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Diagnostic Potential of 99mTc-macroaggregated Albumin Scintigraphy in the Diagnosis of Hepatopulmonary Syndrome: Insights from Two Case Studies and Critical Review of Literature.
Indian J Nucl Med
November 2024
Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Hepatopulmonary syndrome (HPS) is a rare pulmonary vascular complication of chronic liver disease characterized by dilatation of pulmonary capillaries leading to vascular shunting and systemic hypoxemia. Diagnosis of HPS requires documentation of intrapulmonary vasodilation (IPVD), the two most common imaging studies performed for the detection of IPVD include transthoracic contrast echocardiography (TTCE) and 99m-Tc-macroaggregated albumin scintigraphy (99mTc-MAA scan). TTCE has high sensitivity and thus, is the preferred initial investigation, while 99mTc-MAA scan is highly specific and plays an adjuvant role in diagnosis.
View Article and Find Full Text PDFUnlabelled: Accurate estimation of the Lung Shunt Fraction (LSF) is a standard of care in yttrium-90 ( Y) radioembolization treatment planning to prevent excessive lung irradiation due to arterio-venous shunting in the liver. LSF is assessed using Tc macroaggregated albumin ( Tc-MAA) imaging, but this approach adds risk, complexity, and expense to the treatment planning. This study investigates the potential of Contrast-Enhanced Computed Tomography (CECT) as a non-invasive alternative for LSF estimation.
View Article and Find Full Text PDFOptimizing dosimetric accuracy in radioembolization: comparative effectiveness of SPECT/CT, planar imaging, and PET/CT for lung shunt fraction assessment.
Nucl Med Rev Cent East Eur
December 2024
Department of Radiology & Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care, and Research Center, Muscat, Oman.
Background: In radioembolization therapy for hepatic malignancies, the accurate estimation of lung shunt fraction (LSF) is crucial to minimize the risk of radiation-induced pneumonitis and fibrosis due to hepatopulmonary shunting of yttrium-90 (90Y)-microspheres. This study aimed to compare the accuracy and precision of LSF estimation using technetium-99m macroaggregated albumin single photon emission computed tomography ([99mTc]Tc-MAA SPECT) LSF, [99mTc]Tc-MAA planar LSF, and 90Y PET LSF in patients undergoing 90Y-radioembolization.
Material And Methods: A retrospective study was conducted involving 15 patients diagnosed with hepatocellular carcinoma (HCC) or liver metastases and planned to undergo transarterial radioembolization with 90Y SirSpheres after multidisplinary team discussion.
Radioembolization for Hepatocellular Carcinoma: a Comparison on Dual-phase Cone-beam CT, Contrast-enhanced CT (CECT) and Tc-macroaggregated albumin-SPECT/CT in predicting final distribution volumes and dosimetry of the post-embolization Y PET/CT.
Radiol Med
December 2024
Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy.
Purpose: Personalized treatment schemes are being systematically applied to ensure best treatment outcome in oncologic patients. This is true also for personalized dosimetry in transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) patients. Precise and detailed volumetric and functional data derived from radiological and nuclear imaging methods are essential for personalized dosimetry.
View Article and Find Full Text PDFAddressing lung truncation in Tc-MAA SPECT/CT for Y microsphere radioembolization treatment planning.
EJNMMI Phys
December 2024
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63130, USA.
Background: Prior studies have established that macroaggregated albumin (MAA)-SPECT/CT offers more robust lung shunt fraction (LSF) and lung mean absorbed dose (LMD) estimates in Y radioembolization in comparison to planar imaging. However, incomplete SPECT/CT coverage of the lungs is common due to clinical workflows, complicating its potential use for LSF and LMD calculations. In this work, lung truncation in MAA-SPECT/CT was addressed via correction strategies to improve Y treatment planning.
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