±8.96% vs. 15.48% retained±10.52%, P=0.016). Conclusion Our findings show that 99mTc nanocolloid is technically a suitable alternative to 99mTc sulfur colloid for performing milk scans. However, we could not conclude with certainty on the comparison of the GE rates of 99mTc nanocolloid and 99mTc tin colloid. This was because of the variability in the two population groups as well as the fact that the milk that was used in each patient was individualized to the patient and was not standardized.
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- 2019
40. Comparison of
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Allison J, Craig, Iain, Murray, Ana M, Denis-Bacelar, Bruno, Rojas, Jonathan I, Gear, Lucy, Hossen, Annelies, Maenhout, Nasir, Khan, and Glenn D, Flux
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Tomography, Emission-Computed, Single-Photon ,Liver Neoplasms ,Embolization, Therapeutic ,Microspheres ,Article ,Y-90 ,Liver ,Radioembolisation ,Dosimetry ,Humans ,Sirtuins ,Yttrium Radioisotopes ,SIRT ,Technetium Tc 99m Aggregated Albumin - Abstract
Highlights • The resolution conversion method allowed comparison of 99mTc and 90Y imaging. • 99mTc pre-therapy imaging was predictive of the 90Y absorbed dose to normal liver. • 99mTc pre-therapy imaging had poor predictability for tumours smaller than 100 cm3., Purpose The aims of this study were to develop and apply a method to correct for the differences in partial volume effects of pre-therapy Technetium-99 m (99mTc)-MAA SPECT and post-therapy Yttrium-90 (90Y) bremsstrahlung SPECT imaging in selective internal radiation therapy, and to use this method to improve quantitative comparison of predicted and delivered 90Y absorbed doses. Methods The spatial resolution of 99mTc SPECT data was converted to that of 90Y SPECT data using a function calculated from 99mTc and 90Y point spread functions. This resolution conversion method (RCM) was first applied to 99mTc and 90Y SPECT phantom data to validate the method, and then to clinical data to assess the power of 99mTc SPECT imaging to predict the therapeutic absorbed dose. Results The maximum difference between absorbed doses to phantom spheres was 178%. This was reduced to 27% after the RCM was applied. The clinical data demonstrated differences within 38% for mean absorbed doses delivered to the normal liver, which were reduced to 20% after application of the RCM. Analysis of clinical data showed that therapeutic absorbed doses delivered to tumours greater than 100 cm3 were predicted to within 52%, although there were differences of up to 210% for smaller tumours, even after the RCM was applied. Conclusions The RCM was successfully verified using phantom data. Analysis of the clinical data established that the 99mTc pre-therapy imaging was predictive of the 90Y absorbed dose to the normal liver to within 20%, but had poor predictability for tumours smaller than 100 cm3.
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- 2021
41. Edemas of the face and lymphoscintigraphic examination
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Assaf Zeltzer, Guido Giacalone, A Vrancken, E Peters, Pierre Bourgeois, A Van Mieghem, Surgery, Faculty of Medicine and Pharmacy, Physiotherapy, Human Physiology and Anatomy, Surgical clinical sciences, Anatomical Research and Clinical Studies, and Plastic Surgery
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Adult ,Male ,medicine.medical_specialty ,Single Photon Emission Computed Tomography Computed Tomography ,Science ,medicine.medical_treatment ,Pathogenesis ,Left sided ,Article ,03 medical and health sciences ,0302 clinical medicine ,Medical research ,Postoperative Complications ,medicine ,Edema ,Humans ,In patient ,030223 otorhinolaryngology ,Facial edema ,Lymph node ,Technetium Tc 99m Aggregated Albumin ,Lymphatic Vessels ,Multidisciplinary ,Facial lymphedema ,business.industry ,Head and neck cancer ,Middle Aged ,medicine.disease ,Radiation therapy ,medicine.anatomical_structure ,Lymphatic system ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Face ,Medicine ,Female ,Radiology ,Radiopharmaceuticals ,business ,Lymphoscintigraphy - Abstract
Facial edemas not secondary to surgery and/or radiotherapy for head and neck cancer are relatively uncommon. Our aim is to report a retrospective analysis of the lymphoscintigraphic and SPECT-CT investigations obtained in patients with such facial edema. Retrospective review of exams (planar imagings in all and with SPECT-CT in 5) obtained after the subcutaneous injection of 99mTc HSA Nanosized colloids between the eyebrows in five men and seven women. Four main lymphatic pathways were identified on sequential planar imagings: para-nasal left and right and supra- ocular left and right. For eleven patients, the absence of visualization of lymphatic drainage and/or their delayed appearance correlated well with the localisation of the edematous areas. In two patients with post-traumatic and post- surgical edemas, SPECT-CT showed one deep left sided cervical lymph node (LN) in front of the first cervical vertebra. This lymphoscintigraphic approach represents a simple and valuable way to assess the lymphatic drainage pathways of the face and to establish the diagnosis of facial lymphedema.
- Published
- 2021
42. Diagnostic and prognostic value of 99mTc-MAA SPECT/CT for treatment planning of 90Y-resin microsphere radioembolization for hepatocellular carcinoma: comparison with planar image
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Jin Chul Paeng, Mai Hong Son, Mai Hong Bang, Sungwoo Bae, Dinh Truong Giang, Le Ngoc Ha, and Nguyen Tien Thinh
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Male ,Treatment response ,Carcinoma, Hepatocellular ,Single Photon Emission Computed Tomography Computed Tomography ,Tare weight ,Science ,Diseases ,Transarterial Radioembolization ,Resin microsphere ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medical research ,Albumins ,medicine ,Humans ,Radiation treatment planning ,Technetium Tc 99m Aggregated Albumin ,Aged ,Multidisciplinary ,business.industry ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,medicine.disease ,99mtc maa ,Prognosis ,Embolization, Therapeutic ,Oncology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Absorbed dose ,Medicine ,Female ,Nuclear medicine ,business - Abstract
99mTc-macroaggregated albumin (MAA) imaging is performed before transarterial radioembolization (TARE), in which SPECT/CT is presumed more precise than planar image. However, additive role of SPECT/CT has not been well established. Thirty-four consecutive hepatocellular carcinoma patients of intermediate and advanced stages who underwent 90Y-microsphere TARE were recruited. On pre-treatment planning scan using 99mTc-MAA, image characteristics and absorbed dose for target tumors calculated by partition model methods were estimated on planar image and SPECT/CT, respectively. The measurements were repeated on post-treatment 90Y PET/CT, as the reference standard. Treatment response was assessed and predictive values of image parameters were analyzed. The image characteristics including heterogeneity, necrosis and thrombosis uptake were better delineated on SPECT/CT than planar scan. The agreement and correlation of TNr between SPECT/CT and PET/CT were stronger than those between planar scan and PET/CT. Tumor dose estimated on 99mTc-MAA SPECT/CT was more effective than planar image for prediction of treatment response, with cutoff value 125 Gy (sensitivity of 86% and specificity of 75%). In conclusion, 99mTc-MAA SPECT/CT is more closely correlated with post-treatment 90Y PET/CT, and is more effective for predicting treatment response than planar scan. SPECT/CT is superior to planar image in simulation before 90Y TARE.
- Published
- 2021
43. Challenges in Preparation of Albumin Nanoparticle-Based Radiopharmaceuticals.
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Ballinger JR
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- Sentinel Lymph Node Biopsy, Lymphoscintigraphy, Coloring Agents, Albumins, Lymph Nodes, Radiopharmaceuticals, Technetium Tc 99m Aggregated Albumin
- Abstract
Albumin nanocolloids have been used as radiopharmaceuticals for more than 40 years. Their main use is in lymphoscintigraphy and the detection of the sentinel lymph node as part of the surgical treatment of a variety of solid tumours. The main licensed products are labelled with the gamma emitter technetium-99m. Recently, two analogues labelled with positron emitters have been reported, using gallium-68 and zirconium-89. For about 10 years, there has been interest in dual-modal agents with both radioactive and fluorescent labels to improve the localisation of the sentinel lymph node. Indocyanine green (ICG) has been the most widely used fluorescent label, largely due to its availability as a licensed agent and its ease of application. The further development of alternative radiolabels or improved fluorescent tags will require investment in the development and licensing. There is also a vast potential for the targeting of albumin nanocolloids using existing strategies, which could be promising for the development of both diagnostic and therapeutic agents.
- Published
- 2022
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44. Radiochemical Feasibility of Mixing of 99m Tc-MAA and 90 Y-Microspheres with Omnipaque Contrast.
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Yang CT, Ngam PI, Phua VJX, Yu SWK, Apoorva G, Ng DCE, and Huang HL
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- Humans, Microspheres, Technetium Tc 99m Aggregated Albumin, Iohexol, Feasibility Studies, Tomography, Emission-Computed, Single-Photon methods, Radiopharmaceuticals, Embolization, Therapeutic methods, Liver Neoplasms diagnostic imaging
- Abstract
Yttrium-90 (
90 Y) microspheres are widely used for the treatment of liver-dominant malignant tumors. They are infused via catheter into the hepatic artery branches supplying the tumor under fluoroscopic guidance based on pre-therapy angiography and Technetium-99m macroaggregated albumin (99m Tc-MAA) planning. However, at present, these microspheres are suspended in radiolucent media such as dextrose 5% (D5) solution. In order to monitor the real-time implantation of the microspheres into the tumor, the90 Y microspheres could be suspended in omnipaque contrast for allowing visualization of the correct distribution of the microspheres into the tumor. The radiochemical purity of mixing90 Y-microspheres in various concentrations of omnipaque was investigated. The radiochemical purity and feasibility of mixing99m Tc-MAA with various concentrations of a standard contrast agent were also investigated. Results showed the radiochemical feasibility of mixing90 Y-microspheres with omnipaque is radiochemically acceptable for allowing real-time visualization of radioembolization under fluoroscopy.- Published
- 2022
- Full Text
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45. Findings in [99mTc]MAA SPECT/CT in the diagnosis and follow-up of pulmonary embolism after infection by SARS-CoV-2 (COVID-19)
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Tatiana Morales Avellaneda, Jorge Andres Narvaez Gomez, Liset Sanchez Orduz, and Marylin Acuña Hernández
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COPD ,medicine.medical_specialty ,Single Photon Emission Computed Tomography Computed Tomography ,Coronavirus disease 2019 (COVID-19) ,medicine.diagnostic_test ,Ventilation/perfusion scan ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,General Medicine ,Left pulmonary artery ,Middle Aged ,medicine.disease ,99mtc maa ,Pulmonary embolism ,medicine ,Humans ,Female ,Radiology, Nuclear Medicine and imaging ,Radiology ,Pulmonary Embolism ,Complication ,business ,Technetium Tc 99m Aggregated Albumin ,Follow-Up Studies - Abstract
SARS-CoV-2 (COVID-19) infection is a current public health problem that has been shown to cause multiple complications, including pulmonary thromboembolism. The first presented case is a 59-year-old woman with a history of COPD, paroxysmal atrial fibrillation and COVID-19 infection in September 2020, consultation in December 2020 for atypical chest pain with suspected PE, AngioCT of pulmonary vessels was performed negative for emboli, subsequently [99mTc]Tc MAA SPECT/CT was indicated with a report of multiple triangular defects concerning acute pulmonary thromboembolism. A second case is a 70-year-old man with a history of dyslipidaemia, presented COVID-19 infection in September 2020 with a complication of PE with involvement of the left pulmonary artery, followed by [99mTc]Tc MAA SPECT/CT report multiple triangular and not triangles defects concerning pulmonary thromboembolism with signs of reperfusion.
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- 2021
46. Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas
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Pierre Bourgeois and Olivier Leduc
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Male ,Psychologie appliquée ,030218 nuclear medicine & medical imaging ,Diagnostic Radiology ,0302 clinical medicine ,Abdomen ,Medicine and Health Sciences ,Edema ,Lymphedema ,Child ,Musculoskeletal System ,Physiotherapy ,Routes of Administration ,Aged, 80 and over ,Multidisciplinary ,integumentary system ,Feet ,Radiology and Imaging ,Sciences bio-médicales et agricoles ,Middle Aged ,medicine.anatomical_structure ,Lymphatic system ,Lower Extremity ,030220 oncology & carcinogenesis ,Medicine ,Technetium Tc 99m Pentetate ,Legs ,Female ,Radiology ,Lymph ,Anatomy ,Biologie ,Lymphoscintigraphy ,Research Article ,Adult ,Lymphatic edema ,medicine.medical_specialty ,Superficial Lymphatic Vessel ,Adolescent ,Imaging Techniques ,Science ,Inguinal Canal ,Research and Analysis Methods ,Lower limb ,Injections ,Pelvis ,03 medical and health sciences ,Young Adult ,Signs and Symptoms ,Intradermal Injections ,Diagnostic Medicine ,medicine ,Humans ,In patient ,Gluteal muscles ,Technetium Tc 99m Aggregated Albumin ,Skeleton ,Aged ,Lymphatic Vessels ,Retrospective Studies ,Pharmacology ,business.industry ,Biology and Life Sciences ,body regions ,Health Care ,Body Limbs ,Lymph Nodes ,Clinical Medicine ,business - Abstract
Introduction The classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients. Methods and findings We retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed. In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs. In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], “posterior” LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%]. Conclusion Our work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lymphonodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2020
47. Liver Function Changes After Technetium-99m-Macroaggregated Albumin Administration and Their Predictive Value Regarding Hepatotoxicity in Patients Undergoing Yttrium-90-Radioembolization
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Andrei Todica, Fabian Hartmann, Robert Damm, Ricarda Seidensticker, Josefine Albers, Maciej Powerski, Oliver S. Großer, Maciej Pech, Max Seidensticker, Jens Ricke, Stefan Maurus, Sergio Grosu, Jazan Omari, Harun Ilhan, and Matthias P. Fabritius
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Bilirubin ,Computed Tomography Angiography ,Gastroenterology ,chemistry.chemical_compound ,Liver Function Tests ,Internal medicine ,otorhinolaryngologic diseases ,medicine ,Distribution (pharmacology) ,Humans ,In patient ,Technetium Tc 99m Aggregated Albumin ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Albumin ,Disease Management ,General Medicine ,Middle Aged ,Prognosis ,Predictive value ,Embolization, Therapeutic ,Treatment Outcome ,Oncology ,chemistry ,Angiography ,Female ,Liver function ,Chemical and Drug Induced Liver Injury ,Radiopharmaceuticals ,business ,Technetium-99m - Abstract
BACKGROUND/AIM Intraarterial Technetium-99m-Macroaggregated Albumin (99mTc-MAA) administration is an established method to predict particle distribution prior to radioembolization. This study aimed to analyse the impact of intraarterial administration of 99mTc-MAA on changes in liver-specific laboratory parameters and to assess whether such changes are associated with post-radioembolization hepatotoxicity. PATIENTS AND METHODS A total of 202 patients treated with radioembolization received prior mapping angiography with 99mTc-MAA administration. All patients underwent clinical and laboratory examinations, including liver-specific parameters at certain times before and after mapping angiography/99mTc-MAA administration, as well as before radioembolization and during follow-up. RESULTS Bilirubin increased temporarily after 99mTc-MAA administration (p
- Published
- 2020
48. Tracheobronchitis signs observed on ventilation lung scintigraphy during the course of COVID-19 infection
- Author
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Antoine Verger, Laetitia Imbert, Gilles Karcher, Pierre-Yves Marie, Achraf Bahloul, Saifeddine Melki, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Médecine Nucléaire [Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nancyclotep- Experimental Imaging Platform = Plate-forme d'imagerie moléculaire, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), and BIRKER, Juliette
- Subjects
Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Ventilation-Perfusion Scan ,Single Photon Emission Computed Tomography Computed Tomography ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,[INFO.INFO-IM] Computer Science [cs]/Medical Imaging ,[SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,Scintigraphy ,030218 nuclear medicine & medical imaging ,[SDV.IB.MN] Life Sciences [q-bio]/Bioengineering/Nuclear medicine ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,COVID-19 Testing ,Ventilation lung ,Tracheobronchitis ,Albumins ,medicine ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,Bronchitis ,Pandemics ,Technetium Tc 99m Aggregated Albumin ,ComputingMilieux_MISCELLANEOUS ,Aged ,Sodium Pertechnetate Tc 99m ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,medicine.diagnostic_test ,business.industry ,Ventilation/perfusion scan ,Clinical Laboratory Techniques ,Reverse Transcriptase Polymerase Chain Reaction ,SARS-CoV-2 ,COVID-19 ,General Medicine ,3. Good health ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Radiology ,Tracheitis ,Radiopharmaceuticals ,business ,Coronavirus Infections ,Image of the Month ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience
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- 2020
49. Stereotactic Body Radiotherapy Based on
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Yudai, Kai, Ryo, Toya, Tetsuo, Saito, Tomohiko, Matsuyama, Yoshiyuki, Fukugawa, Shinya, Shiraishi, Yoshinobu, Shimohigashi, and Natsuo, Oya
- Subjects
Male ,Tomography, Emission-Computed, Single-Photon ,Carcinoma, Hepatocellular ,Liver ,Liver Neoplasms ,Humans ,Technetium Tc 99m Pentetate ,Middle Aged ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,Radiosurgery ,Technetium Tc 99m Aggregated Albumin ,Research Article - Abstract
Background/Aim: A recent planning study suggested that (99m)Tc-labelled diethylene triamine pentaacetate-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT) image-guided inverse planning (IGIP) shows dosimetric superiority to conventional planning in sparing liver function. Here, we report the first clinical translation of (99m)Tc-GSA SPECT IGIP for stereotactic body radiotherapy (SBRT) in a patient with hepatocellular carcinoma (HCC). Case Report: A 60-year-old male developed obstructive jaundice caused by recurrent HCC in segment 1 after hepatic resection. He underwent repeated radiotherapy (RT) consisting of 45 Gy in 15 fractions 8 years ago and 30 Gy in 5 fractions 2 years ago. We performed SBRT consisting of 40 Gy in 8 fractions using (99m)Tc-GSA SPECT-IGIP. We confirmed the dosimetric superiority of functional IGIP to conventional planning. He achieved complete response as assessed using the target volume. The patient has remained alive without recurrence for 18 months. He did not experience radiation-induced liver disease. Conclusion: Recurrent HCC was successfully and safely salvaged via re-irradiation with SBRT using (99m)Tc-GSA SPECT-IGIP.
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- 2020
50. Is there a role for lung perfusion [ 99m Tc]-MAA SPECT/CT to rule out pulmonary embolism in COVID-19 patients with contraindications for iodine contrast?
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Dimitri Patriki, Tilo Niemann, Jürg H. Beer, Irene A. Burger, François Fontana, University of Zurich, and Burger, Irene A
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2019-20 coronavirus outbreak ,Lung ,Coronavirus disease 2019 (COVID-19) ,business.industry ,chemistry.chemical_element ,Technetium Tc 99m Aggregated Albumin ,Lung perfusion ,610 Medicine & health ,General Medicine ,10181 Clinic for Nuclear Medicine ,Iodine ,medicine.disease ,Pulmonary embolism ,Pneumonia ,medicine.anatomical_structure ,Editorial ,chemistry ,Radiology Nuclear Medicine and imaging ,medicine ,2741 Radiology, Nuclear Medicine and Imaging ,Radiology, Nuclear Medicine and imaging ,Nuclear medicine ,business - Published
- 2020
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